As I write in a patient’s notes in clinic, with the end of my pen in my mouth, I fall into a reverie thinking of the fully paperless NHS, which Jeremy Hunt has promised by 2018. The urgency for the digital agenda is driven by the growth of the data underlying every aspect of healthcare. Big data is defined by the velocity, veracity, volume, variety and value of the data, and in the NHS, as in any health system, it’s never been bigger. More data and better data management will mean improved diagnosis, treatment and prediction of disease course, as well as increased efficiency.
The promises and the opportunities are even greater for advances in research. A perfect example is Google DeepMind Health, which was launched in February this year to bring the arsenal of cutting-edge artificial intelligence to the patient’s bedside. Whether UK Biobank and “-omics”, drug discovery pipelines, health apps or the mushrooming functionalities of medical devices, both doctors and patients around the world are beneficiaries of progress in big data.
Conversely, the effects of inadequate use of data and research at the point of care and lack of analytic skills can be catastrophic. The Keogh Review into underperforming NHS hospitals and the Francis Report after the mid-Staffordshire scandal emphasised the central role of research and data and the ability to analyse data in order to deliver excellent patient care. There is a huge cost of “not doing” when it comes to big data, measured by loss of efficiency, lack of adoption of scientific advances and reduced patient safety.
What are doctors doing and what should they be doing? Since the advent of evidence-based medicine in the early 1990s, doctors must ensure that they are up-to-date with the latest research to back their clinical decision-making. The Pubmed database houses all 26 million biomedical scientific publications to-date, with 1.24 million were added in 2015, highlighting the perilously steep challenge of applying this evidence for new treatments and new diagnoses in real-time.
Doctors increasingly have to monitor their own performance as well as the performance of others, whether in cardiac surgery or intensive care. The same is also true at the macro-level, whether in or across institutions. Therefore, there is a need for robust performance indicators, but perhaps more importantly, clinicians have to understand their own figures as well as those of others in order to improve the quality of care that is delivered. If targets are not met and the metrics are not understood, the healthcare regulators, such as the Care Quality Commission, will be after you.
Medicine and public health are about the monitoring of health and treatment of disease at individual and population levels and with every decade, the amount of available health-related information about an individual multiplies. Bedside observation data, examination findings, scans and blood tests have been joined by home monitoring devices, wearables and patient health records. So despite its glamour, big data can be a monkey on the back of clinicians in at least three ways: evidence, performance and monitoring.
Is today’s clinician ready for this brave new world? At the moment, selection panels for medical schools value chemistry, biology and extracurricular activities, but should they be picking tomorrow’s doctors far more on the basis of their quantitative and analytic skills, such as mathematics and computer science? In medical school, evidence-based medicine is well-taught but data science barely gets a mention, and this trend unfortunately continues into postgraduate medical education, which requires urgent attention. In academia, researchers will have to collaborate with departments of computer science and engineering as much as traditional medical specialties in order to develop technology to simplify evidence use, performance improvement and disease monitoring.
I return to writing the prescription for the patient in front of me. He asks whether I could write a note for his GP as the clinic letter can take a couple of weeks. Information technology in the NHS has not kept pace with the outside world, but that is partly because doctors are not empowered to drive the change. If the potential is to be realised and the challenges are to be surmounted for data in the NHS, then the current and future workforce in clinical and academic sectors needs new data skills for a new era.
- Technology and innovation: enablers but not saviours of the NHS - 8th January 2018
- Data, data everywhere, but are doctors ready? - 24th April 2016