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A Safer health system built on data transparency

In 1999, the Institute of Medicine (IOM) released To Err Is Human: Building a Safer Health System, a groundbreaking report that ultimately led to the creation of the Agency for Healthcare Research and Quality (AHRQ)1,2. This report, widely discussed in the media, claimed that between 44,000-98,000 Americans die each year from preventable medical errors. Despite the outrage from the public and a flurry of initiatives to address this issue, nearly two decades later, medical errors are estimated to be the third-leading cause of death3 , killing up to 400,000 patients annually and causing serious harm to another 10-20x the number of patients, all at an estimated cost of more than $1 trillion4.

A significant barrier to fixing the medical errors problem was that many hospitals and medical centers at the time simply weren’t assessing the quality of their services in a way that could be used for quality improvement programs beyond rudimentary programs associated with Medicare5,6. Data collected for these tasks was based substantially on insurance claims data and hospital billing records; early electronic medical records systems were often designed for a single-purpose and interoperability (e.g., sharing of records between providers) was nonexistent, save for the fax machine.

With the release of the IOM report coinciding with growing use of the internet and technology, the time was right in the early 2000s for a renewed focus on patient safety and hospital and provider quality metrics. The Leapfrog Group, founded in 2000, was one of the first to tackle these problems head on, by uniquely working with the business leaders who were feeling the squeeze of higher healthcare costs for their employees. The Leapfrog Group has grown from an initial survey response of 200 hospitals on three key patient safety dimensions to almost 2,000 hospitals reporting data on a variety of measures, such as the use of a bar code medication administration system that can prevent medical errors before the drugs are given to patients7. What may be most remarkable about The Leapfrog Group’s survey is that the hospitals are reporting their safety and quality data voluntarily, knowing that their data will be released publicly, in reports that employers can use and websites with Leapfrog’s Hospital Safety Grade and consumer-facing information.

In Episode 6 of the MoneyBall Medicine Podcast, I talk with Leah Binder, CEO of The Leapfrog Group about healthcare’s price and quality metrics today and the struggle to increase transparency in these key areas. We discuss where startups in this space go wrong, the role for consumer-facing technology, and trends that will push price and quality transparency to become more mainstream. We consider how data transparency is driving value-based care and barriers to its success.

  1. Donaldson, M. S. 2008 Advances in Patient Safety An Overview of To Err is Human: Re-emphasizing the Message of Patient Safety.
  2. Schulman, K. A. and Kim, J. J. 2000.Medical errors: how the US Government is addressing the problem. Current controlled trials in cardiovascular medicine 1 (1):35-7.
  3. Makary, M. A. and Daniel, M. 2016.Medical error-the third leading cause of death in the US. Bmj 353 i2139.
  4. Bernazzani, S. 2018.Tallying the High Cost of Preventable Harm. Costs of Care.
  5. Gagel, B. J. 1995.Health Care Quality Improvement Program: a new approach. Health care financing review 16 (4):15-23.
  6. Marjoua, Y. and Bozic, K. J. 2012.Brief history of quality movement in US healthcare. Current reviews in musculoskeletal medicine 5 (4):265-73.
  7. The Leapfrog Group. 2018 History.