Wachter: Transparency is 'inexpensive and effective tool'

The pressure to deliver high-value care has led to massive growth in understanding the need for transparency, said Robert Wachter, MD, professor and interim chair of the Department of Medicine at the University of California, San Francisco, speaking at the Aug. 20 installment of the HIT Safety Webinar Series.

Transparency is a relatively inexpensive and effective tool to achieve higher value, he said. “We have found that just putting data out there seems to drive levels of improvement that often are surprising and not as difficult and fraught as many people worry about.”

Barriers to transparency include fears about conflict, disclosure and the potential negative effects on reputation and finances; the lack of a pervasive safety culture and the leadership commitment needed to create it. Stakeholders have a strong interest in maintaining the status quo. The lack of reliable data and standards for reporting and assessing clinician behavior regarding transparency also are hurdles.

“There is always going to be a tug-of-war between the forces that promote and the forces that prohibit transparency,” Wachter said. “To me, the issue here is that IT tips the balance massively towards transparency. IT changes the dynamic of this equation so that some of the objections are now overcome because of the ease with which you are able to be transparent.”

It’s no exaggeration, he said, that up until five years ago, healthcare was primarily analog and now it is primarily digital. “It’s not gone as smoothly as we would have liked. There have been fits and starts and there are a lot of unhappy clinicians.”

But, in the future, patients will have the information they need to make informed choices and much care will be self-care, aided by computerized decision support, he noted.

The internet itself in increasing as a diagnostic tool as well. Wachter cited a study that found that 59 percent of adults have looked online for health information and 35 percent said they have used the internet to figure out what medical condition they or another may have. Larger numbers of patients are consulting online reviews or rankings for drugs or treatments, doctors or other providers and hospitals and other facilities.

Transparency leads to consumer choice and clinical/system improvement. Measures are getting better over time, Wachter said, getting more user-friendly and tailored for patient preferences and needs. “Silicon Valley’s entrance is crucial--they know how to do this.”

A Centers for Medicare & Medicaid Services pay for performance initiative from 2003 to 2008 found that providers improved on several quality measures but, more impressively other hospitals also improved just through the public reporting of their data. “Transparency works better than we expected, pay for performance doesn’t work as well as expected and transparency is easier and much less politically charged.”

But, “fancy analytics applied to crummy data yields crummy measures,” Wachter said.