Category Archives: data saving lives

Medicity: Entering a new era of population health

Payers are primary drivers toward PHM, and the Centers for Medicare & Medicaid Services is accelerating its timeline for shifting Medicare to a value-based system. By the end of 2016, at least 30 percent of fee-for-service Medicare payments will be tied to value through alternative payment models such as accountable care organizations or bundled payment arrangements. By the end of 2018, that will increase to 50 percent.

http://www.healthcareitnews.com/news/entering-new-era-population-health?single-page=true

Entering a new era of population health

We have reached an inflection point in the history of health IT

In the six years since it became law, the HITECH Act has done much to advance the use of health information technology. And although the process of collecting and sharing health data has not yet significantly impacted care costs or quality, it has laid an important foundation for us to move toward population health management.

[See also: Population health success depends on good data]

There are important discussions underway to determine what’s needed to leverage health data to improve clinicaloutcomes and lower costs, and to extend those benefits across entire patient populations. Intelligent tools for population health will enable improvements in care quality, clinical outcomes and care cost.

Working through issues around health data exchange and patient engagement indicate the next challenges. We must construct a platform that will enable innovation in population health and analytics to thrive.

[See also: Pop health analytics top ACO priority]

Federal entities responsible for overseeing health and the healthcare industry in general are advancing rapidly toward a vision of interoperability and data sharing.

Congress taking a look

Congress is taking both near- and long-term actions regarding health IT innovation and standards. Near-term examples include recently directing the Office of the National Coordinator to report progress around interoperability and data sharing, and asking the Government Accountability Office to report on health information exchanges.

Congress has also launched the “21st Century Cures” initiative to help laws keep pace with health innovation. Among other measures, this initiative would consolidate meaningful use, quality reporting and value-based payments into one program – potentially the most significant move related to population health by Congress to date.

Federal Health IT Strategic Plan and Interoperability Roadmap

This past December, the Department of Health and Human Services released the Federal Health IT Strategic Plan, a coordinated effort among more than 35 federal departments and agencies to advance the collection, sharing and use of electronic health information – the cornerstones of population health management.

The HHS plan’s data-sharing section references the ONC’s Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap Version 1.0, which was released at the end of January. The roadmap advances the ambitious goals to be reached by the end of 2017, including:

  • Establishing a coordinated governance framework and process for nationwide health IT interoperability;
  • Improving technical standards and implementation guidance for sharing and using a common clinical data set;
  • Enhancing incentives for sharing electronic health information according to common technical standards; and
  • Clarifying privacy and security requirements that enable interoperability.

In announcing the roadmap, HHS Secretary Sylvia Burwell called for “an interoperable health IT system where information can be collected, shared and used to improve health, facilitate research and inform clinical outcomes. This Roadmap explains what we can do over the next three years to get there.”

ONC Annual Meeting

At the February 2015 ONC Annual Meeting, titled “Interoperable Health IT for a Healthy Nation,” National Coordinator Karen DeSalvo, MD, told attendees that the agency’s focus is moving beyond meaningful use, toward interoperability and outcomes. This includes building out the IT infrastructure that will support health reform and enable better population health management.

A highlight of the ONC Annual Meeting was having all of the former national coordinators talk about the national state of health IT in the past, present and future.

David Brailer, MD, the nation’s first national coordinator, said the industry won’t be able to accomplish appropriate risk management, population health management or payment reform without interoperability. The ONC leaders shared a strong consensus that the intelligent use of technology will prevail in realizing population health goals.

Meaningful use is not dead

Despite the notion that it may be time to move beyond meaningful use, the program continues to drive electronic health record adoption, organizations have built incentive payments into their IT budgets and we continue to see program improvements.

At the time of this writing, proposed rules for Stage 3 meaningful user and 2015 Edition Standards and Certification Criteria were at the Office of Management and Budget for final review. The OMB announced of the proposed rules that “Stage 3 will focus on improving health care outcomes and further advance interoperability.”

Additional recent policy adjustments instituted or proposed include:

  • Simplifying satisfaction of the requirement for summary of care transmissions;
  • More realistic measures around the availability and actual viewing of patient information to satisfy patient engagement requirements; and
  • A potential new requirement to send electronic notification of significant patient health care events to patient care teams.

Measures such as these point to the importance of data sharing and enable achievable and meaningful progress toward population health management.

Payment models increasingly emphasize population health

Payers are primary drivers toward PHM, and the Centers for Medicare & Medicaid Services is accelerating its timeline for shifting Medicare to a value-based system. By the end of 2016, at least 30 percent of fee-for-service Medicare payments will be tied to value through alternative payment models such as accountable care organizations or bundled payment arrangements. By the end of 2018, that will increase to 50 percent.

As recently as 2011, Medicare made almost no payments through alternative payment models.

Among private payers, a group of major providers and insurers have formed the Health Care Transformation Task Force to shift 75 percent of operations to contracts designed to improve quality and lower costs by 2020. These very important public and private payer initiatives strongly underscore the need for critical health IT enablers of effective PHM.

Welcome to the new PHM era of health IT

We have reached an inflection point in the history of health IT, as we move beyond the HITECH era into this new era. We have come a long way in capturing health data, yet have only begun to share that data among providers, patients and payers. The opportunity ahead of us is to take major strides toward using that data to improve care and lower costs for the populace in general. We have been through an incredible decade of health IT. There is no sign of it slowing down.

