If the Prime Minister Wants Accountable Healthcare, let’s make it Transparen...
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Over at the Beyond the Commons blog Aaron Wherry has a series of quotes from recent speeches on healthcare by Canadian Prime Minister Stephen Harper in which the one constant keyword is... accountability.
Who can blame him?
Take everyone promising to limit growth to a still unsustainable 6% (gulp) and throw in some dubiously costly projects ($1 billion spent on e-health records in Ontario when an open source solution - VistA - could likely have been implemented at a fraction of the cost) and the obvious question is... what is the country going to do about healthcare costs?
I don't want to claim that open data can solve the problem. It can't. There isn't going to be a single solution. But I think it could help spread best practices, improve customer choice and service as well as possibly yield other potential benefits.
Anyone who's been around me for the last month knows about my restaurant inspection open data example (which could also yield healthcare savings) but I think we can go bigger. A Federal Government that is serious about accountability in Healthcare needs to build a system where that accountability isn't just between the provinces and the feds, it needs to be between the Healthcare system and its users; us.
Since the feds usually attach several provisions to their healthcare dollars, the one I'd like to see is an open data provision. One where provinces, and hospitals are required to track and make open a whole set of performance data, in machine readable formats, in a common national standard, that anyone in Canada (or around the world) can download and access.
Some of the data I'd love to see mandated to be tracked and shared, includes:
- Emergency Room wait times - in real time.
- Wait times, by hospital, for a variety of operations
- All budget data, down to the hospital or even unit level, let's allow the public to do a cost/patient analysis for every unit in the country
- Survival rates for various surgeries (obviously controversial since some hospitals that have the lowest rates are actually the best since they get the hardest cases - but let's trust the public with the data)
- Inspection data - especially if we launched something akin to the Institute for Health Management's Protecting 5 Millions Lives Campaign
- I'm confident there is much, much more...
I can imagine a slew of services and analysis that emerge from these, if nothing than a citizenry that is better informed about the true state of its healthcare system. Even something as simple as being able to check ER wait times at all the hospitals near you, so you can drive to the one where the wait times are shortest. That would be nice.
Of course, if the Prime Minister wants to go beyond accountability and think about how data could directly reduce costs, he might take a look at one initiative launched south of the border.
If he did, he might be persuaded to demand that the provinces share a set of anonymized patient records to see if academics or others in the country might be able to build better models for how we should manage healthcare costs. In January of this year I witnessed the launch of the $3 million dollar Heritage Health Prize at the O'Reilly Strata Conference in San Diego. It is a stunningly ambitious, but realistic effort. As the press release notes:
Contestants in the challenge will be provided with a data set consisting of the de-identified medical records of 100,000 patients from the 2008 calendar year. Contestants will then be required to create a predictive algorithm to predict who was hospitalized during the 2009 calendar year. HPN will award the $3 million prize(more than twice what is paid for the Nobel Prize in medicine) to the first participant or team that passes the required level of predictive accuracy. In addition, there will be milestone prizes along the way, which will be awarded to teams leading the competition at various points in time.
In essence Heritage Health is doing to patient management what Netflix (through the $1M Netflix prize) did to movie selections. It's crowdsourcing the problem to get better results.
The problem is, any algorithm developed by the winners of the Heritage Health Prize will belong to... Heritage Health. This means the benefits of this innovation cannot benefit Canadians (nor anyone else). So why not launch a prize of our own. We have more data, I suspect our data is better (not limited to a single state) and we could place the winning algorithm in the public domain so that it can benefit all of humanity. If Canadian data helped find efficiencies that lowered healthcare costs and improved healthcare outcomes for everyone in the world... it could be the biggest contribution to global healthcare by Canada since Federick Banting discovered insulin and rescued diabetics everywhere.
Of course, open data, and sharing (even anonymized) patient data would be a radical experiment for government, something new, bold and different. But 6% growth is itself unsustainable and Canadians need to see that their government can do something bold, new and innovative. These initiatives would fit the bill.
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