The concept of “openness,” as described by CED in Harnessing Openness to Transform American Health Care, goes beyond what we traditionally think of as transparency. Of course, transparency is critical for helping markets freely flow. But CED uses openness as an M.O. for transforming markets. Think: open source computing, where information or intellectual property is generated at some origin, and then others build on that initial idea (that’s the open-source Linux mascot, Tux the Penguin, pictured on the right). Thus, openness spawns innovation, which is CED’s mission to promote.
“If information can be modified, repurposed, and redistributed freely it is more responsive, and therefore more ‘open,'” CED explains. “The Council has found that an increased degree of openness often leads to greater innovation because it allows contributions to a work from more individuals whose differing insights and experiences can add considerable value,” the report reasons.
However, CED recognizes that openness has its limits and constraints, such as with personally identifiable health information which must be kept secure and confidential, or with intellectual property such as patents for medical discoveries which merit protection for the life of the patent.
CED found that it takes between 13 to 17 years for 14% of research findings to get into the hands of practicing physicians. The Council argues that by introducing openness into the information chain in health care, evidence-based practices and innovative products can disseminate more quickly into the general medical community. This would result, ultimately, in improved individual patient outcomes and overall enhanced public health.
The report analyzes openness through various health segments, including biomedical research, clinical trials, electronic health records, privacy and security, consumer health information, public health, and medical devices.
The CED has been examining the role of openness in a variety of industries, and highlighted the benefits of openness in a previous report, “Open Standards, Open Source, and Open Innovation.”
Beyond these two, I would hasten to add a third constraint on for-profit companies whose lifeblood is innovation: that is, the life and value of the patent. Not everyone has Linux DNA running through their blood.
Furthermore, the CED’s proposal for openness would not, in and of itself, transform health care without a realignment of incentives across stakeholders: for example, consider providers, such as primary care vs. specialty care, or outpatient vs. inpatient vs. home care providers. Openness will go only so far when one provider’s payments are at stake.
And it’s costs, after all, that need transforming in the health system. Over the very long run — decades, perhaps? — evidence-based practices might proliferate throughout the U.S. health system which would, eventually, help to stem cost inflation. But without structural change within the system, costs would continue to rise. See Bob Laszewski’s post at the Health Care Policy and Marketplace Review of October 16, 2007. In it, Bob — a brilliant Washington insider who critically appraises health politics with the best of the best — talks about CED’s proposal for health reform published last year in “Quality, Affordable Care for All.” While the CED is all about “openness,” they remain closed to the idea of explicitly addressing health cost containment.