Open Health Data Allows Comparison of Cost, Quality

In 2014, there are still huge gaps in public information. Identifying a good doctor or hospital, for example, remains largely a word-of-mouth affair -- but the Agency for Healthcare Research and Quality (AHRQ) is working to change that.

Under the U.S. Department of Health and Human Services (HHS), the agency released in May the newest version of its health-care data reporting tool: MONAHRQ, for My Own Network, powered by AHRQ. MONAHRQ is free software that organizations can use to turn their data into public websites -- websites where users can search and compare information based on metrics like cost or quality.

Today, 11 states use MONAHRQ to publicly report health-care discharge data (other states either have no reporting requirements to meet, or they use proprietary software for public reporting). The most recent download numbers for MONAHRQ -- which was developed as a means for health-care organizations to monitor and improve their operations, and as a shopping tool for the public -- show an uptick in adoption, said operations manager Bill Freeman. 

11 States Use MONAHRQ Arizona Arkansas Hawaii Kentucky Maine Nevada Oklahoma Utah Vermont Virginia Washington

“It’s a way to save resources, because the idea behind MONAHRQ was to provide this mechanism to create public reports so that everyone didn’t have to reinvent the wheel whenever they wanted to create a public report,” he said. “Otherwise, each state would have to create a contract, design their own reports, figure out how it’s going to work -- and MONAHRQ facilitates that process so it’s much easier, and also makes it so it’s much more standardized.”

Born out of the Healthcare Cost and Utilization Project (HCUP), websites generated by MONAHRQ include quality indicator metrics that add another dimension to the health data reported by health-care facilities. An expecting mother, for example, can consult her state’s MONAHRQ website and see the rates of injury among patients or infection in newborns, with comparisons to the national average.

Since the software is free, using MONAHRQ is largely a matter of logistics and getting data in the correct format, Freeman said, adding that for someone who knows the software, it’s possible to get a website launched within a few hours.

“This is AHRQ’s way of facilitating transparency in health care, and in trying to increase the amount of information available to both providers and to patients with the hopes of increasing quality and decreasing cost,” Freeman said.

Utah was one of the first states to adopt MONAHRQ and one of the best examples of what the software can offer, Freeman said. Utah announced on Aug. 19 the launch of its latest version of the website, the 2012 Utah Hospital Comparison Tool (the state’s most recent data comes from 2012). A press release says Utah’s newest tool provides legislators and health-care professionals “an opportunity to inform discussions about ways to improve the quality and safety of health-care while lowering cost.”

Since the state adopted MONAHRQ in December 2011, there have been no documented cases of the data being used to impact legislative or policy change that Kimberly McNamara, senior business analyst at the Utah Department of Health, says she knows of -- but the website is a big improvement over the old way of doing things.

“The origin was that Utah is mandated by one of our health-care consumer bills to read hospital comparison information on quality safety and charges,” McNamara said. “In the past, we did that by releasing really long, scary PDF-type files that went through and listed the hospitals, and people could look at their hospital and then flip back to another hospital, so it wasn’t very useful.”

And the MONAHRQ program, she said, has been both beneficial and problematic for Utah. “The first benefit is that it’s a national tool, so other states can get what we’re doing and we can compare to the nation," McNamara noted, adding that it’s also useful because the state doesn't have to hire a programmer to create the website. “We hire research associates and that sort of thing, and we can use their tools.”

Since adopting MONAHRQ, however, she said that bugs have been a persistent problem. “I know I had to work with them for two to three months to iron out everything that we felt wasn’t working properly,” she said. “And from what I’ve heard around here, it’s been a similar situation every year -- that there are a lot of bugs. There were a lot of things on there that I couldn’t believe other states hadn’t found, and they had already produced their website.”

Another challenge with public health-care data, though not one specific to MONAHRQ, is getting cooperation from health-care facilities that report their data, McNamara said. Though facilities are required to report discharge data, she said that many of the rural or smaller facilities she asked to help test MONAHRQ never returned her messages.

Despite the bugs and how few states use MONAHRQ, McNamara did say that she thinks it’s a “well-done” tool. Utah will upgrade to the newest version of the software, which includes the ability to gear Web queries to the type of user, be it legislator, civilian or health-care professional -- but it also is going to look at other options for releasing its data.

“We’re forming a group this year to try to determine if MONAHRQ is the best tool for that,” she said, adding that since the state doesn’t have traffic monitoring capabilities yet, it doesn’t know how much the tool is being used or how effective it is. “There’s definitely a desire to have transparent health care for people in Utah and increasing quality of safety in health care while lowering costs. I think at this point, we’re just questioning whether MONAHRQ is the tool to get the information out there to consumers and policy makers.”

Looking out west, the state of Washington primarily uses MONAHRQ for data transparency, said Wei Yen, senior forecast and research analyst at the Washington State Office of Financial Management. Washington’s MONAHRQ website includes data from 2009, 2010 and 2011. Though the tool helps facilities meet reporting requirements, the functionality of their website goes beyond those requirements.

“We originally started looking at the hospital discharge data about issues related to regional variations and then we started looking at what’s called the avoidable hospital stays, if we have a primary care outside of the hospitals,” Yen said. “Those two pieces of information are included in the MONAHRQ system so we thought that would be a very nice tool to actually have this information on our website.”

Like Utah, Washington does not monitor traffic and therefore doesn’t know how many users its website sees. Though impact is difficult to determine, Yen said its office has gotten calls from local government agencies, researchers and other state agencies saying that they’re using the data.

“From our point of view, it’s definitely worthwhile,” Yen said, adding that this type of information likely wouldn't be available to the public in one spot without this tool. “Some of the measures you see, you can probably get from some other channels. For example, the hospital compare measures, you could get that from the Centers for Medicare and Medicaid [Services], but this is a place where you have a concentration of hospital information on several fronts: quality, utilization, as well as the avoidable hospitalization. We think it’s worthwhile, and that’s why we’re continuing to do it.”