What the US can learn from Taiwan's EHR system and COVID-19 response

Taiwan's digital health infrastructure and central EHR system has played a big part in the country's successful COVID-19 response, serving as a model for the U.S. to potentially replicate in the future, according to a June 30 STAT op-ed.

On a per capita basis, the U.S. has 1,200 times as many COVID-19 deaths as Taiwan and a 12 percent higher unemployment rate projected for the end of the year. To get the U.S. economy moving again, the country's healthcare system much be functioning properly, op-ed authors Ezekiel Emanuel, MD, Cathy Zhang, and Aaron Glickman wrote.

Here are six insights from the authors about Taiwan's digital health infrastructure and coronavirus response:

1. Taiwan effectively altered its EHR system to support COVID-19 testing and contact tracing efforts; every person in the country has a health card with a unique ID that all physicians and hospitals use to view their online medical records.

2. When COVID-19 appeared in the country, Taiwan government merged the health card database with information from immigration and customs to send physicians alerts about patients who were higher risk for having the disease based on their travel history. This data was also used to pinpoint candidates for coronavirus testing when supplies were limited.

3. In an analysis of 11 countries' healthcare systems, no other country besides Taiwan had an effective real-time EHR system. The U.S. has only recently begun seeing real-time monitoring of EHR data to support proactive interventions for routine care and crisis response.

4. It will be years before these features become an integral part of routine healthcare, the authors wrote, adding, "Even in the midst of the ongoing pandemic, we can learn from Taiwan. Americans share every movement and sentiment with Facebook and Google, yet we seem reluctant to allow [HHS] to monitor patient encounters, as Taiwan does, to track disease and determine what medical tests and treatments to order."

5. In the U.S., Medicare and Medicaid could adopt a similar approach as Taiwan's health card and bring on an independent third party to monitor the data and proactively detect infectious outbreaks and quality of care deficiencies.

6. The co-authors explained that another investment in EHR upgrades, specifically for interoperability support and sharing data in real-time with public health officials, is overdue since the Health Information Technology for Economic and Clinical Health Act of 2009. The investment should be added to any new stimulus bill.

Dr. Emanuel is vice provost of global initiatives and a medical ethics and health policy professor at University of Pennsylvania. Ms. Zhang and Mr. Glickman also work at the university's medical ethics and health policy department, serving as a senior research fellow and project manager, respectively.

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