Peter Hinssen: The Tiger and The Rock

EDxBrussels – Peter Hinssen – The TIGER & the ROCK

Why Extrapolating WON’T WORK & What it means for HEALTH http://www.tedxbrussels.eu About TEDx, x = independently organized event In the spirit of ideas worth…

http://wn.com/tedxbrussels_-_peter_hinssen_-_the_tiger_&_the_rock

8:20 – The Contiguous United States – macdonald’s proximity to people in the US

9:10 The Flip: Pharma moving to Health as a Service (no longer a product)

Institutions > Communities (trust)

Reactive > Proactive (attitude)

Hinssen_HealthMatrix

http://www.datapointed.net/visualizations/maps/distance-to-nearest-mcdonalds-sept-2010/

 

distance_to_mcdonalds_2010_l

Leeder: Exit from Medimuddle

 

http://www.australiandoctor.com.au/opinions/guest-editorial/hope-exists-beyond-the-government-s-medimuddle

Hope exists beyond the government’s Medimuddle

5 comments

Hope exists beyond the government’s Medimuddle

The start of a new year, in conjunction with the appointment of a new federal health minister, raises hope. An agenda of important health matters awaits her attention.

Incoming Health Minister Sussan Ley takes up her portfolio with strong professional experience in guiding education policy through community consultation in city and country. These skills should serve her well in the health portfolio.

Related News: 6 questions for the new health minister 

First, however, the ground must be cleared of the wreckage of the co-payment proposal.

Driven by ideology, uninformed by policy or accurate analysis of the health system, it was always going to be a debacle. In its latest manifestation, the co-payment plan, which will see doctors forego income, is festooned with a host of confusing exceptions.

It looks like a Scandinavian assemble-it-yourself gazebo built without instructions or an allen key.

But unfortunately it is no joke. Were it to quietly disappear, a sigh of relief would be heard across the land. However, it is proceeding amid a storm of justifiable anger from GPs.

Beyond this ‘Medimuddle’, there are actions of far greater substance needed to help secure the future of healthcare in Australia.

Related News: The new co-pay plan: full details

First, energy should be applied to clarifying for all the purpose of the health system and explaining how it has come to be. We need a narrative about why we invest public money in healthcare. We pay for Medicare to meet the needs of all Australians.

The equity thing — a ‘fair go’ — is an honoured Australian value. When it comes to healthcare, those who can pay more do so already. We recognise that much illness can strike anyone, and we seek to help those who get sick or injured. That’s the story of us, but we need to hear it retold quite often.

Chatter about the necessity for an additional price signal for healthcare, on top of the ones we have already, has never made sense.

We aim for a universally accessible system because as a society we care about the health of all our citizens. We care and value equity.

We are a remarkably altruistic community and we do not neglect those who need care simply because they are poor. We placed many wreaths recently because we care. This narrative needs to be clarified, corrected and repeated.

Second, because money does matter in health, waste should be rooted out. The principal areas of waste in healthcare are attributable to archaic management, most notably failure to apply IT where we can. Yes, we have done well in bringing the computer into the surgery and ward, and into pathology and radiology services. But there is so much more we can do to unite the fragments of healthcare by wiring them together.

Then there is the matter of lots of medical and hospital care provided in the face of evidence that it does no good or is unnecessary. The unnecessary parts should not be confused with humane care or time spent in doctor—patient communication, and in showing concern and compassion. That’s quite different.

Waste is not simply a matter of too much hi-tech machinery, but as was shown decades ago, the accumulated waste of doing and repeating far too many small-ticket investigations and prescribing little dollops of unnecessary medication (and this still includes unneeded antibiotics).

Waste is also to be found in the overpricing of generic pharmaceuticals where we continue to pay considerably more for many generics than is the case in, say, Canada.

To tackle this waste will require political skill in negotiating and implementing policy, because professional groups often become vigilant and aggressive custodians of the waste product and the income it generates.

Third, repair work is needed in general practice, especially where the co-payment train wreck blocks the tracks.

There is an urgent need to reduce red tape and improve quality of care in general practice, and to increase its availability in rural and regional Australia and on the edges of our cities.

Most economically advanced countries now recognise the critical importance of general practice in providing co-ordinated care and a medical home for the growing number of people with chronic health problems.

Damage to primary care harms both patients and the bottom line of the national health budget.

Health has many determinants — education, income, environment, diet, genes — and the healthcare system is complex. But these features are no excuse for the substitution of ideology and thought bubbles for a careful and steady approach to the changes needed to secure quality healthcare for all Australians.

Let 2015 be the year when health policy that enables this to occur reappears and is implemented.

Professor Leeder is an emeritus professor of public health and community medicine at the Menzies Centre for Health Policy in the University of Sydney.

Should we pay people to look after their health?

 

http://theconversation.com/should-we-pay-people-to-look-after-their-health-24012

Should we pay people to look after their health?

The key to using incentives may be to do so with a high enough frequency to create healthy habits. Health Gauge/Flickr, CC BY-SA

With the Tony Abbott government expressing concern about the growing health budget and emphasising personal responsibility, perhaps it’s time to consider some creative ways of curbing what Australia spends on ill health. One solution is to pay people to either get well or avoid becoming unwell in the first instance.

The United Kingdom is already doing this kind of thing with a current trial of giving mothers from disadvantaged suburbs A$340 worth of food vouchers for breastfeeding newborn babies. And from January 1 this year, employers in the United Statescan provide increasingly significant rewards to employees for having better health outcomes, as part of the Affordable Care Act.

But should people really be paid to make healthy choices? Shouldn’t they be motivated to improve their health on their own anyway?

Encouraging right decisions

People don’t do what’s in their best interest in the long term for many reasons. When making decisions we tend to take mental short cuts; we allow the desires and distractions of the moment get in the way of pursuing what’s best.

