SAVING PATIENT RYAN

In its recent report the World Health Organization stated, that when it comes to national health-care standards, Denmark now ranks no. 34 in the entire world. A few decades ago our standards were second to none. This rapid decline is even more evident today and continuing at an even faster pace. A dissolution unparalleled even in an otherwise decaying country like Denmark. Does this misery stem from lack of funding ? - No way !   - Danes pay the highest taxes anywhere on the globe, and a substantial share of that goes into providing medical services. 

Nevertheless, saving the Danish national health-care system is an objective that stretches one's imagination far beyond the very limits of imagination. - How's that ?

In order to comprehend the magnitude and implications of that - rather unmodifiable - statement, one must go way back in history. Perhaps Danish history isn't all too familiar to most of you, but you do certainly remember the word of prince Hamlet : "there is something rotten in the state of Denmark !".  Ever since, those famous words have become increasingly true, and probably will remain so for the foreseeable future as well.

The leading star for all sovereigns of this state since the days of prince Hamlet has been mediocrity. Once Denmark ruled not only the waves, but large parts of the known world. The British isles, parts of Russia, France and Germany were under danelaw, as were the bulk of Scandinavia. - Iceland, Greenland and Northern America were colonized and the Pope trembled when the Vikings were mentioned.

By and by that state of affairs changed : today Denmark is nothing but a rural district in the outskirts of the European Union. Will that change matters ? - Hardly.

Well, - we still have a Queen  - and a good one at that. Her influence in contemporary society is however nil. A few of her ancestors were equally good, but suffered from the same misery as our present leadership : ignorant, incompetent or even frankly stupid advisors.

But why - some of you may wonder - isn't Denmark a democracy, a welfare model for most civilized nations ? - Well, at least that's the illusion our government and its marketing pukes want to impose upon the feeble-minded observer. Things are, however, somewhat different.  - Today Denmark is an obscene mismatch between old-fashioned Prussian socialism and untamed, raging capitalism.  Our civil servants, from the prime minister to the humblest ticket-puncher are uniformly educated in the tradition of Vladimir Ilyich Lenin : "confidence is good, but control is better !". Accordingly, this very nation now displays a bureaucracy of gargantuan proportions, unprecedented in the history of mankind. And, to sustain it, the world's heaviest burden of taxation.

On the other hand, large organizations like banks, insurance companies, international corporations etc. don't care about the law at all. They make their own. And only pay tax in the unlikely event of a sloppy chief accountant. But this is not an issue of our present discussion.

And in no man's land, we find the average John Doe facing unscrupulous exploitation from private enterprise and merciless rip-off by the almighty state.

Now, why does a diminutive nation like Denmark need an army of suits and desk-weenies, sufficiently large to govern the former Soviet Union ? -  We don't, of course. As a simple matter of fact, only a tiny fraction of all those people do reasonable work at all.  How do we employ the rest ?  Well, we resort to an old invention by the former chairman of KGB (then NKVD - the bureau of state security), Felix Dcherzhinskiy : Surveillance.  Being short of exterior enemies, we consider every citizen a potential foe, worthy of the state's distrust and thus a target for harassment, prosecution and punishment.  Examining, controlling and recording every aspect of any citizen's thoughts, acts and relations requires huge amounts of clerks, lawyers and registrars. By no means a simple task.

Until recently this was accomplished by hand- and typewriting, resulting in hills of paper. Nowadays we use computers with printers that augment the hills into mountains. We in this room know all too well, that digital technology allows us to sample and store unlimited amounts of information. And hence : once that capacity exists it must be exploited, or so the bureaucrats think.  It doesn't matter if the information thus obtained is superfluous, irrelevant or outright ridiculous. The sheer feasibility of registering, recording and filing something justifies the effort of doing so.

As one could expect, this way of thinking penetrates every aspect of public administration. Furthermore, it tends to eradicate the remaining bits of freedom, inspiration and innovative thinking from people's minds. We simply cave in to the enormous pressure. What is left of common-sense and civil-courage is apt to land you in prison or, as were the case in the former Soviet Union, arbitrary incarceration in psychiatric wards.

