There Is No Holy Grail, Simply Modest Chalices
Tuesday, September 23, 2003
As I noted inwards a weblog post service last year, an surface area that consumes tremendous unloose energy is the search for the Holy Grail of conclusion back upwards products that would mine wellness aid “big data.” People are looking for the algorithms that could assistance doctors—in existent time—analyze the status of patients together with seat inwards house to a greater extent than efficient together with efficacious diagnostic regimes together with handling modalities. I explained inwards that weblog post service why these efforts volition fail. Let me summarize:
1 -- The information that is collected is non reliable plenty to pull connections betwixt patient characteristics, clinical decisions together with outcomes. It is non reliable for 2 reasons. First, it is only non reliable. Much information that is collected and/or coded inwards hospitals together with physician practices is done together with hence poorly, or inwards a format that is non clinically accurate. Second, it is probable to live characterized yesteryear such broad touchstone deviations equally to acquire inwards unsuitable for predictive purposes.
2 -- It is unlikely that the algorithms that are designed to create run rules volition live trusted yesteryear doctors. In part, this is due to the touchstone divergence job noted above. That is, the models volition non live sufficiently rigorous inwards their predictive capacity. Maybe to a greater extent than important, at that spot is a full general lack of trust on the business office of doctors with regard to using formulaic approaches inwards their practices. While doctors are the victims of many kinds of cognitive errors—diagnostic anchoring, confirmation bias, together with the like--they are ofttimes non trained to reverberate on together with pick out grip of these biases. They are trained instead to trust their ain judgment together with convey personal responsibleness for their patients. It would live but a little minority of doctors who would live able to overcome those biases together with that grooming to job big-data-driven conclusion back upwards tools—even if such tools were able to overcome the statistical difficulties mentioned above.
iii – The procedure for selling such systems into the infirmary marketplace is complex together with almost infinitely slow. The sales wheel volition kill off all but the most highly capitalized firms. Even first-class products volition ofttimes wither together with boot the bucket on the vine.
Does this propose that at that spot is no potential for disruptive technologies that tin improve wellness aid delivery at a reduced cost? No, but it suggests that at that spot is non a Holy Grail, but rather a grouping of smaller, potentially jewel-encrusted, chalices. Targeted invention is the agency to go. Think small, intend focused, together with intend close how to ambit quick results that do goodness the doctor, the patient, together with the hospital.
Wait, did I exactly seat the Dr. start on that list? The Ptolemeic wellness aid organisation has the Dr. at the centre of the solar system, together with it volition live that agency for a long fourth dimension to come. Unless your production helps the Dr. experience that they are doing a amend labor together with tin correspond into their run flow, it’s non worth pursuing.
The applied scientific discipline together with the reports produced yesteryear this approach do non substitute for the judgment of the neurologist. Rather that judgment—previously based on trial together with error--is enhanced yesteryear a real-time, patient specific experiment. The procedure tin live repeated equally ofttimes equally the Dr. deems necessary--more ofttimes for a patient suffering a rapid deterioration from the disease, together with less ofttimes for a to a greater extent than stable patient.
The device is non bought yesteryear the hospital, together with and hence it bypasses the highly competitive uppercase budgeting process. Rather, the production is provided equally business office of a service offering, the attempt final result that is provided to the doctor. The fee for each written report is good inside the normal operating budget of the neurology department, requiring no exceptional allotment of funds. In short, credence only requires a conclusion yesteryear the doctors themselves.
I offering this equally a perfect representative of a jeweled chalice. Simple hardware together with software technologies; easily incorporated into the doctors' workflow; enhancing their mightiness to exercise professional person judgment; together with offered inwards a sales procedure that does non do contest alongside infirmary factions together with is consistent with normal budget processes. It is yesteryear this path that applied scientific discipline tin disrupt wellness care—one carefully designed measure at a time.