I appreciate Jonathan Bush’s blog posts on creative disruption and creating a market for health information. These pieces talk about much-needed creativity in medical care in the United States.
He’s onto something, but I think there’s more. Patients need the opportunity to document their own health stories, and they should be helped by doctors, nurses, medical assistants, insurance companies and EHR vendors. When we have a chance to aggregate a patient’s data, we’ve seen interesting narratives evolve. In the same way that keeping a journal can show us things we would have missed otherwise, a health record that’s rich with data can do the same.
This comes at a time when big data is upon us whether we like it or not. On the upside, data will show us interesting trends, new connections and potential pathways for proper healing. Because of this, physicians and patients will increasingly need to be masters of data. And some of us will be more comfortable with that than others.
Take one of my patients as an example. He’s a retired engineer with diabetes, hypertension and atrial fibrillation, who routinely brings me an Excel spreadsheet with his blood pressure, sugars and INR (blood coagulation) readings. While I appreciate his attention to detail, his devices should actually load all of this information into his patient portal so he and I can track the numbers from there. In fact, perhaps an automated system within athenaNet alerts both of us to disturbing trends, or sends a congratulatory message for any improvements.
Now, let’s say the same patient starts forgetting to enter his data and needs an imaging study of his head due to worrisome changes in his memory. As I enter his findings in his electronic health record, a sub-routine running in the background could be adding up the necessary criteria for prior authorization of the appropriate scan. When I enter the study in his assessment and plan, the criteria are automatically forwarded to the insurance company to approve the scan and send an authorization to the patient, me and the radiology center.
Meanwhile, athenaNet scans all of my patients who have his cluster of symptoms and we discover that several of them are on the same three medications. And those patients not on those same three medications rarely report any change in memory. An alert is published to me and to the Food & Drug Administration’s adverse drug reporting system so the potential association can be further investigated.
Fortunately, my patient’s scan shows no significant findings and a change in medication allows him to feel like himself again. Once he is feeling better, my patient asks if he can join a group of similar patients for meetings at my office. At the meeting, we share data that shows 85% of all of the patients from our practice have their blood pressure adequately controlled. The patients in the room who don’t have their blood pressure under control can engage in a lively conversation with the group and everyone leaves feeling like their story is part of a larger, more successful narrative.
That’s the potential.
So, here’s to the era of big data!
Dr. Dudley is an athenahealth client in Denver.