Author’s note: The complete article is titled:

Learning from Taiwan about responding to Covid-19 — and using electronic health records By Ezekiel J. Emanuel, Cathy Zhang, And Aaron Glickman JUNE 30, 2020

and can be found at:


Who beat the Covid Pandemic? If one measures success as fewest coffins per 100k or sustained economy, Taiwan kills the U.S.  

On a per 100k basis, the U.S. has 1,200 times as many new Covid-19 graves as Taiwan. The U.S. issued, begrudgingly, stimulus checks to idle workers and ailing enterprises. Taiwan? Not(). By containing the virus, Taiwan prevented deaths and sustained its economy. What are some obvious differences in the two countries? Taiwan is an island. Taiwan is less populous than the U.S. What else?

Doesn’t being an island and having less people automatically give Taiwan an advantage over the U.S. in the fight against Covid? Other factors counter these advantages. Compare population density per square mile in Taiwan (tái)(wān)= 1,680 vs continental United States = 103. Oh, and did I forget to mention her closest (81 miles) neigbor?

So, Taiwan’s successful response to Covid-19 was luck …NOT()!. Taiwan’s proximity to China abides. Since more than 1 million Taiwanese work in China, those workers carry home more than a paycheck. Having nationals working in the country where the pandemic originated and returning home posed danger but that danger never ensued. Why (was this so)?

Culture plus vigilance plus information equals power to the populous.

Taiwan has generated a culture of taking infections from China seriously. For example, Taiwan’s innovative electronic health records system made possible the country’s swift, targeted response to Covid-19. The health card gives the ministry regular, nearly real-time data. The availability of almost immediate data on patient visits allowed the country to efficiently identify, test, trace, and isolate cases. Therefore private patient data provides public populous good. But information potential does not always serve its many possibilities…

Having electronic health records solves nothing but the abstracts of time and space – unless innovatively utilized. The U.S. has come a long with its use of electronic records, thanks in part to the financial incentives built into the Health Information Technology for Economic and Clinical Health Act of 2009. What’s the next step for electronic records?

Size and site things. But the Republic of China and the “Land of the Free.” Differ in other and invisible ways.

Taiwan shows that data sharing is a challenge of policy, not technology. Americans’ health records privacy policy trumps technological solutions to national health care concerns. Americans seem reluctant to allow the Department of Health and Human Services to monitor patient encounters. Taiwan solves the riddle while the U.S. burns. When freedom prevents liberty, people die.

Putting privacy policy aside for popular good allows lifesaving innovations. Medicare and Medicaid could adopt something similar to the Taiwanese health card. Why haven’t they? Insurers already get data based on hospital and physician claims, albeit only weeks or months after encounters, making the information less useful for tracking infectious outbreaks. Adapting U.S. electronic health records to an expanded role would be work but not hard work because…

Accepting that hindsight may not always be 20/20, past experience should be the future starting point for developing a Taiwan like system. The U.S. has the benefit of hindsight for what went well and what went wrong with electronic health records development. Hindsight smooths the path (dào)to take the next step – health record utilization for public good. The U.S. needs a faster, more serious response to public health emergencies. When will this happen? Can it happen without serious revision of the privacy accord?

Shoring up the U.S.’s digital health infrastructure will help improve routine care in the long run while empowering us to better respond to future infectious disease outbreaks.