Rate my doc: Opening up health data

By Martin Johnston

Health authorities told they must provide the public with surgical safety records.
Patients must be given access to the data 'across specialties', and yearly updates on progress. Photo / Getty Images
Patients must be given access to the data 'across specialties', and yearly updates on progress. Photo / Getty Images

Patients may be able to check their surgeons' safety records before going under the knife under new reporting systems to be put in place within five years.

After inquiries by the Herald, health authorities have been put on notice to start publicly reporting patient death rates and other "outcomes" data of public hospital doctors or the units they work in by 2021.

Ombudsman Ron Paterson has told the Health Ministry patients must be given access to the data "across specialties" by then, and yearly updates on progress were required.

In Britain patients can look up the National Health Service website for these kinds of doctor ratings and in the United States the investigative website ProPublica has published a controversial Surgeon Scorecard comparing about 17,000 US doctors' individual complication rates in a variety of procedures.

Professor Paterson has today, on his last day as an Ombudsman before returning to his academic law career, issued his ruling on the Herald's December 2014 request for statistics from five district health boards on the heart and brain surgery complication rates of surgeons by name.

He credits the Herald's request for leading to "a greater level of commitment in the health sector with regard to the collection, analysis and publication of healthcare intervention outcomes data".

We asked for the data, adjusted by medical complexity of patients and other variables, to allow fair comparisons between surgeons. In case that wasn't available we also asked for the raw data.

In his 32-page report, Professor Paterson says the risk-adjusted data can't be released under the Official Information Act as it doesn't exist, but he notes some specialties, including cardiac surgery, are working to produce better data.

He agreed to the Auckland, Waikato, Capital and Coast, Canterbury and Southern DHBs withholding the raw data in part because the surgeons' high privacy interest is not outweighed by the public interest. All he is forcing the DHBs to release is the numbers and types of operations done by individual surgeons.

He accepted health agencies' arguments the existing data doesn't permit meaningful comparisons and its release could be harmful.

"The public reporting of data that is misleading, incomplete or otherwise of poor quality could erode public confidence in the health system. It might also undermine teamwork and result in surgeons seeking to avoid complex procedures."

But if the DHBs had produced the risk-adjusted data, "the exercise of weighing the surgeons' privacy interests against the public interest would be much more finely balanced".

The Health Quality and Safety Commission, spurred in part by the Herald's inquiries, said in March that it favours public reporting of carefully chosen, properly risk-adjusted data on healthcare intervention outcomes at the "team, unit or organisational level".

"We discourage reporting at an individual level, as it is likely to be statistically unsound and counterproductive by undermining the teamwork we wish to encourage. Unit-level data would provide the necessary reassurance to the public and contribute to improvement in quality of our healthcare services."

Professor Paterson says the arguments against naming doctors - such as the annual number of cases per surgeon being too small to produce meaningful statistics - were weaker than some suggest.

"In jurisdictions and specialties where data collection and analysis is more advanced, such as cardiothoracic surgery in the UK, it has been accepted by the profession itself that there is good reason to publish information at the level of individual practitioner.

"Such information is readily available on the NHS Choices website.

"New Zealand lags behind other comparable healthcare systems in disclosure of performance and outcomes information.

"Professionalism in a 21st-century doctor should include a commitment to the collection and publication of meaningful outcomes data."

ProPublica editor-in-chief Stephen Engelberg said publishing risk-adjusted complications data helped patients to make more informed choices and hospitals to identify problem doctors and improve their work. "One hospital we looked at had several doctors who were not following best practices on infection prevention," he said.

"The problem was addressed and complication rates for those doctors declined."

I wish I'd known more, says patient

After a horrific experience, suffering severe internal burns, one woman admits she now distrusts surgeons.

Jo Partridge, here with husband Scott, suffered horrific burns in surgery.
Jo Partridge, here with husband Scott, suffered horrific burns in surgery.


And she backs anything that could have helped her - or may help future patients.

In 2012, West Coast mother-of-two Jo Partridge underwent a thermal ablation, an internal gynaecological procedure, during which she suffered horrific burns.

The burns occurred when an intrauterine balloon containing a near-boiling solution burst inside her four minutes into the procedure. The surgeon, at Grey Base Hospital, also suffered burns to his face.

Mrs Partridge said last night that she supported more disclosure on surgeons' safety records - but only if the information was accurate and included all of a surgeon's past procedures.

"People should be totally aware of what's going on because you're putting your life into their hands."

The surgeon who carried out Mrs Partridge's procedure has since moved overseas.

No one was held accountable for the incident, she said, and she hoped her experience would still be included in that surgeon's record.

Had she seen something like that appear on a surgeon's record, she would have made her decision accordingly, she said.

"If I had known, I wouldn't have gone to him."

- Vaimoana Tapaleao

- NZ Herald

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