“We should not oversell transparency as a panacea. But it must become the defining characteristic of the NHS: the future must be open.”
- Tim Kelsey, NHS Commissioning Board
In 2010, the UK’s National Health Services (NHS) embarked upon a bold journey to bring transparency to its citizens; Prime Minister David Cameron pledged that the NHS will make comparative performance and prescribing data for individual primary care practices, as well as anonymized patient-level data, publicly available to permit scrutiny of clinical teams in hospitals. Additionally, the NHS made plans to digitize all health data and make it available to staff by April 2018. While these goals are challenging and will take an army of support and effort to achieve, recent NHS initiatives illustrate that the UK is making progress.
For example, last month Wythenshawe Hospital in Manchester rolled out online statistics and ratings where patients can pick their surgeon based on mortality rates and reviews from people who have had operations. I questioned if this initiative would garner support within the hospital, but administrators at Wythenshawe actually welcomed the effort, saying that it will boost standards and make surgeons more accountable. Sir Donald Irvine, the former president of the General Medical Council, went as far as to say “This has the potential to revolutionize patients’ ability to choose their doctors, and it is a step that other hospital trusts would be wise to follow.”
Given the widespread support for the initiative and Kelsey’s plans for more open data, it could very well be a practice more hospitals in the UK begin to adopt. Kelsey suggests that transparency in health care means sharing three types of data: big data, user data, and my data.
- Big data is available to everyone – clinicians, patients and the public – and includes things like clinical quality measures and survival/mortality rates.
- User data is where the citizen is the source of information. The Wynthenshawe patient reviews are an example of user data. Another example is the NHS’ "friends-and-family test” that gathers and publishes information on whether patients would recommend health services to their loved ones.
- My data is personal information of and for each individual. NHS plans to provide each patient online access to their health record by March 2015.
Do you think sharing these types of data will positively influence the health care system in the UK? Moreover, do you think they are good practices in health care?
The US has begun to introduce the availability of cost data, but we have a road ahead of us for the sharing of quality data, ‘user data’ and ‘my data.’
Do you think the US will adopt similar policies for data transparency?
Introducing transparency as the new norm in the UK was not easy and as the US travels down this road, states will be faced with many of the same challenges that the UK faced and continues to face. McKinsey & Company has identified four key lessons that can be learned from the NHS’ transparency journey:
- Start small – don’t wait for perfect data.
- Political bravery may be required.
- Address public concerns at all stages, and
- Professional engagement is paramount.
These lessons are very applicable to the creation of an APCD at both the strategic and tactical levels and can be resourceful to state governments as they advocate for and implement APCD policy. In my next several posts, I’ll be applying similar concepts to the states; in particular, to the creation of an increasingly popular health care transparency initiative – the all-payer claims database.