One such “irrationality” is our tendency to focus on the immediate benefits or costs of a situation while undervaluing future consequences. Known as present bias, this is evident every time you hit the snooze button instead of going for a morning jog.

Researchers have found effective incentive programs can offset present bias by providing rewards that make it more attractive to make the healthy choice in the present.

Research conducted in US workplaces, for instance, found people who were given US$750 to quit smoking were three times more successful than those who weren’t given any incentives. Even after the incentive was removed for six months, there was still a quit rate ratio of 2.6 between the incentive and control groups – 9.4% of the incentive group stayed cigarette-free versus only 3.6% of the control group.

A refined approach

Still, while research on using financial incentives to encourage healthy behaviours is promising, it isn’t as straightforward as doling out cash in exchange for good behaviour.

Standard economic theory posits that the higher the reward, the bigger the impact – but this is only one ingredient to success. Behavioural economics shows that when and how you distribute incentives can determine the success of the program.

Here are a few basic principles to consider. First, small rewards can have a big impact on behaviour if they’re provided frequently and soon after the healthy choice is made. We have found this to be true in the context of weight-loss programs, medication adherence, and even to quit the use of drugs such as cocaine.

Games of chance are an effective way of distributing rewards as research has found people tend to focus on the value of the reward rather than their chance of winning the prize. Many people think that a 0.0001 and a 0.0000001 chance of winning a prize are roughly equivalent even though in reality they are vastly different probabilities.

Finally, people are more influenced by the prospect of losses than by gains. Studies show people put much greater weight on losing something than gaining something of a similar value.

In one weight-loss experiment, for instance, participants were asked to place money into a deposit account. If they didn’t achieve their weight goals, the money would be forfeited, but if they were successful, the initial deposit would be doubled and theirs to keep.

Reluctant to lose their deposits, participants in the deposit group lost over three times more weight than the control group, who were simply weighed each month.

Creating good habits

Incentives are particularly effective at changing one-time behaviours, such as encouraging vaccination or attendance at health screenings. But with increasing rates of obesity and other lifestyle-related diseases, we need to focus on how incentives can be used to achieve habit formation and long-term sustained weight loss.

We know financial incentives can increase gym usage and positively impact weight, waist size and pulse rate, but how to sustain gym use after the incentive is removed? The key may be to use incentives to achieve a high frequency of attendance for long enough to create a healthy habit.

We also need to consider how we can leverage social incentives, such as peer support and recognition, together with new technologies to maximise the impact of incentive-based programs.

Innovative solutions, like paying people to encourage the right health choices, may help to reduce both the health and economic impact of Australia’s growing burden of disease.

Establishing markets in prevention and wellness – 3 examples

1. AIA Vitality Life Insurance

  • https://www.aiavitality.com.au/vmp-au/
  • Wendy Brown – University of Queensland wbrown@hms.uq.edu.au
  • Tracy Kolbe-Alexander – University of Queensland

2. Data Driven Healthcare Quality Markets

3. Abu Dhabi Health Authority – Weqaya

 

 

Vitality Institute Commission – Recommendation 3 http://thevitalityinstitute.org/commission/create-markets-for-health/

FT: Big data: are we making a big mistake?

A very good article on the ins and outs of big data.

http://www.ft.com/intl/cms/s/2/21a6e7d8-b479-11e3-a09a-00144feabdc0.html#axzz3AVZ1Wv00

March 28, 2014 11:38 am

Big data: are we making a big mistake?

Big data is a vague term for a massive phenomenon that has rapidly become an obsession with entrepreneurs, scientists, governments and the media
Illustration by Ed Nacional depicting big data©Ed Nacional

F

ive years ago, a team of researchers from Google announced a remarkable achievement in one of the world’s top scientific journals, Nature. Without needing the results of a single medical check-up, they were nevertheless able to track the spread of influenza across the US. What’s more, they could do it more quickly than the Centers for Disease Control and Prevention (CDC). Google’s tracking had only a day’s delay, compared with the week or more it took for the CDC to assemble a picture based on reports from doctors’ surgeries. Google was faster because it was tracking the outbreak by finding a correlation between what people searched for online and whether they had flu symptoms.

Not only was “Google Flu Trends” quick, accurate and cheap, it was theory-free. Google’s engineers didn’t bother to develop a hypothesis about what search terms – “flu symptoms” or “pharmacies near me” – might be correlated with the spread of the disease itself. The Google team just took their top 50 million search terms and let the algorithms do the work.

The success of Google Flu Trends became emblematic of the hot new trend in business, technology and science: “Big Data”. What, excited journalists asked, can science learn from Google?

As with so many buzzwords, “big data” is a vague term, often thrown around by people with something to sell. Some emphasise the sheer scale of the data sets that now exist – the Large Hadron Collider’s computers, for example, store 15 petabytes a year of data, equivalent to about 15,000 years’ worth of your favourite music.

But the “big data” that interests many companies is what we might call “found data”, the digital exhaust of web searches, credit card payments and mobiles pinging the nearest phone mast. Google Flu Trends was built on found data and it’s this sort of data that ­interests me here. Such data sets can be even bigger than the LHC data – Facebook’s is – but just as noteworthy is the fact that they are cheap to collect relative to their size, they are a messy collage of datapoints collected for disparate purposes and they can be updated in real time. As our communication, leisure and commerce have moved to the internet and the internet has moved into our phones, our cars and even our glasses, life can be recorded and quantified in a way that would have been hard to imagine just a decade ago.

