News at NCH
"Transparency Drives Healthcare Data to Become Information, then Knowledge" By Allen Weiss, MD, MBA, President and CEO


Transparency Drives Healthcare Data to Become Information, then Knowledge

December 1, 2009 - Transparency continues to be an important trend in healthcare.

When an organization is truly “transparent,” it is open and candid with its many constituencies. Patients, physicians, hospitals, payers (insurance companies or individuals), and regulators are better informed than ever before, because there is improved access to both subjective and objective information.

In the process, value in healthcare can become the paramount objective for everyone. First, let's talk about value and then we'll explore the reasons why everyone is trending towards transparency. We'll include some good sources for additional information.

We're defining “value” as quality divided by cost. As an equation, it looks like this: Value = Quality/Cost. A Value Equation utilizes any objective quality measure in the numerator—the top part of a fraction—such as mortality (death rate), morbidity (side effects), infection rate, complication rate, etc. In the denominator—the bottom of the fraction—are costs. Examples of costs include the total amount of money spent by both the payer and the patient, the supplies consumed, the number of hours needed to complete a diagnosis or treatment or even the capital costs to buy new equipment.

As the quality improves, value goes up. As cost diminishes, value also goes up. Patients, care givers, payers and regulators all benefit when value improves.

Years ago, before the information age, obtaining accurate data was very time and energy intensive. Now with most everything being digital and Internet access ubiquitous, we are almost overwhelmed with data. This data needs to be thoughtfully considered and then converted into information. In turn, information needs to be synthesized into knowledge which can be acted upon.

Consider the role of transparency in this transformation from data to information to knowledge. According to Deloitte health care research consultant Ruth Given, Ph.D., there are currently 34 health care user-generated websites to evaluate health care from a patient's perspective. One of the newer sites is Angie's List (http://www.angieslist.com/) which started out rating other service industries such as plumbers, painters, and movers.

The reasons for this intense new interest are three-fold:

First, more than 24 million Americans have become careful shoppers as they pay for their own individual insurance policies and have high deductibles and co-pays. This activity makes these patients prudent and removes the moral hazard of having someone else paying for a health benefit. (http://www.deloitte.com/view/en_US/us/Industries/US-State-Government-Public-Sector/Center-for-Health-Solutions-State-Government/article/274ed1800c0fb110VgnVCM100000ba42f00aRCRD.htm).

Second, the health care system is better than ever at communicating information. For example, visit HealthGrades (http://www.healthgrades.com/).

Third, patients, payers, and regulators now understand there is tremendous variation in value in healthcare, as defined above (http://www.dartmouthatlas.org/interactive_map.shtm).

Traditionally, patients looked to physicians as trusted sources of information. Now patients supplement this information with research, and thus expand their experience. “This triangulation of knowledge is not a world that most physicians live in today,” observes Dr. Paul Keckley, executive director of the Deloitte Center for Health Solutions. In the future, Jim Conway, senior vice president of the Institute for Healthcare Improvement, believes that one way to improve value is to actively engage consumers as participants in their care.

Healthcare is both an individual participation and a team sport. Patients, physicians, hospitals, payers and regulators all need to work as a team to improve value.

· Patients who have a good understanding of their history—including symptoms, diagnosis and treatments—will generally have a better experience with his/her physician.

· Physicians who consult other professionals regularly will generally deliver better results for the patients they serve.

· Hospitals with a full complement of busy services such as cardiology, cardiac surgery, maternity care, oncology, orthopedics, pediatrics, psychiatry and women's services will generally have better experiences as these services support each other.

· Even insurance companies who work well with the patients they insure and the physicians and hospitals who care for these patients will add value.

One participant alone does not engage the synergy of the team in diagnosing or curing what is wrong with the patient, or dealing with the ineffectiveness in the system.

We are all in this together and we all need access to the same accurate, timely, understandable and pertinent data, information, and knowledge.

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Dr. Allen Weiss is CEO & President of the NCH Healthcare System. He is board certified in Internal Medicine, Rheumatology and Geriatrics, and was in private practice in Naples, Florida from 1977 - 2000. Dr. Weiss is active in a variety of professional organizations and boards, and has been published in numerous medical journals, including the American Journal of Medicine and the Journal of Clinical Investigation.