Veillance and Electronic Medical Records in Disease Management Programs in the Netherlands

Abstract

Networked electronic medical records (EMR) play a growing role in healthcare delivery in the Netherlands, especially within disease management programs as a method of sharing care for those with a chronic disease between multiple clinicians, such as GPs, dieticians, and internists. Through interviews with project leaders and managers in 17 disease management programs in the Netherlands, this chapter explores how electronic medical records were set up to be 'watched', how the duties of watching were shared, and the roles that privacy and security played in the use of (networked) electronic medical records. As our research shows, the structure of (networked) electronic medical records were set up, at the cost of much effort by project leaders, the content of the records to be watched by project leaders, clinicians, and (sometimes) patients. The watching of and in the electronic medical records included lateral watching or coveillance (Mann et al. 2003), self-surveillance, dataveillance (Clarke in Roger Clarke's dataveillance and information privacy pages, 1999), and watching from below, or sousveillance (Mann et al. 2003). These forms of watching in and of the (networked) electronic medical record steered project leaders, clinicians, and patients.