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I’ll Take More Transparency with a Side of Claims Data, Please

June 13, 2013
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I’ve been thinking a lot lately about transparency in the government.

How could you not? Edward Snowden has become a household name. The National Security Agency’s (NSA) reported practice of collecting private citizens’ phone and internet data has come under rapid fire. The government has been accused of spying on everyday people.

It’s all about transparency and trust. For many people, the answer of “9/11” and “terrorism,” as to why this program does the things it reportedly does, is not good enough.

In the post-Watergate era, there are countless Americans with an inherent distrust of the government. People ask: why does the government do the things they do? Why can’t they be clearer about why certain things are the way they are? We need a thorough explanation and understanding of certain policies and procedures.  This is not a population content to smile and oblige.

This issue also ties into the companies that work with government agencies. Google, Facebook, and other tech giants, which had been working with the NSA on that surveillance program, urged the government to let them be transparent about the whole initiative. Why? Google has to answer to the public too.

The issue of transparency, which can take on different meanings and interpretations, has come up recently in healthcare. Last week, I was at Health Datapalooza, which is quickly becoming one of the industry’s best-known events, and HHS Secretary Kathleen Sebelius announced the Centers for Medicare & Medicaid Services (CMS) had released additional claims data on hospital outpatient charges and Medicare spending and utilization.

Many in attendance, myself included, cheered this news. It was a nice step. But later, Jonathan Bush, the CEO of athenahealth, urged the government to release even more data. The amount of data released that day wasn’t good enough, in his book. The government can be even more transparent. His sentiment was echoed by U.S. Senators Chuck Grassley, R-Iowa, and Ron Wyden, D-Ore.

“Medicare is a $500 billion program with billions of dollars going out in error each year,” Grassley said in a statement. “The bad actors get bigger and bolder all the time. They stay out of law enforcement’s reach all too often. It’s time to try new things. More transparency about billing and payments increases public understanding of where tax dollars go and foster accountability. The bad actors might be dissuaded if they knew their actions were subject to the light of day.”

One of the things I appreciate most about the Health Information Technology for Economic and Clinical Health (HITECH) Act is that it has strong transparency requirements around data privacy. Every time there is a data breach that impacts 500 or more patients, the provider has to notify the public. The third-parties who are connected to those providers, they too must be transparent.

Yet the same kind of transparency the government requires of these providers, does it require of itself? It’s a loaded question, but one that needs to be explored in this era of digitization. There are people, such as Senators Grassley and Wyden and Jonathan Bush, who think the answer is no, the government doesn’t require the same kind of transparency of itself. Others might see danger in too much transparency.

I for one would love to see more done in terms of pricing data. Look at this cool database I found on Twitter this week from a California radio station, KPCC. Considering how recent the data was released by CMS, this was obviously created in a short period of time. Can you imagine something even more extensive if even more data was released? It could really go a long way in helping patients understand the system better.

You want to talk about empowering the patient? In my book, there is not much that would do more to empower the patient than releasing this kind of data.

Thoughts? Feel free to leave comments below or respond to me on Twitter by following me at @HCI_GPerna.



The need for transparency in government is vital. That is why we have three - hypothetically independent - branches to provide checks and balances (ie: mutual oversight). The founders realized the inherent corruptability of government without transparency and diligent watchfulness by everyone. Those who oppose transparency now are simply seeking to subvert the separation of powers and the protection it brings against people like them.