Thursday, August 22, 2013

The Computer As Health Reform Tool
Man is a tool-using animal… without tools he is nothing.  With tools he is all.
Thomas Carlyle (1795-1881)

The computer is a tool.  With health reformers,  data has become a be-all and do-all measurement tool.  
When humans  have a tool, they  use it.  Health reformers  use it to dig up, generate, and spread data to measure health care performance. improve it, and to lower costs. 
Computer-generated data  are  part of tool-kit,  a set of computer applications – clinical algorithms,   evidence-based guidelines,  pay-for and parcel of  performance metrics,  cost trends– anything to advance the cause of reform by measuring it.  
With other human tools,  the sharp-edged human tongue reaching the masses, and social media,  reaching millions of individuals within those massive populations,  reformers use data to  transform and reform  the world of health care.
There are, however,  problems.

·        Data aren't  necessarily objective. You can shape your argument by selectively using data that favor your side.  As Mark Twain observed,  there are “Lies, damned lies, and statistics.”   Nevertheless, numbers and data have a strong persuasive power.  As Arthur Deming noted, “In God we trust, all others bring data.”  Lord Kelvin chimed in, “When you measure what you are speaking about, and express it in numbers, you know something about it; but when you cannot measure, when you cannot express it in numbers, your knowledge is of a meager and unsatisfactory kind.”  

·         Data  represent numbers collected in populations and may not apply to individuals, their genetic backgrounds,  variations and  choices.    Data are  a blunt tool.   Doctors distrust big data as an all-encompassing tool to judge them and what they do for patients.   Paul Cerrata says in this week’s Informationweek,In the final analysis, many physicians don't like big data being applied to their practice's quality and cost performance because it limits their options. In some circumstances, these limitations are dangerous because they impede a clinician's ability to provide good patient care by preventing him or her from ordering valuable tests that aren't on an officially recommended list.” 

·         Big data helps managers and payers learn about physicians  from afar,  not from what is  actually occurring on the ground in physicians’ offices,  in the minds and hearts  of physicians and patients, and in their billions of transactions.  Wikipedia defines Big Data as “The term for a collection of data sets so large and complex that it becomes difficult to process using on-hand database management tools or traditional data processing applications. The challenges include capture, curation, storage search, sharing, transfer, analysis, and visualization. The trend to larger data sets is due to the additional information derivable from analysis of a single large set of related data, as compared to separate smaller sets with the same total amount of data, allowing correlations to be found to "spot business trends, determine quality of research, prevent diseases,…”

Tweet: Big data is important as a health reform tool, but it has limits for judging physician performance and reasons for poor clinical outcomes.

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