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is data-driven healthcare a good idea?

by Laura McLay on June 22nd, 2013

I read an article skeptical of the benefits of data-driven medicine while preparing for the INFORMS Healthcare conference [Link]. The article correctly discusses the

A recent study at Johns Hopkins University indicated that hospital interns — physicians at perhaps their most formative stage of training — spend only about 12 percent of their time interacting with patients. By contrast, they spend 40 percent of their time — more than 3 times as much — interacting with hospital information systems. The flesh-and-blood patient is getting buried under gigabytes of data.

The article is a bit frustrating. It’s worthwhile to discuss both the benefits and costs associated with any medical intervention or healthcare policy. The author (Richard Gunderman) almost exclusively focuses on what doctors record in patient records. I agree that this potentially sounds problematic. However, doctors spending so much time recording patient data in medical records does not imply that data should not be recorded to be used later. There are often good ways and bad ways to do something. When someone chooses a bad way, maybe they should adopt a good way rather than abandon the game altogether. Maybe residents today need to learn the “optimal” amount/type of data to record for each patient? This is a new-ish issue, and there are probably some lessons to learn.

The main issue I have with the article is that Gunderman seems to get data confused with data-driven. Many healthcare policies are data-driven but don’t generate any (extra) data to implement. For example, women are no longer recommended to get an annual Pap smear to test for cervical cancer (the “Annual”). Recent changes in cervical cancer screenings are customized according to a patient’s sexual history and test results [Link]. The new recommendations are flexible enough that they maintain a high degree of sensitivity in detecting cancer/precancer while minimizing the number of actual tests performed. The new recommendations are data-driven in that they used large amounts of historical data to estimate the impact of a new testing policy, but no extra data needs to be collected for women for each medical examination. In fact, since women have fewer examinations, less data overall will be collected.

Other medical interventions can be data-driven but simple to implement. The first place winners of the 2012 INFORMS Doing Good with Good OR student paper competition — Jonathan Helm and Greggory Schell — explored a new data driven approach for monitoring chronic disease and for scheduling patient appointments according to lab results rather than according to a fixed schedule. They used a statistical approach to forecast when multivariate test results would no longer be classified as “normal.” The patients scheduled a visit when their was a higher chance that their disease had progressed, thus avoiding unnecessary appointments before then. Again, data is collected here, but no more than what was done before an improved patient scheduling approach was used.

The INFORMS Healthcare Conference will be an excellent place to discuss data-driven approaches to healthcare that offer great benefits with modest costs, and many of the proposed models would not add oodles of data to patient medical records when implemented. I’m looking forward to seeing talks that discuss in greater detail whether data-driven healthcare is a good idea.

 

 

1 Comment
  1. One possible reason for unnecessarily long time engagement of clinicians with the IT systems is their bad design. The interaction of clinicians with the IT systems is currently inefficient in many care delivery organizations. Being data-driven is good but without being user-driven (or activity-driven) IT design, it may even hurt.