Big Data Consequences
Sunday, August 18, 2013 at 10:58AM Health Informatics and Data Analytics are burgeoning fields following on the footsteps of ehealth efforts. Big Data is now touted as the solution to solving health care costs by mining for numbers and patterns. Some influential people believe that the "Watsonization" of health care is also at hand whereby computers will diagnose the disease or advise on next steps.
I can't help think of how the car industry has evolved from mechanics to computer identification as to why the dashboard is flashing various lights....problem is that patients aren't cars or widgets with replaceable mother boards. They are a complex combination of emotional, psychological, physiological matter held together with bones and flesh. And our brains...way more than grey and white matter with some synapsing neurons and a few sulci.
As always the devil is in the details and at a time when clear communication and positive relationships are acknowledged as key to patient well being and patient satisfaction, efforts are in full swing to mine for data from health records or any other data that various networks and health systems can get their hands on.
Whether it is analysis of care coordination, readmissions or even medication compliance we should acknowledge upfront that numbers don't tell the whole story. Human behaviour is as complex as our physiology and when we combine the complexity of providers with the complexity of patients and the complexity of our environments we have something that even Big Data cannot fully elucidate.
For providers it means a system of payment more focused on generating data that can be tied to funding either positive or more likely negative as economies fail to grow.
As provider funding is tied to data and generating patient indices or outcomes deemed "positive", expect a greater attempt by providers to choose more optimum practice locations or select patient populations. The law of unintended consequences will be in full swing.
When governments tie financial incentives to patient selection for various kinds of care including the murky "end of life care", we can expect Liverpool Care Pathway type events to occur.
Providers incented to select patients for end of life pathways and hospitals provided with funding to deny patients care is not a recipe for trust.
Who will the patient trust to give them medical advice on their care when the physician or nurse or other is conflicted in their attempt to preserve the system or limit care?
How do we ration based on evidence or quality or value when there are so many unknowns?
When do we determine that a patient should have an "end of life discussion"?
Why does any decision-maker in health care believe that Big Data can take the place of the relationships that humans seem to need so deeply?
When will the public and patients come to the realization of the risks inherent in the sharing of their personal data for government rationing efforts?
What does Big Data do to caring and compassion?
None of this is to say that evidence isn't important in creating understanding of medical science. Neither is it to say that we don't need statistics and facts.
It's just to say that as we create more complexity and try to comfort ourselves in data, we are mixing a recipe for more costs and not better outcomes either in patient satisfaction or in eventual quality of life.
As always, I'm grateful for your insights!
Reader Comments (339)
Big data will identify precisely the "big consumers" who then will targeted to use the system better. Problem is the the big consumers, will continue to be big consumers. The data is will know a very small percent of the population consumes the resources. The more precise we can make diagnoses on rarer conditions, the more cost will rise. that's why the push for end of life care. More committees to be struck to "ethically" cut off care, based on cost.
Everyone must participate in a closed system. Taxes are collected, committees are struck of funded providers on how best to ration the tax monies they control, by establishing the cutoffs that will be established to initiate end of life care. The ultimate acknowledgement, the state has won.
Well, that's the issue isn't it because as we spend more to co-ordinate care for these people they will still cost more.
As for the state having " won" , don't think so. The state will ultimately be stuck between the pitchfork carrying public and the harsh realities of a stagnant economy.
Well, that's the issue isn't it because as we spend more to co-ordinate care for these people they will still cost more. - R
Absolutely. The big consumers will continue to be big consumers, and there are more being created as we treat more and more previously untreated conditions, with high costs. Cataracts, hip replacements, etc were just the beginning.
Taxes will go up. More committees will be struck to find efficiency. Still waiting the Supreme Court decision - can providers cut off care to speed up end of life issues, to save money?
One hears the OMA committee on death got lots of activist applicants to help make the process more efficient.
The perfect monopoly. All must receive health care from the single system, all care provided by tax resources distributed by providers/managers paid by the system, as services get rationed no way to buy them, as rationing accelerates, end of life care must be reviewed to help you out the monopoly.
The state has won, comrades.
http://www.nytimes.com/2013/08/18/sunday-review/is-big-data-an-economic-big-dud.html?pagewanted=all&_r=0
The strange thing is that futile care only be identified as "futile" after the patient dies.
I have no crystal ball do you?
But then again, with the push from some provinces for euthanasia perhaps there will be a predetermined death time- an expiry date of sorts. A rather horrific thought in my opinion. This is NOT the way forward.
" Watsonization" of health care already occurs in science fiction where futurists anticipate patients stepping in some kind of contraption that would diagnose and cure in an instant....our central planners see too many science fiction movies ( I don't think that they can read).
To the paragraph starting with "Whether it is the analysis of care coordination, readmissions and even medication compliance...." should be added the medication itself...is it the actual medication, or is it a ba$tardization of the original product with unknowable contents and properties....as the Chinese state Zoos reveal a lion may look like a lion until it barks.
