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The Relationship Between “Big Data” and Health Care – Value or Rubbish?

Author: Alan Fleischman, MBA      E-mail: a.fleischman@verizon.net

A blog (pathcareblog.com) entitled Why Big Data for Healthcare is Rubbish

http://pathcareblog.com/why-big-data-for-healthcare-is-rubbish/?goback=%2Eanb_1839273_*2_*1_*1_*1_*1_*1 takes direct aim at a recent report by the McKinsey Global Institute (Big Data: The Next Frontier for Innovation, Competition, and Productivity) http://www.mckinsey.com/insights/mgi/research/technology_and_innovation/big_data_the_next_frontier_for_innovation that projects substantial quantitative and qualitative benefits from implementing Big Data initiatives in health care.  Pathcare essentially states that McKinsey and Big Data ignore the two major stakeholders in healthcare – doctors and patients: “The study does not cite a single interview with a primary care physician or even a CEO of a healthcare organization that might support or validate their theories about big data value for healthcare. This is shoddy research, no matter how well packaged.” http://pathcareblog.com/why-big-data-for-healthcare-is-rubbish/?goback=%2Eanb_1839273_*2_*1_*1_*1_*1_*1

An article in Businessweek (The Health-Care Industry Turns to Big Data by Jordan Robertson, May 17, 2012) http://www.businessweek.com/articles/2012-05-17/the-health-care-industry-turns-to-big-data quotes benefits experienced by New York-Presbyterian Hospital from several data initiatives – including reducing “the rate of potentially fatal blood clots by about a third”, according to surgeon Nicholas Morrissey.  Morrisey is also working to develop a big data driven system to assess risk factors on new patients in the emergency room and the admission wards.  Along with hospitals, NSF and NIH have launched an initiative on Big Data to accelerate progress in biomedical research.

This article will not attempt to defend the research methodology utilized by McKinsey or the magnitude of the benefits projected, but it will defend the premise that medicine must improve its processes and procedures. Information systems are essential to this improvement and large amounts of data will need to be exchanged, integrated, and analyzed as a result. Evidence based medicine, effectiveness research, and performance assessments require the analysis of large amounts of data.  Like it or not, medicine is an industry with massive amounts of data, whether it is clinical, administrative, performance, or business.  Medicine can no longer function as a guild where senior craftsmen dispense tricks of the trade to apprentices and society grins and bears the results in terms of lives impacted and national treasure dispensed.  What is truly alarming to this author is the fact that healthcare has been so slow to adopt methods that have been proven effective in other industries – even low-tech methods.  This may explain the positive reception given to the use of simple checklists that have been advocated by the Institute for Healthcare Improvement and A. Gawandi in his book The Checklist Manifesto. http://gawande.com/the-checklist-manifesto  Checklists have been used in the airline industry since its inception.  Other industries have already demonstrated the benefits of Big Data over a substantial time frame – including finance, transportation, manufacturing, and retail. To be sure, I do not believe that Big Data is a cure-all for what ails medicine, nor do I believe that McKinsey advocated that viewpoint in its study.  However, it is one component on the road to improving a chaotic system.

The eye opening report by the Institute of Medicine on Medical Errors (To Err is Human: Building a Safer Health System, November 1999) http://www.iom.edu/~/media/Files/Report%20Files/1999/To-Err-is-Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf

estimated that as many as 98000 people die in hospitals each year as a result of preventable medical errors.  The costs in addition to loss of life are estimated to range from $17 billion to $29 billion each year.  One of the major conclusions from the Institute’s study was that faulty systems, processes, or conditions lead people to make mistakes or fail to prevent them.  The report clearly stated a need to address medicine from a systems perspective to decrease the alarming rate of medical errors.  A number of prominent physicians and healthcare organizations have advocated other approaches to improve the provision of healthcare – including changes to the basic organization of how primary care is dispensed (ACO, PCMH),  http://www.pcpcc.net/guide/better_to_best how hospitals fit into the provision of care, and how information systems can be utilized to improve both safety/quality and productivity /effectiveness.

Due to the impact of healthcare costs on our society and the slow rate of change in the industry, government policy makers have also been forced to take a more active role.  Thomas Lee and James Mongan of Partners HealthCare System in their book Chaos and Organization in Health Care http://mitpress.mit.edu/catalog/item/default.asp?ttype=2&tid=11875 strongly advocate for this role and the importance of improving the healthcare information infrastructure.    In 2009 Congress passed the HITECH Act http://www.pwwemslaw.com/content.aspx?id=540 providing nearly $30 billion to address barrier to health IT adoption, $14.6 billion of which went to encourage adoption of electronic medical records.  Other funds were focused on developing Health Information Exchanges (HIE)  http://searchhealthit.techtarget.com/definition/Health-information-exchange-HIE toward the goal of making patient information available across all care delivery settings.  Bitton, Flier, and Jha (Health Information Technology in the Era of Care Delivery, To What End? JAMA,June 27,2012 – Vol 307,No. 24, P2593)

http://jama.jamanetwork.com/article.aspx?articleid=1199162 argue that the debate over whether health information and technology will save money and improve care is anachronistic.  They state flatly that information technology will be used in health care.  “Health IT is inevitable.  The question now is how best to do it”.