Health, Biomedical Science and Society Initiative
Health, Biomedical Science and Society Initiative
An effective health care system is a transparent one
An effective health care system is a transparent one. Stewardship and individual health empowerment require the right information and tools. Health information should be timely, accessible and user-friendly, particularly to individuals. It must be available to us at the right place and at the right time to make the right decisions for our health. This information must enable individuals and clinicians to consider and compare the full spectrum of care, not just isolated procedures. Individuals must have the right to any data on their health that exist electronically at no charge or nominal cost. Such transparency needs to extend to health costs and quality as well. Insurers, hospitals, doctors ? all health care stakeholders ? should share their performance and health outcome information so that they can improve and individuals can make well-informed decisions regarding their health care choices, especially when it comes to early health, wellness and prevention.
According to the Institute of Medicine, today "individuals are asked to assume new roles in seeking information, advocating for their rights and privacy, understanding responsibilities, measuring and monitoring their own health and that of their community, and making decisions about insurance and options for care.” Without information, decisions are merely guesses. Empowering individuals requires giving them information that is relevant, accurate and understandable. In fact, everyone involved in health care needs such information—physicians and other care providers, health plans, drug and device suppliers, employers, and government at various levels. In today’s fragmented care systems, ensuring that all parties have the right information is nearly impossible.
The present system lacks information on cost and quality. And the needed information is not just hidden from view; it rarely exists. We need information on the risk-adjusted health outcomes and costs over full care cycles, or appropriate episodes of time, not just the results of a surgery or the cost of a drug or other separate pieces of care. To enable informed decisions by all parties, we need publicly available comparative information about the quality of results for patients with similar medical circumstances, for different treatment approaches, and for each clinical team. Transparency enables clinical teams to understand what they need to improve and when they are improving; it enables them to identify from whom they should want to learn; it enables referring physicians to make informed choices, and it will help individuals to understand their choices.
Transparency of results (outcomes and costs) across the cycle of care will enable better decisions. It is a fallacy to limit or avoid expensive treatments if they are effective in preventing compounding problems. Similarly, the value of acute care needs to account for the health improvements or cost reductions in long term care or disability. On the other hand, many treatments are not effective in improving health or quality of life. Transparent information is essential to understand what works – and what doesn’t.
It is not enough to require and track compliance with established good practice. The information about results must be published and identified by provider teams. In Minnesota compliance with best practices in care for patients with diabetes was reported for several years before doctors began measuring outcomes, and compliance was high. But the percentage of patients that achieved an array of five health outcome measures more than doubled in the first two years of public outcome reporting.1 Clinical teams need help understanding and adopting best practices, and they need to be transparent about the outcomes they actually achieve with patients.
Even when patients do not use the available information, the very act of reporting spurs improvement in both the outcomes and the method of measuring. For example, in response to public reporting of heart surgery mortality rates, The Society of Thoracic Surgeons developed a sophisticated array of risk-adjusted outcome measures that shed light on results and best practices. The society shares this information with its members to drive learning. When clinical teams have information on outcomes, they find out what they need to improve and learn from one another on how to improve. Substandard care is identified as such. The overall quality of care improves for everyone. But this example is relatively rare. Information on results needs to be collected for every medical condition and every clinical team.
Health IT has a large contribution to make in gathering data on outcomes and costs and making that information available. Merely automating records of today’s fragmented care will not drive the needed change. Properly designed IT systems, however, can help clinical teams adopt a coordinated perspective on care and can facilitate an ongoing analysis of the effect of different treatment approaches on health outcomes. In addition, IT can enable personal health records that would allow a patient's health information to be shared with authorized individuals quickly, privately and securely via the Internet. Government can speed the adoption of IT with interoperability standards and common data definitions to facilitate exchange, comparison and analysis.
Outcome measures and risk adjustments are imperfect today, but we should not be deterred. Most of today’s more sophisticated outcome measures had their genesis in public reporting requirements. Nothing will speed improvement in both the outcomes and the measures themselves faster than a commitment to making such measurements transparent.
 MN Community Measurement 2006 Health Care Quality Report, February 2006, page 7, www.mnhealthcare.org.