This pattern of information-gathering madness is especially prominent in our public health-care. For decades, the bureaucrats have tried to create a registrar's paradise in our hospitals. A spin-off from that effort is a completely new language : an incomprehensive blend of meaningless gobbledygook and gibberish nonsense. For example, a surgeon no longer removes a patient's inflamed appendix, he does JEA00. Next week, the nurse doesn't remove the stitches, she does TQW99.  When this patient returns to work he or she might have a quarrel with his or her boss, and that's classified as DZ564.  If he or she is fired, it's DZ560 and the resulting poverty is DZ550.  Next step in her social deroute, being "lost" by the so-called "welfare" system, is vagabondry, walking around with plastic carrier-bags, which is DZ590. The syntax to connect those acronyms is equally idiotic : nowadays we don't  do things anymore, we "implement", we don't figure things out, we "evaluate" and so on.

The occasional inquirer who, like the little boy in the tale of the emperor's new clothes, might have the courage to ask : "What's all this about ?" might get the answer - if he gets one at all - that those cryptic clothes - excuse me : codes - are necessary in order to have the information stored in computers !  - As it turns out, the accountants seem to believe that their computers understand the string "DK359" better than the string "appendicitis".  Those bureaucrats tend to have a somewhat strange relationship with their precious toys : on one hand they worship their PC's more than anything else, to the extent of religious obedience, on the other hand they don't have the faintest idea of what's going on inside them.

Well, a fool with a tool is still a fool !

As it turns out, their ultimate objective seems to be the so-called "Patient's Electronic Record". Although most other western countries have had those for years, Denmark hasn't. And we never will. The reason : a Digital Record is for doctors and nurses. As such it serves multiple purposes. Foremost of all it's in the interest of every patient, that his or hers data are consistent, trustworthy and available to medical personnel only. In fact, such a recording system can be very efficient and safe and even life-saving. Missing medical records should be a thing of the past. Information on blood tests, cultures, x-ray-studies and so forth are immediately at hand, regardless of former hospitalization, habitat or doctors involved. Expedite, safe diagnosing and treatment prevails. Of course, the technical issues here are somewhat complex, mainly due to the missing standards and protocols of communication. All in all a software problem of some proportion. Luckily, as time goes by, standards seem to evolve : propriety software is a vanishing thing of the past, open standards flourish.  Excellent examples are straightforward : today we gather around UNIX as the standard for operating systems from the largest mainframes to the smallest laptop PC. Programs are increasingly written and publicized according to the GPL public license. And, most important of all, communications are rapidly conforming into TCP/IP protocols. Amongst those, especially the HTML or even the XML protocol are perfectly suited for our purpose. Everybody - even a doctor - can click a mouse and, in a few years, talk to his portable computer.

Now, that's an Electronic Journalizing System !

But not so in Denmark. Here doctors and nurses are subordinates to the bureaucrats. Doctors and nurses share goals and objectives with their patients, not with "suits". Accordingly the suits don't give a damn for this version of digital journalizing. They want surveillance, control and accounting. Those who must be controlled are employees as well as patients. The items to control, register and file are indefinite. And so is the need for even more registrars, clerks and desk-weenies. Indefinite.

Obviously, the accountants having such unlimited access to sensible data about everyone is a Nirvana for any totalitarian system like ours. When sensible information is no longer restricted to access for medical personnel only, but readily at hand to say everybody, the gain is enormous : insurance companies, law-enforcement agencies and employers no longer have to concern themselves about privacy restrictions or ethical considerations.  Ultimately, they know everything about everybody.

If you, my fellow "hackers", feel an ice cube sliding down your back by this perspective, - be comforted : I can assure you, that thou shall have no fear !

Scaring, as it may seem, the dream of the bureaucrats are far beyond reality. We shall have no such thing as a digital, medical record. In no way, manner, shape or form. How's that ? - Well, as you know perfectly well by now, the suits decide everything in Denmark, including the "implementation" of various surveillance systems. And hitherto no one - I repeat : NO ONE - has turned out to be anything but a full-blown fiasco. It seems that every single electronic system in Denmark has but two effects : increasing the expenditure on behalf of the tax-payers and obstructing the functionality of society. The examples are numerous and uniform : public scandal, inquiries in parliament and additional funding into inherent crash-bound software. And, I can assure you, this pattern will continue for the foreseeable future, and the doctors and nurses will continue to write their observations, considerations and results on the brilliant invention of 5000 years ago : the good old papyrus of ancient Egypt.