58. Monopolies on medical knowledge and information are unethical.

Jonathan Bush, CEO athenahealth

This is part of a series of essays on the Health Rosetta’s Principles.

First, let’s acknowledge what we’re not talking about: holding onto knowledge derived from an organization’s years of hard work and learning to outperform the competition. Let’s all agree that protecting one’s secret sauce is critical to compete fiercely and win in the open market.

Despite the title of #58 here on the 95 Theses list: “Monopolies on medical knowledge and information are unethical,” I’m going to semantically disagree. It’s not unethical to profit from withholding information related to patient care, care coordination, service quality or cost; it’s perfectly ethical in a not so cool, honorable or great way. If you believe your brand can withstand the perception problems and backlash of information-blocking, by all means keep the gates up. And while it might not be unethical when care organizations limit the universe of providers with whom they’ll share information, it should prevent them from being given a break in taxes or recognized as a social benefit organization.

The thing is that sharing information related to patient care is an inherent responsibility if you’re in healthcare – it runs parallel to accepting the Hippocratic Oath. But sharing alone isn’t enough; the responsibility extends to delivering consumable, usable information universally to the point of care. Ask anyone who has ever received a 1,900-page CCDA on a patient. It may very well be compliant, but it’s also absolutely useless.

Information isn’t flowing as it should in healthcare. Findings from a 2015 national survey of nearly 3,000 physicians who use the Epocrates medical reference app demonstrate as much, with 95 percent of physicians saying they’ve experienced a delay or difficulty delivering medical care because patients’ health records were not easily accessible or shared. Thousands upon thousands of clinicians and care providers experience information deficits, and even information blocking in a variety of forms. Whether they’re told they can’t gain access to certain information by their local hospital unless they too are on the same IT system as the hospital, or are granted such access but only once they invest in what has been described again and again as massive interface fees. Within healthcare there remains a series of infrastructural, financial and business practice barriers to the efficient and cost-effective flow of health information. That doesn't mean the solution is to empower yet another federal intrusion into the marketplace. “Thou shalt” do anything isn’t exactly a value proposition for providers or for patients. Rather, market pressure will do more to eliminate impediments to information flow than any government investigation or mandate could ever do.

Given the future of healthcare will be shaped by an increasingly consumer and provider-driven demand curve, healthcare services that are designed to only work inside-the-box (the care organization that offers them) and not stand for comparison against other options in the market will not sustain. Some organizations may stand behind a rationale that claims keeping information contained is necessary for fully coordinated care, or assert that information can’t be shared because of technological shortcomings. These are false realities. The hoarding of medical knowledge and information is not just unethical; it’s bad for business and limits the insights available to the industry as a whole to improve upon both quality and cost. The good news is that market forces are finally coming into play that will cause every self-interested information blocker to reconsider what they share and with whom. One enticing example where we’ll see loosened information flow is around the emergence of risk-baring entities with whom health systems and health plans can realize new value-based profits through savings that they can’t generate on their own, and without strategic information sharing.

As we’ve seen in other industries, internal information sharing isn't novel. Think of United and Delta, both of which invested heavily redoing their websites in the 90’s, thinking consumers would skip the travel agent and book directly through them. But along came Kayak, which disrupted that idea; now a vast number of travelers book tickets directly through Kayak without visiting those new United or Delta websites. Consumers want a marketplace, a choice. Instead of returning to the one place or one brand with which they are familiar, consumers want to shop around, find the best prices for the best deals or buy the deluxe version. The same applies to healthcare. Those care organizations who realize sharing information is not only the right thing to do, but has the potential to win them a new kind of market share – well beyond their current geographical footprint – will lead the charge for more informed and competitive healthcare.

Hospitals and health systems, and payers too, should share medical knowledge and information, not just because it is ethical, but because it’s key to survival in healthcare’s emerging economy of openness. Healthcare is moving outside the traditional four walls. According to the New England Journal of Medicine, between 13 and 27 percent of all emergency room visits can be treated in an urgent care setting, of which there are projected to be more than 12,000 across the US by 2018. Also, according to American Well 64 percent of all patients are open to a doctor visit via video telehealth. Realities such as these will disrupt healthcare’s traditional business model, which has been artificially supported by internal connectivity versus sharing information with other players across the care continuum. Ironically, it’s the organizations that have grown and profited from building closed environments which have created such enormous opportunity for alternative players, like retail clinics, convenient care, and providers embracing telehealth. While traditional players were protecting and defending their slice of their market, the disrupters sought out and seized new opportunities that the traditional players could have pursued themselves.

No care organization can be all things to all patients. Most hospitals can’t offer the convenience of a retail brand. Retail clinics will never do brain surgery as well as an academic medical center. The best thing for provider organizations to do to remain viable is to find the slices of the market where they can be the best, or the most convenient, or the most cost competitive vs. trying to monopolize the entire care offering pendulum. Those who try to defend their market position by locking down information won’t be able to keep pace with those who are opening up and reinventing themselves.

Share information. Build information bridges. Supplement your offerings. Make your brand more compelling to the consumers you serve. Do it because it’s ethical. Do it because it’s good for business.

Get involved

Improve your benefits

Start down the path to 20-40% lower costs & better benefits, whether you have 100 or 100,000 employees.

Become a member

We help mission-aligned groups and people learn, connect, advance goals, and scale healthcare's fixes.

Get certified

We help benefits advisors stand out through transparency, expertise, and aligned incentives.

Get our emails

News, case studies, tips, and data on Health Rosetta style benefits and our mission to scale healthcare's fixes.