Nick Jacobs provided an interesting blog post recently on Wikis, Blogs and Transparency as it relates to healthcare. Nick argues that hospitals should disclose more information such as deaths through medical errors and adds, “Openness causes accountability.” He adds “So, as we move more completely into a new world order of more open communication, we will continue to see the morphing of our previous rules, perceptions, and realities.” This is certainly true.

Nick notes as an example, without endorsing the idea, that a UK study suggested that doctors should sometimes use Google to find diagnosis for unusual cases. Do doctors know that this action is discoverable? Should Google reveal the search strings of a doctor if there is a malpractice suit as it has done in other cases? Another doctor, David Williams, compares Googling a diagnosis to stupid pet tricks in his blog. I do not pretend to be an expert here but I hope my doctor has better tools than Google.

More to the broader enterprise issues, Alfred Fortin, another physician blogger, links to a more comprehensive treatment of the healthcare transparency issue in a comment to Nick’s post. He lists some of the things that the public might want to be transparent (with links for a few examples) such as

· “Physician and hospital costs

· Physician and hospital charges

· Physician and hospital compliance with best medical practices

· Physician and hospital compliance with evidence-based medicine

· Physician and hospital health outcomes

· Physician and hospital medical errors

· Physician and hospital disciplinary actions and lawsuits

· Physician and hospital accreditation, board certifications

· Health plan benefit design and benefit decision making

· Health plan subscribers health demographics, indices

· Health Plan rate-making process, cost of benefits

· Quality of care stats for minorities, gays, immigrants and others

· Everyone’s lobbying activities, dining expenses, airline seat preference

· Health Care CEO’s, and high-priced medical specialists’ outrageous salaries and fees”

Nick closes his post with the comment, “Let’s force transparency in health care, and insurance, and the building industry and the investment industry and law. Well, you probably see where I’m coming from on this one.” This caused me to reflect on what should be transparent and what should be private? Where do we draw the line in the above list? What do we add to it? This transparency takes many forms. There are also now a growing number of pubic sites where patients can rate their doctors, parents can rate their kids teachers, clients can rate their lawyers, and I am sure this will spread to other industries, if it has not already.

We have been promoting transparency within the enterprise as a good thing on this blog and I remain part of this chorus. However, the ease of transparency raises important policy issues. Many discussions have already been started here but the posts of Nick and Alfred were clear reminders of the need. Certainly when it comes to healthcare the records of individuals must remain private. This is not limited to healthcare. The individual records within any industry should remain private or are there instances when they should be public? We could come up with an equivalent to Alfred’s list for any industry including, but not limited to, the other industries that Nick names in his conclusion. Before we get too far into unleashing transparency within the enterprise, there needs to be some more clear thinking about policy.