Theodor Henriksen

Jun 1, 2018

4 min read

The dark side of Globalisation

I’ve always been pro globalisation. To me, globalisation means democratisation of knowledge, a shorter distance between people, which I’ve (some would say naively) have taken for granted as a good thing. To a large degree, I still believe this to be true. How ever, today I saw one example that made me shiver…

The Norwegian healthcare system works something like this:

  1. First of all, it is public. Which means you pay indirectly with your taxes. It also means that procurement of material, machines, medicines and IT systems needs to go though a public procurement process, where the it is the supplier job to sell what they got, to a price they themselfs suggest.
  2. In Norway we have heathcare which the munincipality is recuired to deliver. This includes your regular GP, school nurses, nursing homes ect.
  3. We also have what we call specialist healthcare which is devided into four geographic regions (Regional Health Authority)– North, southeast, west, and central. Each of these have local hospitals and larger, centralized ones, they have radiology, chemo treatment, surgical expertese – basically each region have what it needs in order to fix broken citizents.

The issue here is that each of these businesses (hospitals, GP ect) heach have their own journal system. There is some sentral database with some information, but this is scarce.

A few years back, in 2013, the Norwegian government placed a call for an evaluation of a target picture, which were to gather all health records in one centralized system, allowing health personel (with the need to do so) to access information about the patient. They named this target “One citizen, one health record.” So far so good.

In 2017, the government also initiated a pilot project in the Central health region, called The Health Platform. This was basically to test out the target in one part of Norway, combining health record information from the region, as well as from the munincipalities within the region. Four international vendors delivered an offer to build the pilot.

Fast forward to may 2018. The Health Platform is soon to be realized in region Central. Once the platform is up and running, all hospitals, ER, each GP and nurse at a nursing home file information and records about a patient within the same system. So if you get sick, the people who should know, will have the possibility to acces your history of illnesses, your allergies, and diagnosis’. Pretty sweet, right? And it is. (Disclaimer: the trust to the government, including the health care system, in Norway is really really high.)

The problem is this: The Health Platform is not something that every IT company can deliver. So the government looked for international vendors to deliver the pilot. In total, 4 vendors delivered an offer to make te Health Platform become a reality. During the procurement process, more and more of the possible vendors backed out. Yesterday, may 31st, one of the two remaining backed out. Leaving one vendor. Now the table has turned. Not only turned, but the table is crushing us. as you can imagine, the balance of power has shifted. It is now the government with one possible vendor, and no competiontion. On one hand you could say that this is an issue due to the fact that vendor now has more opportunity to increase prices, and possibly increase their threshold for customization and adaptation, but the real issue is this; the second vendor who backed out, backed out due to «the lack of a viable businesscase».

Even though The Health Platform is a pilot project, it has a clear aim to expand to entire Norway. Basically to deliver the IT system that handle all of Norways health records. Even though it is a big responsibility and a high risk, it still sounds like a prestegious project, and possibly tons of money, right? I guess not. Five million people is not «a viable business case». Ok, so if we accept that, hey, five million is not that many, and i guess the vendor has calculated the possible gains. What frightens me is just that – they claim that it is not viable – that it is not a good business case in the vendors global perspective.

When developing and running health data platforms is what your company doe, how can running a whole country health data platform is not something that is desirable to do? Then what is? Then what a tha-actual-hell is?

This is the reason for my statement in the title of this article. When market leading companies do not see the value in delivering a health care IT platform for an entire country, then where does that leave us? Do we, Norway as a country, adapt to the vendors way of work? Do we accept the terms, that we will have to change and adapt to a mutual, global way of working? You could argue that yes, that would be the objectively smart thing to do. How ever, in real life, this challange is a major one.

We, as a nation, is basically left to the mercy of a global business case.

I regard this absolute power as a frightening consequence of globalisation. Giving us the chance to dance to the tune of the big players — or not to bother to dance at all.