Cheerleaders for big data have made four exciting claims, each one reflected in the success of Google Flu Trends: that data analysis produces uncannily accurate results; that every single data point can be captured, making old statistical sampling techniques obsolete; that it is passé to fret about what causes what, because statistical correlation tells us what we need to know; and that scientific or statistical models aren’t needed because, to quote “The End of Theory”, a provocative essay published in Wired in 2008, “with enough data, the numbers speak for themselves”.

Illustration by Ed Nacional depicting big data©Ed Nacional

Unfortunately, these four articles of faith are at best optimistic oversimplifications. At worst, according to David Spiegelhalter, Winton Professor of the Public Understanding of Risk at Cambridge university, they can be “complete bollocks. Absolute nonsense.”

Found data underpin the new internet economy as companies such as Google, Facebook and Amazon seek new ways to understand our lives through our data exhaust. Since Edward Snowden’s leaks about the scale and scope of US electronic surveillance it has become apparent that security services are just as fascinated with what they might learn from our data exhaust, too.

Consultants urge the data-naive to wise up to the potential of big data. A recent report from the McKinsey Global Institute reckoned that the US healthcare system could save $300bn a year – $1,000 per American – through better integration and analysis of the data produced by everything from clinical trials to health insurance transactions to smart running shoes.

But while big data promise much to scientists, entrepreneurs and governments, they are doomed to disappoint us if we ignore some very familiar statistical lessons.

“There are a lot of small data problems that occur in big data,” says Spiegelhalter. “They don’t disappear because you’ve got lots of the stuff. They get worse.”

. . .

Four years after the original Nature paper was published, Nature News had sad tidings to convey: the latest flu outbreak had claimed an unexpected victim: Google Flu Trends. After reliably providing a swift and accurate account of flu outbreaks for several winters, the theory-free, data-rich model had lost its nose for where flu was going. Google’s model pointed to a severe outbreak but when the slow-and-steady data from the CDC arrived, they showed that Google’s estimates of the spread of flu-like illnesses were overstated by almost a factor of two.

The problem was that Google did not know – could not begin to know – what linked the search terms with the spread of flu. Google’s engineers weren’t trying to figure out what caused what. They were merely finding statistical patterns in the data. They cared about ­correlation rather than causation. This is common in big data analysis. Figuring out what causes what is hard (impossible, some say). Figuring out what is correlated with what is much cheaper and easier. That is why, according to Viktor Mayer-Schönberger and Kenneth Cukier’s book, Big Data, “causality won’t be discarded, but it is being knocked off its pedestal as the primary fountain of meaning”.

But a theory-free analysis of mere correlations is inevitably fragile. If you have no idea what is behind a correlation, you have no idea what might cause that correlation to break down. One explanation of the Flu Trends failure is that the news was full of scary stories about flu in December 2012 and that these stories provoked internet searches by people who were healthy. Another possible explanation is that Google’s own search algorithm moved the goalposts when it began automatically suggesting diagnoses when people entered medical symptoms.

Illustration by Ed Nacional depicting big data©Ed Nacional

Google Flu Trends will bounce back, recalibrated with fresh data – and rightly so. There are many reasons to be excited about the broader opportunities offered to us by the ease with which we can gather and analyse vast data sets. But unless we learn the lessons of this episode, we will find ourselves repeating it.

Statisticians have spent the past 200 years figuring out what traps lie in wait when we try to understand the world through data. The data are bigger, faster and cheaper these days – but we must not pretend that the traps have all been made safe. They have not.

. . .

In 1936, the Republican Alfred Landon stood for election against President Franklin Delano Roosevelt. The respected magazine, The Literary Digest, shouldered the responsibility of forecasting the result. It conducted a postal opinion poll of astonishing ambition, with the aim of reaching 10 million people, a quarter of the electorate. The deluge of mailed-in replies can hardly be imagined but the Digest seemed to be relishing the scale of the task. In late August it reported, “Next week, the first answers from these ten million will begin the incoming tide of marked ballots, to be triple-checked, verified, five-times cross-classified and totalled.”

After tabulating an astonishing 2.4 million returns as they flowed in over two months, The Literary Digest announced its conclusions: Landon would win by a convincing 55 per cent to 41 per cent, with a few voters favouring a third candidate.

The election delivered a very different result: Roosevelt crushed Landon by 61 per cent to 37 per cent. To add to The Literary Digest’s agony, a far smaller survey conducted by the opinion poll pioneer George Gallup came much closer to the final vote, forecasting a comfortable victory for Roosevelt. Mr Gallup understood something that The Literary Digest did not. When it comes to data, size isn’t everything.

Opinion polls are based on samples of the voting population at large. This means that opinion pollsters need to deal with two issues: sample error and sample bias.

Sample error reflects the risk that, purely by chance, a randomly chosen sample of opinions does not reflect the true views of the population. The “margin of error” reported in opinion polls reflects this risk and the larger the sample, the smaller the margin of error. A thousand interviews is a large enough sample for many purposes and Mr Gallup is reported to have conducted 3,000 interviews.

But if 3,000 interviews were good, why weren’t 2.4 million far better? The answer is that sampling error has a far more dangerous friend: sampling bias. Sampling error is when a randomly chosen sample doesn’t reflect the underlying population purely by chance; sampling bias is when the sample isn’t randomly chosen at all. George Gallup took pains to find an unbiased sample because he knew that was far more important than finding a big one.

The Literary Digest, in its quest for a bigger data set, fumbled the question of a biased sample. It mailed out forms to people on a list it had compiled from automobile registrations and telephone directories – a sample that, at least in 1936, was disproportionately prosperous. To compound the problem, Landon supporters turned out to be more likely to mail back their answers. The combination of those two biases was enough to doom The Literary Digest’s poll. For each person George Gallup’s pollsters interviewed, The Literary Digest received 800 responses. All that gave them for their pains was a very precise estimate of the wrong answer.