We can almost predict how this is going to roll out:
■ OMA activist fueled panel leads government down an aggressive path
■ Early adoption and success leads to some small gains
■ Sensing an opportunity to expand early success, government links financial incentives to continued adoption
■ Cracks in process begin - cases of inappropriate patient selection and/or hyper-aggressive selection occur
■ Local media publicize these cases and make link to incentivization
■ Cases are brought forward to Question Period in the Legislature
■ For next events see "eHealth" or "ORNGE"
For goodness sake, it they decide to name the new care pathway after a community, make sure that it isn't the one in which you live!
http://www.theatlantic.com/health/archive/2013/06/the-drawbacks-of-data-driven-medicine/276558/?goback=.gde_35222_member_247437774&&utm_source=twitter&utm_content=1069852
It's predictable.
Quebec physician association appears to be pushing hard for euthanasia. Does it have anything to do with their economic situation in Quebec.
People have been dying in the modern world for a very long time. Suddenly there is a push for euthanasia when a lagging economy coincides with aging pop'n and inability for public hc monopoly to fund it. No coincidence.
But one of Ontario's solutions is to pump up immigration of healthy young who will pay taxes, but not draw on health care, thus allowing a slow , responsible, euthanasia policy to evolve. The big data solution = the under 40s put more in than they draw out, bring them in.
Read this and laugh.
http://www.pharmalive.com/op-ed-entering-golden-age-big-data
I don't think we are just "plies of carbon, nitrogen and oxygen".....what a materialist worldview. Bah.
"futile care" - Cost of therapy exceeds the economical payback the patient can provide. The beauty of the QALY system is that value of life to central has been determined. Only thing left is the politics.
I think there is important information in the link you shared...the only issue I have with it is the conclusion. There will not be a "Golden Age" of Genomics, just new understanding and more complexity that will require policy changes and new approaches. Overall, the funding problem will remain in that we have too much demand for too few resources. No Golden Age.
The "futile care" on the end of life folks will be stopped. Quebec will lead the national process.
The plan is good, and agreed on.
Identifying futile care is not easy. When the 80 yo with dementia falls and comes in to the ER and is found to have pneumonia, treating the pneumonia and injuries is not futile care if the patient survives. On the other had if the same patient succumbs to the pneumonia, the treatment could be labelled futile. It is difficult to know when a frail elderly person will rally with treatment or not. It just depends on a whole lot of things.
There are cases of frail elderly patients in hospital who are not doing well with pneumonia (Mandela for instance) and it is expected they will die. Heroic measures are not in consideration. The patient`s meds are all stopped. They recover and go home to have the whole process the next few months and on and on for years.
At what point do you not treat a patient who is functioning in the community with reasonable first steps in care for usual things....
Who is looking after patients as the interns are preoccupied by the hospital information services and the nurses are too busy with their box ticking on computers to look after them?
Quebec will lead the way....the primary euthenasia prototype study will focus on non pure laines....Anglos would do nicely.
Primo non nocere should be tattooed on their foreheads...but they are not...the imitators are always so supremely confident...one wonders if they would be so eager if we had a system where they are put against a wall and shot if their predicted goals were not met.
I still remember when my mother was called urgently in the middle of the night as her mother (my grandmother) was admitted to hospital at the age of 70 with a small MI. The resident wanted an immediate verbal DNR order and suggested the family come right away. When we arrived the 65 year old attending cardiologist apologized for the early morning call from the young resident who saw the white hair and assumed it was time to die at the age of seventy. The patient went on to live another 24 years in her own home on two medications and then died at the age of 96 in the nursing home.
Beware of the white hair reflex if you are attending a hospital in Ontario especially as the tax base shrinks further. There may actually be good reason to dye one's hair in order to avoid a futile care pathway designation by some young activist physician who has been inculcated in medical school that the role of physician is to help the state decide who is entitled to what resources.
This is not going to end well.
"August 18, on the cusp of its three-day meeting, the Canadian Medical Association (CMA) called on all levels of government to cooperate in creating a seniors’ strategy, citing the looming pressure ageing baby boomers will place on the health-care system.
“The anxiety Canadians have about health care in their so-called golden years is both real and well-founded,” Dr. Anna Reid, CMA president, said in a news release. “Let there be no doubt that a national strategy for seniors’ health care should be a federal priority.”"
http://www.cmaj.ca/site/earlyreleases/18aug13_Canada_needs_seniors_health_care_strategy_CMA_report_card.xhtml
Good advice.
One question, even though I understand the CMA is the medical lobby group at the federal level...why is it that the only solution that is voiced is to call for the federal government to fix things...
Those who do not "contribute" will be culled out, if they consume health care. Where possible, they will be discharge to home care, which is really just discharging to no care.
It will not be a physician, it will be a nurse navigator.
You are assuming that the public will accept the changes that are anticipated. I am willing to bet that a large proportion will not and will demand access to non-industrial care and will be willing to pay for it. Free is only acceptable when the quality is maintained above a certain threshold.
http://www.theglobeandmail.com/life/health-and-fitness/health/science-could-add-decades-to-the-average-human-lifespan/article13816506/
The public which can afford avoiding the end of life "rush" represents a very small group. Most can't afford to purchase health care of any sort, and will get shuffled out.
