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Big Data Means Doctors Have Nowhere to Hide, Bureaucrats Hope


One of the biggest problems with care delivery in our healthcare system is the huge variation in the quantity and quality of care provided by different doctors and hospitals. The WSJ reports on new efforts to use big data to cut costs and improve quality by standardizing care. Hospitals and healthcare providers across the country are using new software that tracks, compiles, and crunches all the numbers related to a doctor’s performance. The data allows higher-ups to compare doctors to each other and check to see that they are meeting generalized best practice standards:

Mojtaba Sabahi, who practices at Long Beach Memorial, was warned by a pharmacist that data showed one member of his group of inpatient-care physicians was using Levaquin, an antibiotic, at a far higher rate than peers. MemorialCare guidelines generally recommend limiting use of the drug, largely on concerns about generating drug-resistant bacteria.

Dr. Sabahi says he shared the result with his colleague, and the doctor was receptive. MemorialCare says physicians are often willing to change if they believe they aren’t performing as well as peers.

Later, Dr. Sabahi checked the data and confirmed his colleague had cut back on the drug. “It completely changes the way we practice,” he says

This method saved one health system over $13 million in 2011 alone, just by reducing the average cost per patient by $280 dollars. And as health systems grow more adapt at using this technology, and make more progress convincing doctors to listen to it, the savings and the quality improvement could both skyrocket.

There are lots of problems with these data gathering systems. Hospitals can and do game the system, figuring out what information will bring the most revenue from Medicare and health insurers. It is very hard to design a system that gathers information in enough detail to be useful that doesn’t bog health practitioners down in endless form filling. The American health care system is messy: hundreds of thousands of health care personnel engage with tens of millions of patients at various stages of senility, inebriation and debility. We are a long way from having data collection systems that can really capture the variety and complexity of the health system.

Even so, the transformative potential of big data technology for health care is one of the biggest medical stories of our time. When people think about ‘progress’ in health care, they often think about the discovery of exciting new treatments. But there is more to better health care than more and better drugs, or brighter and shinier machines. Learning how to deliver better health care at a lower cost is one of the most urgent research challenges we face.

For some, these kinds of information systems offer the hope of a centrally guided, centrally controlled health care system. Bureaucrats in Washington will crunch the numbers and regulate the national health care system based on the numbers. They think and hope that Big Data will empower Big Government, and that armed with the information about ‘best practices’ that they get from the data, they will be able to micro-manage what health care practitioners do. That would be a misuse of this technology and would be more likely to turn the health system into an even more nightmarish den of inefficiency and bureaucracy run amok than it already is.

The reforms our health care system needs most involve enhancing its flexibility and creativity through better responses to a more transparent pricing system. Bureaucrats may dream that supercomputers will give them the ability to run a national health system from Washington DC, but what’s really needed is a system in which self-interested professionals, institutions and patients are all using the data to make better decisions. The struggle to develop Big Data, analyze it effectively and use it appropriately is one of the most important health care and national policy stories around. We’ll be following it closely.

[Hospital technology image courtesy of Shutterstock]

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