Big Brother is watching. Just as in George Orwell's futuristic novel "1984," the advent of big data has brought with it the ability for organizations to track our every move.
Smartphone applications track your children's habits when they are playing games on their devices. Government crooks such as those managing the Internal Revenue Service are able to tap into your private conversations and business dealings and create a special tax code for "non conformists" and those who disagree with the current administration.
Your GPS navigation system can track your location and analyse your travel habits. Internet search engines compile profiles of your search history and display advertisements based on your determined interests. Now, physicians are being tracked and rewarded (or penalized) based on their net cost to hospital systems.
Ultimately, patients, and our healthcare system in general, will suffer. Linking economics too closely with the physicians providing patient care may be similar to allowing "church and state" to dance to closely on Capitol Hill. As physicians, we are trained to work hard and to make decisions that are in the best interest of our patients. Hospital administrators, CEOs and "bean counters" are trained to do what is in the best interest of the hospital system and ultimately their own pocketbooks.
This weekend in the "Wall Street Journal," author Anna Mathews discusses the issues surrounding "Big Data" and healthcare systems. In a California healthcare system, physicians are tracked through the use of massive data collection systems. Their cost to the system is analyzed as well as their patient outcomes. The Electronic Medical Record (EMR) mandate has now begun to allow hospital systems to better track physician behavior and clinical habits. EMR databases can be easily queried and the data "mined" for easy analysis.
In this particular California-based system, Big Brother is now watching every time you order a CBC, a chest X-ray or a CAT scan. If those who administrate the system and evaluate cost do not agree with your clinical decision, you may be penalized. The most frightening thing about the entire story is that it is unclear who sets the standards and exactly what data these standards are derived from.
This article has left me with more questions than answers. Just as referenced in the Wall Street Journal piece, many physicians are angry and feel as though they cannot practice medicine any longer but must learn to follow a checklist and move carefully through disease specific and symptom specific algorithms.
What's the fallout of big data and how will it impact patients? Are physicians no longer treating patients and practicing medicine? Or are administrators and data analysts now going to mandate how medicine is practiced? What happens to the ART of medicine and gut instinct?
As I contemplate these questions, I am feeling a bit depressed. The future of medicine is not as I imagined it when I was in training. Here are my thoughts on some of these questions:
These types of practices may very well end the need for lengthy residency and fellowship training.
Rather than learn how to make decisions and respond to clinical scenarios at 3 a.m., physicians in training may be better served learning how to read flowcharts and algorithms and negotiate with hospital executives.
I worry that many physicians will not want to treat the elderly, sicker patients with multiple medical problems as these patients often have poorer outcomes and may bring down an individual physician's performance rating. Unfortunately, these patients are the ones who often need the most help–these patients benefit from a doctor who understands complex illnesses and treats them with instinct and compassion.
I am frightened by the prospect of having my clinical decision-making and practice habits evaluated by an MBA executive for a healthcare system with absolutely no clinical training and no medical degree. I am afraid that with government mandates, greedy healthcare systems and administrators with egos as large as oceans, we are in for a dark period in medicine.
In medical school and residency we are taught to think critically about patients and their problems. In the future we will be taught to think carefully about our clinical decisions because Big Brother is watching.