Most of the population that now consumed health care, can't afford its cost.
Time for Botox as well....one wonders if the botoxed will get a better rating when the end of life nurse practitioner walks through the ward carrying her i Pad, box ticking away.
Relatives should go to visit their loved ones with a make up artist, to rouge up the cheeks of those about to be assessed.
Best donate money , dated for a month ahead, uncashable if demised, to the hospital ( more than the end of life bonuses ) so that one can pass muster.
“Don't you see that the whole aim of Newspeak is to narrow the range of thought? In the end we shall make thought-crime literally impossible, because there will be no words in which to express it. Every concept that can ever be needed will be expressed by eactly one word, with its meaning rigidly defined and all its subsidiary meanings rubbed out and forgotten. . . . The process will still be continuing long after you and I are dead. Every year fewer and fewer words, and the range of consciousness always a little smaller. Even now, of course, there's no reason or excuse for commiting thought-crime. It's merely a question of self-discipline, reality-control. But in the end there won't be any need even for that. . . . Has it ever occcured to you, Winston, that by the year 2050, at the very latest, not a single human being will be alive who could understand such a conversation as we are having now?”
― George Orwell, 1984
As we redefine care, new words and action appear. "Care" will shortly disappear in that it has buried in it "concern for well-being". Processing time will replace care, time in to time out. How fast one can be processed in.
As health care became "free", it has become a service available from central we are entitled too because it is prepaid. Because it is prepaid, it has no service standard, you get what we want to do. That is the service.
Entirely possible. There is still a chance, however, that the Supremes may decide that this is a public policy issue and not a legal issue and punt it back to the Province - with a timeline and consultation requirements for action.
Then it becomes political and Ontarians are not Quebecers...Ontarians do not have the appetite for this discussion.
It should be a public policy decision and not a legal issue. It will be interesting.
Public policy. You are dying and will consume more resource than you can provide back, We agree for moral reasons, we support that regardless of cost. It is an acknowledged waste of resources but the moral value exceeds the economic value, and we support moral value,
or,
your economic value to society exceeds your economic value. We must terminate you because your carbon cost to the planet has too high a cost to others,
Tough issue, but it is here.
I'm having difficulty reconciling these two actions.
Prevent, Prevent, Prevent, then "time to die". Really?
When pigs fly, maybe...
The shorters will win.
One benefit off increased longevity is that more will qualify for the " end of life " bonuses.
This is not new...but as science changes to reveal more personalized differences, I have to ask exactly how the patient will ever be at the decision-making centre as costs control the gatekeeping which is determined by incomplete evidence.
Will the patient be given the option to choose the care that they are informed about with respect to evidence of benefit or not if they still want it?
Evidence-based care is great but we should acknowledge that it is incomplete and increasingly so as we identify more genetic differences that lead to disease.
The door is just being opened to genomics and the microbiome. We have a long way to go to understand fully. Until then, will the patient have a say in where they believe they are on the spectrum of evidence?
http://www.pharmalive.com/china-stymies-fda-inspection-plans-by-delaying-visas
Meanwhile in the UK:
http://www.pharmatimes.com/Article/13-08-20/UK_gives_prescribing_powers_to_physios_podiatrists.aspx
One reason ostensibly is because "At the moment every year thousands of people with diabetes have to endure unnecessary amputations as the specialist care that they need to ensure quick treatment is not in place", she noted.
Can this be true????
Good grief. Care in India or Chile would be better.
Thanks for keeping up to date with the desperation of other countries. It does make me wonder where we are headed....
The USA was our bolt hole for medical procedures if not available in Canada...under Obamacare where could our team treated diabetics go with their Peripheral vascular disease and near gangrenous toes if in the same situation as those in the British NHS who are getting their legs amputated.
Our system as mentioned before seems to follow the policies of the UK's NHS tweaked so as to be described as having been made "in Canada".
" ... amputations as the specialist care that they need to ensure quick treatment is not in place"
Diabetic disease, a chonic problem that is stated to require "specialists care", is acomodated by empowering physiotherapists (and others) to prescribe? Is this like passing out accordions to soldiers on the frontlines? Medical specialists trained for 9 years are replaced by this?
http://gagne.homedns.org/%7Etgagne/contrib/unskilled.html
as Charles Darwin (1871) sagely noted over a century ago, “ignorance more frequently begets confidence than does knowledge” (p. 3).
But physicians got bogged down in semantics, in lengthy discussions about the appropriate language to use to describe hastening death at the end of life, and deferred real debate to a later, unspecified date and another unspecified time.
In short, fear prevailed."
http://www.theglobeandmail.com/life/health-and-fitness/health/fears-prevailed-during-cma-policy-debate-on-euthanasia/article13910392/
One can free it of potential ethical, moral, racial, etc bias by stating the purpose. Central has determined better use of the available resources than prolonging your life.
Well said mfO.
The tortured attempt at the CMA to come up with the right words was likely an attempt to say just that without saying that.
The "Calgary end of life care pathway " didn't fly...I can'y imagine why.