The big data craze threatens to be The Literary Digest all over again. Because found data sets are so messy, it can be hard to figure out what biases lurk inside them – and because they are so large, some analysts seem to have decided the sampling problem isn’t worth worrying about. It is.

Professor Viktor Mayer-Schönberger of Oxford’s Internet Institute, co-author of Big Data, told me that his favoured definition of a big data set is one where “N = All” – where we no longer have to sample, but we have the entire background population. Returning officers do not estimate an election result with a representative tally: they count the votes – all the votes. And when “N = All” there is indeed no issue of sampling bias because the sample includes everyone.

But is “N = All” really a good description of most of the found data sets we are considering? Probably not. “I would challenge the notion that one could ever have all the data,” says Patrick Wolfe, a computer scientist and professor of statistics at University College London.

An example is Twitter. It is in principle possible to record and analyse every message on Twitter and use it to draw conclusions about the public mood. (In practice, most researchers use a subset of that vast “fire hose” of data.) But while we can look at all the tweets, Twitter users are not representative of the population as a whole. (According to the Pew Research Internet Project, in 2013, US-based Twitter users were disproportionately young, urban or suburban, and black.)

There must always be a question about who and what is missing, especially with a messy pile of found data. Kaiser Fung, a data analyst and author of Numbersense, warns against simply assuming we have everything that matters. “N = All is often an assumption rather than a fact about the data,” he says.

Consider Boston’s Street Bump smartphone app, which uses a phone’s accelerometer to detect potholes without the need for city workers to patrol the streets. As citizens of Boston download the app and drive around, their phones automatically notify City Hall of the need to repair the road surface. Solving the technical challenges involved has produced, rather beautifully, an informative data exhaust that addresses a problem in a way that would have been inconceivable a few years ago. The City of Boston proudly proclaims that the “data provides the City with real-time in­formation it uses to fix problems and plan long term investments.”

Yet what Street Bump really produces, left to its own devices, is a map of potholes that systematically favours young, affluent areas where more people own smartphones. Street Bump offers us “N = All” in the sense that every bump from every enabled phone can be recorded. That is not the same thing as recording every pothole. As Microsoft researcher Kate Crawford points out, found data contain systematic biases and it takes careful thought to spot and correct for those biases. Big data sets can seem comprehensive but the “N = All” is often a seductive illusion.

. . .

Who cares about causation or sampling bias, though, when there is money to be made? Corporations around the world must be salivating as they contemplate the uncanny success of the US discount department store Target, as famously reported by Charles Duhigg in The New York Times in 2012. Duhigg explained that Target has collected so much data on its customers, and is so skilled at analysing that data, that its insight into consumers can seem like magic.

Duhigg’s killer anecdote was of the man who stormed into a Target near Minneapolis and complained to the manager that the company was sending coupons for baby clothes and maternity wear to his teenage daughter. The manager apologised profusely and later called to apologise again – only to be told that the teenager was indeed pregnant. Her father hadn’t realised. Target, after analysing her purchases of unscented wipes and magnesium supplements, had.

Statistical sorcery? There is a more mundane explanation.

“There’s a huge false positive issue,” says Kaiser Fung, who has spent years developing similar approaches for retailers and advertisers. What Fung means is that we didn’t get to hear the countless stories about all the women who received coupons for babywear but who weren’t pregnant.

Illustration by Ed Nacional depicting big data©Ed Nacional

Hearing the anecdote, it’s easy to assume that Target’s algorithms are infallible – that everybody receiving coupons for onesies and wet wipes is pregnant. This is vanishingly unlikely. Indeed, it could be that pregnant women receive such offers merely because everybody on Target’s mailing list receives such offers. We should not buy the idea that Target employs mind-readers before considering how many misses attend each hit.

In Charles Duhigg’s account, Target mixes in random offers, such as coupons for wine glasses, because pregnant customers would feel spooked if they realised how intimately the company’s computers understood them.

Fung has another explanation: Target mixes up its offers not because it would be weird to send an all-baby coupon-book to a woman who was pregnant but because the company knows that many of those coupon books will be sent to women who aren’t pregnant after all.

None of this suggests that such data analysis is worthless: it may be highly profitable. Even a modest increase in the accuracy of targeted special offers would be a prize worth winning. But profitability should not be conflated with omniscience.

. . .

In 2005, John Ioannidis, an epidemiologist, published a research paper with the self-explanatory title, “Why Most Published Research Findings Are False”. The paper became famous as a provocative diagnosis of a serious issue. One of the key ideas behind Ioannidis’s work is what statisticians call the “multiple-comparisons problem”.

It is routine, when examining a pattern in data, to ask whether such a pattern might have emerged by chance. If it is unlikely that the observed pattern could have emerged at random, we call that pattern “statistically significant”.

The multiple-comparisons problem arises when a researcher looks at many possible patterns. Consider a randomised trial in which vitamins are given to some primary schoolchildren and placebos are given to others. Do the vitamins work? That all depends on what we mean by “work”. The researchers could look at the children’s height, weight, prevalence of tooth decay, classroom behaviour, test scores, even (after waiting) prison record or earnings at the age of 25. Then there are combinations to check: do the vitamins have an effect on the poorer kids, the richer kids, the boys, the girls? Test enough different correlations and fluke results will drown out the real discoveries.

