The commons refers to resources that are collectively owned. There are two tragedies that may befall a commons: The Tragedy of the Commons and The Tragedy of the Anticommons. Paraphrasing Michael Heller (Gridlock Economy): the tragedy of the commons is when too many people share a single resource, we tend to overuse it; and the tragedy of the anticommons is when too many people own a single resource, and anyone can block the use. Modifying this for healthcare, the tragedy of the healthcare anticommons is that too many people own portions of a patient’s health information (HI), and anyone at anytime can block a full rendering of the patient’s HI.
A patient’s HI might be charcterized by those that have an interest in the HI, including the patient. This interest extends beyond the mere information itself and its transactional value—to a property interest, or ownership. We’ve created a whole host of terms for the access, control, and ownership of health information: personal health record (PHR), electronic medical record (EMR), and electronic health record (EHR) to name the most common terms. Here EHR is broadly construed to include those directly involved in patient care (e.g., hospitals and nurses) and indirectly involved or third–parties (e.g., insurers or coders).
If a full rendering of a patient’s HI might be considered a unique resource, then an anticommons effects exists where any entity maintaining an interest in the patient’s HI fails to participate in a common real–time sharing of the patient’s HI.
Health Information Fragmentation by Interests (Anticommons)
A partial HI commons is created where participating interests create a common storage of HI available to all (authorized) at anytime. Health Information Exchanges (HIE) are a form of commons. Participation in this form of commons has two requirements (or barriers): a willingness to participate and the capability (interoperability) to participate.
Creating a Health Information Commons
The barriers that distinguish the commons from the anticommons might be eliminated where HI storage is a function of the commons and not of the participants. A change in storage positioning (perceptual ownership) creates full participation of all interests, full real–time rendering of applicable HI, and no need for interoperability or HIE (eliminated by design).
Building a Health Information Commons
If we create an HI commons (and by extension a commons of commons), all interests may be addressed and all participant experience a full informational rendering. Who benefits? We all do!
Experiencing a Health Information Commons
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