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What are the advantages and pitfalls of using big data to inform clinical practice?
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Beware the Siren’s song
Big data is the Siren’s song that seduces the mariner physician to wreck one’s medical practice ship on the regulatory rocks surrounding the isle of big government. The allure of big data, collected by an army of compliant physicians from underinformed and inadequately consented patients to (hopefully) improve clinical outcomes across our heterogeneous population with the promise of an aggregate understanding of the cost-to-benefit ratio of specific interventions, has turned thousands of physician private practices into data-mining public practices beholden to government.
The distorted promise of “Meaningful Use,” offering reward promises and noncompliance punishment, has enlisted undercompensated physicians to gather patient data that will be used by all sorts of health care policy wonks to mandate certain therapies, obligate certain prescribed behaviors and justify disciplinary actions for noncompliance. Your electronic health records will be used against you.
And with the increasing regulatory authority of the “fourth branch of the federal government,” populated by nameless, faceless bureaucrats with their agency’s power to create regulations with the same enforcement strength of laws, including civil and criminal penalties on physicians who stray, the outlook for ophthalmologists enrolled in these programs is bleak, a consequence of voluntarily surrendering your medical autonomy and professional jurisprudence for the application of big data to demand certain inflexible clinical decision-making that could be simply handed over to IBM’s supercomputer Watson.
We have all taken the Hippocratic Oath upon graduation to uphold certain professional and ethical standards in advocating for the care and treatment of our patients. As big data becomes more infused into the conduct and policies of those who seek to control medical care, the government and compliant medical schools are now altering this oath to have new physicians swear allegiance to the state, to support the social programs of society, to responsibly comply with certain economic realities of medical care delivered across the population, as instructed by the man behind the curtain.
This big data is creating wonderful opportunities to help more individuals with proven therapies, when responsibly used. But the massive number of new jobs created in the medical-industrial-government complex that seeks to control access to health care (not medical care, but health care) provide little quality to direct medical care rendered by physicians at the point of service. The cost-to-benefit ratio of this distorted process exceeds multifold the cost of individual medical care provided by a caring community to the local citizens through the experience of a few well-trained, ethically driven and highly intelligent physicians. If the government controls the health care of the people, the government can control the people.
In the epic written by Homer nearly 3,000 years ago, brave King Odysseus plugged his sailor’s ears with beeswax to prevent their seduction from the dangerous but enticing Sirens; physicians need to resist the temptations of federal insurance morsels and regulatory agency threats, and not turn away from their oath to protect and advocate for the individual patient’s medical safety.
Jeffrey Liegner, MD, is from Eye Care Northwest, Sparta Township, New Jersey. Disclosure: Liegner reports no relevant financial disclosures. He reports his practice is exempt from electronic health records and Meaningful Use penalties as a HIPAA-exempt physician (that is, a non-covered entity, easily obtained). He reports he is the medical director of a community free clinic in which medical malpractice coverage is provided by the federal government.
Great potential in big data
Big data has the potential to give us insight that would otherwise be difficult to discern.
Amassing the data from many surgeons has both advantages and potential pitfalls. In the example of lens power calculation for cataract surgery, using the data from many surgeons poses the issue of each surgeon having a slightly different technique and biometers that may have different calibrations. But there is a large advantage: We can have access to a large volume of unusual cases. In addition, the differences between surgeons and machines tend to wash out with large volumes of data.
If we look at the lens calculation for an unusual eye with a very short axial length of just 19 mm, we know that it is difficult to accurately determine the IOL power. Even for a high-volume surgeon who does more than 1,000 cataract surgeries per year, just a couple of patients per year will have an axial length this short. How can this surgeon then draw conclusions with so few eyes in his database? The answer lies in crowd-sourcing data from hundreds or thousands of fellow surgeons in a big-data approach. This is what we are doing with www.IOLcalc.com, and we now have hundreds of eyes with an axial length of 19 mm or less and we can now draw definitive conclusions and hone the accuracy of our calculations.
My first step into big data was 20 years ago when one of my mentors, Anne Coleman, MD, PhD, showed me how to access and analyze the large Medicare database in order to study patterns and deliver better health care to large populations. We are now taking this to the next level with our lens power calculations to finally bring precise refractive outcomes to cataract surgery patients worldwide.
Uday Devgan, MD, is Healio.com/OSN Section Editor. Disclosure: Devgan reports he is a principal in www.IOLcalc.com and related companies.