There are various ways to deal with this but the problem is more serious in large data sets, because there are vastly more possible comparisons than there are data points to compare. Without careful analysis, the ratio of genuine patterns to spurious patterns – of signal to noise – quickly tends to zero.

Worse still, one of the antidotes to the ­multiple-comparisons problem is transparency, allowing other researchers to figure out how many hypotheses were tested and how many contrary results are languishing in desk drawers because they just didn’t seem interesting enough to publish. Yet found data sets are rarely transparent. Amazon and Google, Facebook and Twitter, Target and Tesco – these companies aren’t about to share their data with you or anyone else.

New, large, cheap data sets and powerful ­analytical tools will pay dividends – nobody doubts that. And there are a few cases in which analysis of very large data sets has worked miracles. David Spiegelhalter of Cambridge points to Google Translate, which operates by statistically analysing hundreds of millions of documents that have been translated by humans and looking for patterns it can copy. This is an example of what computer scientists call “machine learning”, and it can deliver astonishing results with no preprogrammed grammatical rules. Google Translate is as close to theory-free, data-driven algorithmic black box as we have – and it is, says Spiegelhalter, “an amazing achievement”. That achievement is built on the clever processing of enormous data sets.

But big data do not solve the problem that has obsessed statisticians and scientists for centuries: the problem of insight, of inferring what is going on, and figuring out how we might intervene to change a system for the better.

“We have a new resource here,” says Professor David Hand of Imperial College London. “But nobody wants ‘data’. What they want are the answers.”

To use big data to produce such answers will require large strides in statistical methods.

“It’s the wild west right now,” says Patrick Wolfe of UCL. “People who are clever and driven will twist and turn and use every tool to get sense out of these data sets, and that’s cool. But we’re flying a little bit blind at the moment.”

Statisticians are scrambling to develop new methods to seize the opportunity of big data. Such new methods are essential but they will work by building on the old statistical lessons, not by ignoring them.

Recall big data’s four articles of faith. Uncanny accuracy is easy to overrate if we simply ignore false positives, as with Target’s pregnancy predictor. The claim that causation has been “knocked off its pedestal” is fine if we are making predictions in a stable environment but not if the world is changing (as with Flu Trends) or if we ourselves hope to change it. The promise that “N = All”, and therefore that sampling bias does not matter, is simply not true in most cases that count. As for the idea that “with enough data, the numbers speak for themselves” – that seems hopelessly naive in data sets where spurious patterns vastly outnumber genuine discoveries.

“Big data” has arrived, but big insights have not. The challenge now is to solve new problems and gain new answers – without making the same old statistical mistakes on a grander scale than ever.

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Tim Harford’s latest book is ‘The Undercover Economist Strikes Back’. To comment on this article please post below, or email magazineletters@ft.com

 

RWJF: Making Sense of the Medicare Physician Payment Data Release: Uses, Limitations, and Potential – The Commonwealth Fund

Making Sense of the Medicare Physician Payment Data Release: Uses, Limitations, and Potential – The Commonwealth Fund.

PDF: 1789_Patel_making_sense_Medicare_phys_payment_data_release_ib

Overview

In April 2014, the Centers for Medicare and Medicaid Services released a data file containing information on Medicare payments made to physicians and other providers. Though an important achievement in promoting greater health system transparency, limitations in the data have hindered key users, including consumers, payers, and providers, from discerning meaningful information from the file. This brief outlines the significance of the data release, the limitations of the dataset, the current uses of the information, and proposals for rendering the file more meaningful for public use.

Creating a Market for Disease Prevention

 

http://thevitalityinstitute.org/news/focus-on-pharma-creating-a-market-for-disease-prevention/

Focus on Pharma: Creating a Market for Disease Prevention

SustainAbility Newsletter “Radar” | Oct 30, 2014

Should pharmaceutical companies be in the business of producing pills, or of making people well? The answer is both. Elvira Thissen argues that with diminishing returns in medicines it is time for pharma companies to move away from philosophical discussions on prevention and adapt to new realities instead.

[…]

The Business Case for Prevention

A recent report by The Vitality Institute – founded by South Africa’s largest health insurance company – estimates potential annual savings in the US of $217–303 billion on healthcare costs by 2023 if evidence-based approaches to NCD prevention are rolled out.

At an estimated global cost of illness of nearly US$1.4 trillion in 2010 for cardiovascular disease and diabetes alone, there is a market for prevention. In the UK, the NHS spends 10% of its budget on treating diabetes, 80% of which goes to managing (partly preventable) complications. Reducing disease incidence represents a considerable value to governments, insurance companies and employers.

Some sectors are already eyeing the value of this market.

[…]

For access to the full article and SustainAbility newsletter, click here.

Dr Atul Gawande – 2014 Reith Lectures

Lecture 1: Why Do Doctors Fail?

Lecture 2: The Century of the System

Lecture 3: The Problem of Hubris

Lecture 4: The Idea of Wellbeing

http://www.bbc.co.uk/programmes/articles/6F2X8TpsxrJpnsq82hggHW/dr-atul-gawande-2014-reith-lectures

Dr Atul Gawande – 2014 Reith Lectures

Atul Gawande, MD, MPH is a practicing surgeon at Brigham and Women’s Hospital and Professor at both the Harvard School of Public Health and Harvard Medical School.

In his lecture series, The Future of Medicine, Dr Atul Gawande will examine the nature of progress and failure in medicine, a field defined by what he calls ‘the messy intersection of science and human fallibility’.

Known for both his clear analysis and vivid storytelling, he will explore the growing importance of systems in medicine and argue that the future role of the medical profession in our lives should be bigger than simply assuring health and survival.

