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March 30, 2008

Openness in Health Care

Innovation depends on access to shared, cumulative research.

If there is one area of American life that could benefit from greater transparency and participation, it is the health care system. Now comes a terrific new report that describes in rigorous detail the many ways in which the open sharing of information could improve the quality of health care for everyone. Harnessing Openness to Transform American Health Care (pdf file) is a new report by the Committee on Economic Development, the business research group, released in January 2008.

The report calls upon government, biomedical researchers, academic scientists, administrators of health records, manufacturers of medical devices and public health officials to recognize the virtues of open access to knowledge. The point is that people should be able to learn about new discoveries and innovations rapidly, and be able to improve knowledge with their own contributions and redistribute it freely.

This is the essential insight of open source software, of course. As one major open-source expert has put it, With enough eyes, all bugs are shallow. Only by allowing the code to be shareable can the prodigious power of networked collaboration work its magic.

The author, Elliot E. Maxwell writes 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. He cites economist Paul David, who notes:
bq.The progress of scientific and technical knowledge is a cumulative process, one that depends in the long-run on the rapid and widespread disclosure of new findings, so that they may be rapidly discarded if unreliable, or confirmed and brought into fruitful conjunction with other bodies of reliable knowledge.

The CED report describes a variety of areas in which openness in healthcare would be beneficial. Federal research could be much more productive if there were more explicit policies for the sharing of research in standardized forms and protocols. This could lead to a faster pace of discovery and a shorter time between discovery and its use in general medical practice (currently about 13-17 years for about one in seven discoveries).

If people’s electronic health records could be accessed—with proper privacy protections—researchers and policymakers could gather far more reliable evidence-based research about health problems and treatment strategies.

Just as users of software have come up with lots of improvements to open-source software, so medical devices could be improved by practitioner-driven customization. Why couldn’t the FDA oversee a new regime of open innovation in medical devices while continuing its traditional monitoring of safety and efficacy?

For a fascinating introduction to the power of open networks – and its practical utility for the healthcare system – the CED’s new report is a valuable report that should be widely read.