Wednesday, May 20, 2009

Medical Records Management in Chile. A Maravilla. (and puppetry of the people, if you will).

In keeping with talking about how modern and unbelievable Chile is (in this post about how we pay taxes), which makes at least one of my friends think that the whole shebang is part of a giant conspiracy, puppet-goverment style, I want to talk to you about medical records management.

When I had my first contact with the Chilean medical establishment it was after a very hard splat upon the pavement, having been sprung from verticality by the quick application of a 4x4's side view mirror against my bicycle handlebars. This joyous event was covered by Chilean worker's comp, as it happened on my way home from work, even on a Saturday. I was, in fact, on my way home from classes which I'd been teaching at the Universidad Central, a four-hour behemoth of a class with jumping up and down and occasional glove removal to draw a particularly sticky diagram on the board. It was cold, oh yes, it was cold, even in the days before I'd given up Nescafe with its mysterious thick layer of froth on top (what is that? surfactant?)

So my first contact with the Chilean medical system was with ACHS, La Asociacón Chilena de Seguridad, under which I was covered through my employer's insurance, and which conveniently has offices right downtown, a stone's throw from the place that had sent me to the University to begin with. Not that it was their fault.

Over the course of several months, I was treated to ultrasound, electrostimulation, xrays, sonograms, an MRI, a cortisone shot, a free sling, lots of physical therapy and the whole previous year of Cosas and Caras magazines, which I think you only get if you subscribe to certain newspapers, and it was a very educational time there in the "box" (what they call the booth where the doc sees you and where some of those treatments take place). I also met a guy who was regaining mobility in his fingers by putting them into an elastic net and squeezing them shut. I wondered how he'd sustained his work-related injury at the Casa de Cambios (money exchange), where he worked but then maybe he wondered how I'd managed to wrench my shoulder so badly teaching English. We exchanged email addresses, but he WROTE ME IN ALL CAPS, and well, you can see how annoying that is, so we broke off communication as quickly as we started, and his hand injury will just have to remain a mystery. Quickly-slammed cash register? Repetitive stress from bill-counting? The mind boggles.

What was surprising to me about the whole system, aside from the fact that my name was now "Señora Barbara" and that my doctor tried to poach me over to his holistic medical center he was starting, was the computerizedness of everything. When I had the sonogram, I had to go to a different location of ACHS (the one on Ramon Carnicer, if you're wondering). I'd seen people walking down the street with giant art-project-sized envelopes bringing scan results and xrays from doctor to doctor, so I expected to be given the same. Oh no, my doctor said, your doctor can see this online.

Wha? Ditto your bloodwork or annual exam (Pap) results (though not HIV test). You can just log onto your clinic's website with your RUT (national ID number) and your payment number and get your results. Most people still go to the desk to get the printout and the many be-windowed envelopes so they can have a printed record and maybe feel more official. But are you serious? I can manage my cholesterol lowering success (strangely, gave up the fish oil capsules and saw a drop) from the comfort of my office/living room/satellite kitchen/bicycle parking area? This, I think is a maravilla (wonder).

I also have to give Chile a shoutout for being able to access all my records and my health insurance affiliation with a simple touch of my right index finger on the eerie red-lit lector (reader). With insurance, you can show up at any clinic (this is at least true for Integramédica, Santa María and Arauco Salud, anyone else know different?) press your finger to the lector and be trusted that your insurance is really real. There is no photocopying of id and health insurance card, no calling of your provider to find out how much of your visit will be covered.

Let's all say it again: una maravilla (a wonder/marvel). I just hope that when I'm in the states in a few months (just a visit, worry not Chilean blog reading addicts, and you are many) a) I have no contact with the health system and b) that the system is 1/2 as modern in what we have going on down here in the nobody-knows-us experimental puppet society. Gotta go, my strings are getting tangled.


Sara said...

I forgot if I had already commented on this post. It's hard to tell when they disapear for monitoring.

Anyways, the one time I had a semi-serious issue and I went to the urgent care clinic, I was very happy and impressed with my care. That is until my doctor add me as a friend on facebook and asked me how the antibiotics where working.

Bystander said...

The last set of medical examinations N had, they gave him the results on a CD as well as having it online.
I always have to plonk my finger on the reader at least three times for it to work.

Richard said...

That is incredible. South Africa's public health system seems light years behind - many of the clinics here struggle with basic supplies, never mind computerised record keeping. I think I might get carried away with the fingerprint reader thingy though - too much like being in a spy film :)

Margaret said...

You know what the finger plunking is about? Back before the red finger light, people used to "borrow" each other's health insurance... as in "you don't have insurance? Here's my card, use mine." So now they have your fingerprint on record and ¡Voile! life just got easier (except for the ex-insurance borrowers, of course!)

Eileen said...

and I still know people that buy bonos (copay vouchers for non-Chile dwellers) using other people's carnets (because at the ISAPRE they don't use the lector!), and use them with doctors who don't mind. But yes, it is a good way to minimize fraud.

I guess Chile could use universal health care, too!