Monday, April 17, 2017

Data is the New Cowbell

...or is it a smokescreen for inaction by policymakers?

Unless you've been living under a rock for twenty years, you're probably familiar with the "More Cowbell" skit from Saturday Night Live, originally aired in 2000. Mocking the recording sessions for Blue Oyster Cult's Don't Fear the Reaper, Christopher Walken (playing the band's producer) feels that the album's title track demands an ever-more-prominent cowbell, played masterfully by a flabby Will Ferrell. The skit has reached legendary status, in some corners even called the greatest SNL skit of all time. I'm not sure I would go that far, but it's certainly among the all-time greats.

It's hard to put a finger on what's made the sketch so beloved. Christopher Walken is outstanding as always, delivering even the most idiotic lines like they're ripped from Shakespearean tragedy. The other cast members nail the cliched look and mannerisms of 70s rock stars. And more than any comic save the late Chris Farley, Will Ferrell is unafraid to make himself look like a complete ass for laughs, his belly jiggling outside a shirt several sizes too small. Then again, it could just be the immortal meme of More Cowbell.

In health care, it would appear that we have our very own flavor of cowbell, namely data. Yes, we gotta have More Data: safety data; quality improvement data; waitlist data; usage data; efficacy data; payment data; and so on and so forth, up to and including the all-important meta-data. If we're to believe the High Priests of TED Talks, data shall set us free, solve all of our problems, and make sure not a dime of taxpayer money is wasted. Is there anything more data can't do?

I'd never argue that collecting data is without merit. Post-market surveillance of medication safety is essential to making sure bad drugs are taken off the shelves. Every health care provider and facility should strive to ask itself if and how it can do better. But there are trade-offs to everything, and the present obsession with data in health care is having unintended negative consequences. It's well past time we took a more critical look at the purpose and costs of all this data collection, rather than analyzing the results ad nauseum without taking action.

The first problem is that gathering all this data generally demands the use of electronic medical/health records (EMR or EHR). Suffice it to say that the promised cost, time, and error reductions of EMRs haven't been borne out by the evidence, and doctors anecdotally would seem to agree. EMRs run the risk of eroding clinician-patient interaction, are prone to technical failures, and are a time-sucking pain to boot. Is it any wonder why doctors will half-jokingly describe themselves as very expensive data entry clerks, spending from double to triple the time on a computer as with patients? How does all that administrative time not put good patient care in jeopardy?

More importantly, is all this data we're collecting being used in good faith? I'm not talking about an individual clinic deciding that a quality improvement initiative isn't worth the bother after all. Rather, is the demand for ever More Data really just a stalling tactic? How many hospitals have had a capital project or new initiative turned down because the numbers weren't to the government's liking? It's hard not to see the push for data as a play for time, when hospitals are having to stuff meeting rooms and storage(!) rooms with patients, only to be brushed off by government officials that fret over what hour of the day to take a patient census, or even question the severity of the problem.

Or worse still, perhaps More Data is being demanded with a more galling purpose in mind: privatization. Nobody would be surprised to learn that U.S. based pharmaceutical companies have a keen interest in EMR data - what better way to find the doctors that are or are not prescribing enough of their product? But what about Canada, where the Ontario government is looking to market all that juicy data to help balance its budget? Is that what all those hours of data entry are for: to enable the power brokers and policy makers to be complicit in the deterioration of patient care, in the name of making a buck or saving political hides?

I've argued before that we've invested too much faith in the benefits of electronic records, and have paid too little attention to the price of that faith. Now we have a second-order reason to question our passion for information technology, and the supposed utopia of ever More Data: just what (and who) are collecting all this data for? 

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