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Healthcare Transparency - A Vision of Change

September 8, 2008
by Wayne Craige
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Like Newt Gingrich article on the “Future State” (April 2008 issues of Healthcare Informatics), my vision of tomorrow’s healthcare system cannot be accomplished with Healthcare IT alone, we need Transparency!

The perfect healthcare system should be based on Transparency. From a strategic perspective healthcare IT should allow health plans, physicians, and patients to instantly see their entire set of medical records. Clinicians should be able to receive evidence-based treatment recommendations for frequent diagnoses, and be able to retrieve comprehensive treatment alerts. Healthcare IT strategy should help to push for transparency for every US healthcare consumers and practitioners which will provides quality, cost and other open information to be used to make informed healthcare decisions for all.

The result is a reduction in costly medical errors, the ability to efficiently and effectively treat a greater volume of patients at a lower cost, and the opportunity for informed patients to receive care regardless of location status.

It is apparent that some of the benefits of health care IT alone have resulted in unexpected social, cultural and ethical issues dealing with individuals, and our society on a whole. Over time these issues have become more challenging because technological innovations are making dealing with the social effects and cultural considerations even more complex that expected.

Transparency is therefore a critical need, to keep in mind of all individuals, in different societies, as we design health care technology to support them. Our IT solutions should be designed around individuals to provide for the multiplicity of settings, organizational, and other social and cultural concerns.

Georgia Office of HITT has been working jointly with the Governor (Sonny Purdue), local organizations board members, hospitals and local stakeholders to promote transparency across the full spectrum of healthcare services in the state of Georgia. Together strategies have been developed to enable health information technology to be available across the full continuum of care and to foster linkages between health care providers and public health. All US citizens deserve to know the quality and cost of their health care.

“Health care transparency will provide consumers with the information necessary, and the incentive, to choose health care providers based on value”

Providing reliable cost and quality information will empowers consumer choice. Transparency will create incentives at all levels, and motivates the entire healthcare system to provide better care for less money. Consumers will see improvements in services as providers see how their practice compares to others.

What’s does transparency mean to you?



As a consumer of a high-deductible health plan and an entrepreneur, I am dedicated to promoting transparency in our health care system. The focus of consumer driven health care is to empower consumers to exercise choices, make informed decisions and become an active participant. This sounds simple. Consumers in every other industry exercise choice, research quality and prices and find the best value before purchasing goods and services. Consumers are able to do so because of the tools and information that are publically available to them. Our current health care system requires greater transparency and unfortunately, the transparency tools that are available today are meaningless and offer very limited data to help consumers make informed choices. Transparency is not easy. It's a huge culture shift for many in the industry and quite frankly, consumers are finding it impossible to find the best value for health care services using the transparency tools that are available today.

Some ideas on guiding principles of transparency:

- Focus on the consumer
- Transparency requires historic collaboration across the industry (sharing resources and making information comparable across plans and comprehensible to consumers)
- All efforts must be forward focused, relevant and valuable to the consumer
- Requires significant culture shift

Some of the challenges:

- Who will be the first mover in the industry
- Procedures are complicated
- Cultural differences within insurance companies
- Who has the guts to let go of the "secret" information and share this information publicly with consumers

Instead of waiting for the industry to solve the transparency problem, consumers are collaborating to share price information and recommendations on health care services and providers using social networking tools.

One of the tools available today to help consumers find the best value is called This website is a platform that enables consumers to post/share prices they paid for actual services — to share with other consumers. This community search engine allows consumers to search for prices, learn what other consumers paid for similar services, and find the best value — before purchasing routine health care services like MRIs, x-rays, mammograms, office visits, vaccinations, lab tests, dental and vision.

Mona Lori

Joe and Mona very good points and information!

Two of the most obvious points are patients are in a weak position to demand better price and efficiency and secondly, physicians rarely have readily and comparative information on the quality of their own care or on the quality of the care of referring physicians.

Measurements is also key part of the transparency model. The investment in healthcare IT or the push of overall adoption is critical to transparency. IT investment is the only way to ensure that the right data is available at the right time (for the best care) to patients, payers and providers.

I believe in transparency. I've blogged about it (see STEEEP).

There are a lot of entrenched/existing, as well as new practices that are strongly counter-transparency.

On the payer side, denial of claims based on deliberately non-transparent and shifting practices are common.

On the provider side, measurements of quality are routinely not done in important areas. Why? Measurement isn't free, and it works against providers in revenue and medico-legally to have such transparency.

For example, tests aren't just repeated because the prior result isn't available. And, they're not just repeated to make a buck in some important cases.

Consumer and Media treatment of transparency has effectively punished proponents, like Dr. James Bagian at the VA's National Center for Patient Safety.  The mainstream media 'going negative' and driving fear response with the predictable 'name and blame' was one of several messages to us that the public response to transparency was, to be generous, counter-productive to improving society's culture on safety.  That was ten years ago.  Another example is New York state's publishing all surgical outcomes a decade before that.  Surgeons stopped taking cases that would hurt their raw statistics.

As a consumer, I'd love to see the track record of providers (docs, clinics, services and hospitals) on episode-treatment grouped conditions that I may want or need to purchase.

The data is often not-comparable across payers. This has been so problematic that insures will only release their data to their members. Is clinical performance on a commercial population representative of performance on a MediCare population? (BTW, I do read Health Affairs.)

The best articulation of fair and reasonable transparency I've seen is Don Berwick's "My Right Knee" story. It was an IHI plenary and is available as such. He describes issuing an RFP for a knee replacement, laying out specifically the transparency that would be meaningful to him, as a consumer.

Another interpretation of transparency is the more crude one specifically SMRs. Increasingly, hospitals are publishing this data. So, transparency, with the good outcomes you describe is happening.

Broad transparency on quality and cost is a vision. And, a good one.
I would be thrilled to have readers comment on best practices to implement transparency.  Per the above, it's far from a slam-dunk!