The 2014 Reith Lectures

The first lecture, Why do Doctors Fail?, will explore the nature of imperfection in medicine. In particular, Gawande will examine how much of failure in medicine remains due to ignorance (lack of knowledge) and how much is due to ineptitude (failure to use existing knowledge) and what that means for where medical progress will come from in the future.

In the second lecture, The Century of the System, Gawande will focus on the impact that the development of systems has had – and should have in the future – on medicine and overcoming failures of ineptitude. He will dissect systems of all kinds, from simple checklists to complex mechanisms of many parts. And he will argue for how they can be better designed to transform care from the richest parts of the world to the poorest.

The third lecture, The Problem of Hubris, will examine the great unfixable problems in life and healthcare – aging and death. Gawande will argue that the reluctance of society and medical institutions to recognise the limits of what professionals can do is producing widespread suffering. But research is revealing how this can change.

The fourth and final lecture, The Idea of Wellbeing, will argue that medicine must shift from a focus on health and survival to a focus on wellbeing – on protecting, insofar as possible, people’s abilities to pursue their highest priorities in life. And, as he will suggest from the story of his father’s life and death from cancer, those priorities are nearly always more complex than simply to live longer.

Five things to know about Dr Atul Gawande

Find out about Atul Gawande ahead of his 2014 Reith Lectures…

1.

In 2010, Time Magazine named him as one of the world’s most influential thinkers.

2.

His 2009 New Yorker article – The Cost Conundrum – made waves when it compared the health care of two towns in Texas and suggested that more expensive care is often worse care. Barack Obama cited the article during his attempt to get Obamacare passed by the US Congress.

3.

Atul Gawande’s 2012 TED talk – How do we heal medicine? – has been watched over 1m times.

4.

Atul Gawande has written three bestselling books: Complications, Better and The Checklist Manifesto.

The Checklist Manifesto is about the importance of having a process for whatever you are doing. Better focuses on the drive for better medicine and health care systems. Complications was based on his training as a surgeon.

5.

In 2013, Atul launched Ariadne Labs – a new health care innovation lab aiming ‘to provide scalable solutions that produce better care at the most critical moments in people’s lives everywhere’.

Creepy data

 

http://www.theguardian.com/technology/2014/dec/05/when-data-gets-creepy-secrets-were-giving-away

When data gets creepy: the secrets we don’t realise we’re giving away

We all worry about digital spies stealing our data – but now even the things we thought we were happy to share are being used in ways we don’t like. Why aren’t we making more of a fuss?
ben goldacre illustration data security
We have few sound intuitions into what is safe and what is flimsy when it comes to securing our digital lives – let alone what is ethical and what is creepy. Photograph: Darrel Rees/Heart Agency for the Guardian

But these are straightforward failures of security. At the same time, something much more interesting has been happening. Information we have happily shared in public is increasingly being used in ways that make us queasy, because our intuitions about security and privacy have failed to keep up with technology. Nuggets of personal information that seem trivial, individually, can now be aggregated, indexed and processed. When this happens, simple pieces of computer code can produce insights and intrusions that creep us out, or even do us harm. But most of us haven’t noticed yet: for a lack of nerd skills, we are exposing ourselves.

At the simplest level, even the act of putting lots of data in one place – and making it searchable – can change its accessibility. As a doctor, I have been to the house ofa newspaper hoarder; as a researcher, I have been to the British Library newspaper archive. The difference between the two is not the amount of information, but rather the index. I recently found myself in the quiet coach on a train, near a stranger shouting into her phone. Between London and York she shared her (unusual) name, her plan to move jobs, her plan to steal a client list, and her wish that she’d snogged her boss. Her entire sense of privacy was predicated on an outdated model: none of what she said had any special interest to the people in coach H. One tweet with her name in would have changed that, and been searchable for ever.

An interesting side-effect of public data being indexed and searchable is that you only have to be sloppy once, for your privacy to be compromised. The computer program Creepy makes good fodder for panic. Put in someone’s username from Twitter, or Flickr, and Creepy will churn through every photo hosting service it knows, trying to find every picture they’ve ever posted. Cameras – especially phone cameras – often store the location where the picture was taken in the picture data. Creepy grabs all this geo-location data and puts pins on a map for you. Most of the time, you probably remember to get the privacy settings right. But if you get it wrong just once – maybe the first time you used a new app, maybe before your friend showed you how to change the settings – Creepy will find it, and your home is marked on a map. All because you tweeted a photo of something funny your cat did, in your kitchen.

medical records

Pinterest
Many people will soon be able to access their full medical records online – but some might get some nasty surprises. Photograph: Sean Justice/Getty

Some of these services are specifically created to scare people about their leakiness, and nudge us back to common sense: PleaseRobMe.com, for example,checks to see if you’re sharing your location publicly on Twitter and FourSquare (with sadistic section headings such as “recent empty homes” and “new opportunities”).

Some are less benevolent. The Girls Around Me app took freely shared social data – intended to help friends get together – and repurposed it for ruthless, data-driven sleaziness. Using FourSquare and Facebook data, it drew neat maps with the faces of nearby women pasted on. With your Facebook profile linked, I could research your interests before approaching you. Are all the women visible on Girls Around Me willingly consenting to having their faces mapped across bars or workplaces or at home – with links to their social media profiles – just by accepting the default privacy settings? Are they foolish to not foresee that someone might process this data and present them like products in a store?

But beyond mere indexing comes an even bigger new horizon. Once aggregated, these individual fragments of information can be processed and combined, and the resulting data can give away more about our character than our intuitions are able to spot.

