New Insights on Big Data

Say hello to big data!

This week's The Economist discusses some of the implications of "big data."

Population Health Blog readers may recall the Facebook kerfuffle when it was revealed that the company had been "experimenting" on its users.  While this is another timely reminder that Facebook users are not customers but a product, what's far more interesting is how the company used its vast utilization data to monetize the changes of a hundredth of single percent in its users' behavior. 

These weenie changes can add up to additional ad revenue.  Ditto for the techy Google's search, Amazon's placements and Facebook's ads which, according to Schumpeter, are getting a return on investment from "every pixel" of the monitor screen you're using to read this blog.

Unfortunately, says The Economist, this big data approach has been more difficult for the for the traditional "bricks and mortar" businesses, which have traditionally been fixated on traditional accounting measures.  But, as these businesses tether their infrastructure increasingly to information technology, they're getting there: UPS is monitoring 60,000 delivery vans, retailers are assessing how in-store placements generate the most revenue and businesses are measuring how the mix of different types of employees relates to productivity.

The PHB would rate most health care providers as being in the bricks and mortar category than in the technology space.  They have a way to go.

Two lessons:

1) Big data doesn't replace traditional business monitoring of revenue and expense, balance sheets, averages and standard deviations, it adds to it.  And yes, that ceaseless tinkering adds cost that - in the right hands - should have a return on investment.

2) The "tinkering" has its share of failures in addition to successes.  While The Economist can point to some wins, the landscape is probably littered with losses.

Speaking of the right hands and minimizing losses from big data, the PHB is proud to link this article appearing in the NACD Directorship Magazine.  While a password is necessary, the bottom line is that corporate boards can do ten things to help their companies successfully achieve a big data return on investment:

1. Provide analytic leeway;

2. Be clear on who is responsible;

3. Set realistic budgets;

4. Assess how big data is fitting into the pre-existing culture;

5. Be skeptical;

6. Link it to Enterprise Risk Management;

7. Task the Audit Committee with some oversight;

8. Assure privacy;

9. Reduce inappropriate incentives;

10. Get a big data expert on the Board.

Image from Wikipedia

Social Media: Does It Really Change Patient Behavior?

Thanks to the technologic allure of iPhones replacing stethoscopes, apps substituting for doctors and electronic information substituting for having to actually talk to patients, the thoroughly modern Disease Management Care Blog is all about medical-social media. 

Think Facebook for the flu.  Twitter for tinnitus. Egads, listen to the typical consultant, pundit or futurist and it's easy to believe that we're on the verge of a silicon-based health care revolution

But then reality intrudes and some skeptic somewhere always asks about the bang for the buck, the juice for the squeeze, the return for the investment. It's a good question.

For something of an answer, consider the results appearing in a recently published randomized clinical trial.  The actual condition in question is going unmentioned for now, so that the DMCB can better focus on the issue of patient engagement

Over a 4 month period, "at risk persons" were recruited for a clinical research trial with on-line ads (Facebook banners, Craigslist, for example) as well as announcements in community settings and venues.  Once persons met the usual inclusion criteria and had a unique Facebook account, they were randomly assigned to one of two treatment arms.

One treatment arm used a closed Facebook group to coach persons about their at risk condition.  The other treatment arm similarly used Facebook to coach persons about general health improvement.  Lay "Peer Leaders," who were given a three hour training session on "epidemiology of the condition or general health subjects and ways of using Facebook to discuss health and stigmatizing topics," were assigned to lead the groups.

Peer Leaders attempted to reach out to their assigned group persons with messaging, chats and wall posts.  Once the link was established, the relationship in the intervention group included communication about prevention and treatment of the condition. At the end of 1, 2 and three months of the study, participants completed a variety of surveys.

Results?

57 individuals were in the control general health group and 55 were in the condition coaching group.  According to the surveys, intervention patients were ultimately statistically significantly more likely to agree to condition testing (44%) than the control patients (20%).  Because there were few participants, the modest decrease in actual tests or risk behaviors were not statistically meaningful.

The DMCB's take:

While this was a small study, this is the first time that the DMCB has seen reasonable proof that social media by itself can move the behavior needle.  On the other hand, this did not result in a patient engagement stampede toward better care or hard clinical outcomes.  A majority of participants (56%) did not appear to benefit.  Nonetheless, the results do support the inclusion of Facebook-style closed group social media in the suite of population health management services.

That being said, the condition at risk was HIV and study population was men who have sex with men ("MSMs").  It doesn't necessarily follow that what would work in this community of persons would necessarily be transferrable to other conditions, such as diabetes.  The DMCB doesn't think that's really true and finds it credible that 112 persons with diabetes or hypertension would probably achieve the same kind of results (A1c testing or home blood pressure monitoring) in a similarly tailored Facebook closed group.

Here's the study.

Let the research continue!