“It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us, we were all going direct to Heaven, we were all going direct the other way… From A Tale of Two Cities, by Charles Dickens 1859
Big Data: Best of Times or Worst of Times?
This beginning line from the first installment of Dickens classic story of duality and dichotomy, set during the time of the French and American Revolutions, can be aptly applied to the contrasting perspectives on Big Data in Healthcare. Big Data has the potential to solve healthcare’s many woes such as crippling inefficiencies, poor if not dangerous quality levels of care, massive waste, and lack of real effectiveness; or perhaps Big Data is Big Brother, an ominous, creepy, privacy shattering, coldly calculating plot to erode human empathy and connection between caretaker and patient and force upon us “cookbook medicine”.
The Good vs. Evil debate accompanies virtually every advancement in technology; what concerns me more is the troubling appearance of disjointed understanding of what Big Data means, and how it can be harnessed for good in healthcare. Big Data has been the topic of many industry conferences this year, three of which I attended over the course of roughly six weeks:
|Big Data Healthcare Conference||Event Sponsor||City||Primary Attendee background||Primary View of Big Data|
|Strata Rx: Data Makes a Difference||O’Reilly||Boston, MA||Technology professionals, technology vendors||HadoopExternal non-healthcare dataModel Driven Medicine|
|Real World Evidence||EyeforPharma||Bethesda, MD||Pharmaceutical companies, Payers, large consulting firms||Observational study data, comparative effectiveness,Patient reported outcomes|
|Data Big and Small; What Healthcare Decision Makers are using Now||ECRI Institute||Washington, DC||Healthcare systems, Journal publishers, physicians, government||EHR data, other clinical data sources, government data|
While there certainly were some encouraging signs of overlap, and none of them were entirely monolithic audiences, mostly the conferences diverged into very different topics, understanding, and perspectives on the pathway to achieving Big Data’s value to healthcare through advanced analytics. They were like parallel universes, talking about the same problems and opportunities, but on a current trajectory unlikely to converge on a common course of action.
These conferences were small enough (less than 300-400 people each] for me to scan the horizon for familiar faces; to the best of my knowledge, only one other person besides myself attended all three conferences; he and I shared concern over the glaring disconnects between the conferences. A sample of the disconnect; at two of the three conferences, general awareness of Hadoop, one of the key Big Data technology enablers, was nearly universally missing for the vast majority of the attendees, while at the other conference it took center stage. How can that be possible when all three repeatedly used the phrase “Big Data”?
Healthcare is a Wicked Problem
Dr. Atul Gawande, a surgeon and staff writer at the New Yorker, captured the complexity of healthcare and the applicability of the wicked problem definition in his commentary published last year. In a nutshell, a wicked problem is defined by lack of common agreement on the problem and question itself, let alone any solutions.
In a time of vigorous and frequently acrimonious arguments over the policy directions of healthcare reform, the need and ability to improve decision-making through better use of data is perhaps the only topic that is generally uncontested, and can stand above partisan politics and economic theoretical debate.
We have the opportunity to seize the moment in advanced analytics in healthcare by bringing together all of the traditional system participants, most all of which were represented at these three conferences, around a common cause- the patient, and a common source of potential new solutions-data.
Given that neither this worthy goal (patient centered care) or new technology enabled solutions (advanced analytics and Big Data) remove healthcare from its wicked problem status, what can we expect? In the words of Dr. Gawande, “Solutions to wicked problems…..are only better or worse. Trade-offs are unavoidable. Unanticipated complications and benefits are both common.
Big Data Advanced Analytics will not solve all problems completely within the healthcare system at large; it will continue to carry with it risks and downsides that are unavoidable. Better value extraction from data may mean a trade-off in privacy protection, and privacy safeguards and legal or policy restrictions may limit what it technologically possible with software like Alpine’s. However, that does not mean we remain on the sidelines and wait for the perfect solution and balance to be sorted out.
Multi-Disciplined Teams Working Together can achieve the Promise of Advanced Analytics and Big Data in Healthcare
I’m optimistic that we can overcome this fragmentation challenge, and still achieve what all three conferences really emphasized; there is latent value in the data that can improve our ability to deliver better healthcare at lower costs. The best prediction for the promise of Big Data and Advanced Analytics in healthcare came from one of the conference speakers, who happened to be an MD, who I think summed up the promise of advanced analytics in healthcare very succinctly: “Correlation isn’t causation, but it sure helps.”
If we are to avoid letting Big Data and Advanced Analytics get mired down in the wickedness of traditional approaches to healthcare problem solving, in 2014 I’d like to see one Big Data event that attracts all of the different audiences by combining the best of all three of these otherwise excellent conferences. One event that brings policy, administrative, technical, research and clinical care experts together under one Big Data Tent, focused on healthcare problem solving.
At Alpine, we are committed to continuing to improve and enhance the collaborative, democratized, advanced analytics tool kit we’ve developed to enable the Big Data Tent in Healthcare to become a reality. We can do this!