Last month the Samaritans launched a suicide app. The idea was simple: they monitor the tweets of people you follow, analyse them, and alert you if your friends seem to be making comments suggestive of very low mood, or worse. A brief psychodrama ensued. One camp were up in arms: this is intrusive, they said. You’re monitoring mood, you need to ask permission before you send alerts about me to strangers. Worse, they said, it will be misused. People with bad intentions will monitor vulnerable people, and attack when their enemies are at their lowest ebb. And anyway, it’s just creepy. On the other side, plenty of people couldn’t even conceive of any misuse. This is clearly a beneficent idea, they said. And anyway, your tweets are public property, so any analysis of your mood is fair game. The Samaritans sided with the second team and said, to those worried about the intrusion: tough. Two weeks later they listened, and pulled the app, but the squabble illustrates how much we can disagree on the rights and wrongs around this kind of processing.

The Samaritans app, to be fair, was crude, as many of these sites currently are:analyzewords.com, for example, claims to spot personality characteristics by analysing your tweets, but the results are unimpressive. This may not last. Many people are guarded about their sexuality: but a paper from 2013 [pdf donwload] looked at the Facebook likes of 58,000 volunteers and found that, after generating algorithms by looking at the patterns in this dataset, they were able to correctly discriminate between homosexual and heterosexual men 88% of the time. Liking “Colbert” and “Science” were, incidentally, among the best predictors of high IQ.

Sometimes, even when people have good intentions and clear permission, data analysis can throw up odd ethical quandaries. Recently, for example, the government has asked family GPs to produce a list of people they think are likely to die in the next year. In itself, this is a good idea: a flag appears on the system reminding the doctor to have a conversation, at the next consultation, about planning “end of life care”. In my day job, I spend a lot of time working on interesting uses of health data. My boss suggested that we could look at automatically analysing medical records in order to instantly identify people who are soon to die. This is also a good idea.

But add in one final ingredient and the conclusion isn’t so clear. We are entering an age – which we should welcome with open arms – when patients will finally have access to their own full medical records online. So suddenly we have a new problem. One day, you log in to your medical records, and there’s a new entry on your file: “Likely to die in the next year.” We spend a lot of time teaching medical students to be skilful around breaking bad news. A box ticked on your medical records is not empathic communication. Would we hide the box? Is that ethical? Or are “derived variables” such as these, on a medical record, something doctors should share like anything else? Here, again, different people have different intuitions.

shopping centre

Pinterest
Many shopping centres can now use your mobile data to track you as you walk from shop to shop. Photograph: Christian Sinibaldi/Guardian

Then there’s the information you didn’t know you were leaking. Every device with Wi-Fi has a unique “MAC address”, which is broadcast constantly as long as wireless networking is switched on. It’s a boring technical aspect of the way Wi-Fi works, and you wouldn’t really care if anyone saw your MAC address on the airwaves as you walk past their router. But again, the issue is not the leakiness of one piece of information, but rather the ability to connect together a thread. Many shops and shopping centres, for example, now use multiple Wi-Fi sensors, monitoring the strength of connections, to triangulate your position, and track how you walk around the shop. By matching the signal to the security video, they get to know what you look like. If you give an email address in order to use the free in-store Wi-Fi, they have that too.

In some respects, this is no different to an online retailer such as Amazon tracking your movement around their website. The difference, perhaps, is that it feels creepier to be tracked when you walk around in physical space. Maybe you don’t care. Or maybe you didn’t know. But crucially: I doubt that everyone you know agrees about what is right or wrong here, let alone what is obvious or surprising, creepy or friendly.

It’s also interesting to see how peoples’ limits shift. I felt OK about in-store tracking, for example, but my intuitions shifted when I realised that I’m traced over much wider spaces. Turnstyle, for example, stretches right across Toronto – a city I love – tracing individuals as they move from one part of town to another. For businesses, this is great intelligence: if your lunchtime coffeeshop customers also visit a Whole Foods store near home after work, you should offer more salads. For the individual, I’m suddenly starting to think: can you stop following me, please? Half of Turnstyle’s infrastructure is outside Canada. They know what country I’m in. This crosses my own, personal creepiness threshold. Maybe you think I’m being precious.

There is an extraordinary textbook written by Ross Anderson, professor of computer security at University of Cambridge. It’s called Security Engineering, and despite being more than 1,000 pages long, it’s one of the most readable pop-science slogs of the decade. Firstly, Anderson sets out the basic truisms of security. You could, after all, make your house incredibly secure by fitting reinforced metal shutters over every window, and 10 locks on a single reinforced front door; but it would take a very long time to get in and out, or see the sunshine in the morning.

Digital security is the same: we all make a trade-off between security and convenience, but there is a crucial difference between security in the old-fashioned physical domain, and security today. You can kick a door and feel the weight. You can wiggle a lock, and marvel at the detail on the key. But as you wade through the examples in Anderson’s book – learning about the mechanics of passwords, simple electronic garage door keys, and then banks, encryption, medical records and more – the reality gradually dawns on you that for almost everything we do today that requires security, that security is done digitally. And yet to most of us, this entire world is opaque, like a series of black boxes into which we entrust our money, our privacy and everything else we might hope to have under lock and key. We have no clear sight into this world, and we have few sound intuitions into what is safe and what is flimsy – let alone what is ethical and what is creepy. We are left operating on blind, ignorant, misplaced trust; meanwhile, all around us, without our even noticing, choices are being made.

Ben Goldacre’s new book, I Think You’ll Find It’s a Bit More Complicated Than That, is published by Fourth Estate. Buy it for £11.99 at bookshop.theguardian.com