Don’t look at us

According to one Swedish trade rag, the US administration is looking admiringly to the Swedish model of IT in healthcare. I can’t find any US sources that confirm any of this admiration, so it may be more wishful thinking than reality. Please correct me if I’m wrong. They’re not mentioning sources, so it’s hard to check.

Anyway, even though Sweden has introduced IT into almost 100% of primary care and almost as much for specialist care, this in itself means very little. Healthcare i Sweden is run by bureaucrats, very few of whom have any real knowledge of direct patient care and not much interest in it either. Their interest is in running an efficient organisation, getting good measurements and statistics and controlling the flow of information and money, and it that they do succeed. The IT systems they purchase and roll out are almost exclusively intended to implement this control more effectively. You have to understand that our IT systems are defined, purchased, and run by these bureaucrats, with very little, if any, input from  the medical professions.

Now, don’t get me wrong. Swedish healthcare is pretty darn good, the numbers speak for themselves. But none of that is due to our IT systems, since these IT systems do practically nothing for the actual patient care.

What this means for the USA is that there is only one single thing the US administration can learn from the Swedish IT initiative and that is how to order a shitload of cheap Dell desktops and roll them out everywhere, but I think the US administration can figure this one out for themselves. None of the software we use for electronic healthcare records (EHR) is of much use to the USA.

In the US, billing is a central function in all EHR systems, and we simply don’t have that in ours. We don’t do billing, it’s as simple as that. A main feature of Swedish systems is a shared EHR between all care givers within a geographical region. The largest systems we have don’t even implement any kind of confidentiality barriers between care givers, so that psychiatric history is visible to all other care givers, whatever the patient may think about it. Interestingly, this implementation is actually against Swedish law, but since it’s rolled out by the government, the government seems reluctant to do much about it. I have a really hard time imagining the US medical profession wishing for unlimited sharing of their EHR contents to everyone within a certain geographical radius without any say in the matter.

The real savings in healthcare will only be realized when EHR systems support doing better healthcare. That is, when these systems are based on decision support, in turn based on evidence based medicine (EBM). Even though Sweden is much further along in the roll out of IT systems in healthcare, Sweden will never actually implement any system that improves actual healthcare since all decisions about which systems to implement are taken by bureaucrats, not medical people. But the good news is that this is not the case in the USA, where these systems will be financed mainly by the physicians or their organisations, so the incentive to create systems that work for better healthcare does indeed exist over there.

So my advice to you is: don’t look at us.

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