Looking for ROI: Can big data deliver on its promise to boost value?

Last month, a GHRI team published results of a survey we did for the Institute of Medicine (IOM) on “Integrating Research into Health Care Systems.” Written by GHRI’s Karin Johnson, PhD, the report reveals the expected litany of rewards and difficulties of conducting science in everyday clinical settings. But one theme struck me as particularly challenging: In both the report and the IOM workshops that inspired it, the participating health systems’ executives said they question their return on investment (ROI) in building the infrastructure that supports research—particularly for information technology.

In other words, for all the resources American health care is putting into electronic health records and other information technology elements that generate big data, many execs believe it’s not producing the knowledge they need to improve quality and reduce costs. While advances are improving efficiency and the security of patient/provider communication, much of technology’s promise has not yet been realized. This is especially true for what matters most to patients—getting good care at a price they can afford.  If anything, in fee-for-service settings, the main effect of electronic health records is higher billing levels.

It’s a perplexing problem that deserves careful consideration given our nation’s ongoing health care cost crisis. If you doubt that problem’s complexity and urgency, check out journalist Steven Brill’s best-selling new book, America’s Bitter Pill, described in this review in the New York Times. Brill presents a convincing argument, while pointing to health systems such as Kaiser Permanente (like Group Health) as our nation’s best hope. Once again, we see the promise raised, but how can we deliver?

Expectations have grown in recent years that big data will provide answers. But first we need better ways to mine information continually collected in clinical visits and translate it into knowledge that providers and administrators can use to improve care and lower cost. While we have yet to see huge, system-wide payoffs, signs of hope abound as health systems like ours experiment with use of clinical data. Some are discovering ways to reduce low-value care. Examples at Group Health:

A pragmatic trial of back pain treatment led by University of Washington radiologist Dr. Jeffrey Jarvik: Alongwith GHRI’s Dr. Dan Cherkin, the team is testing whether giving physicians contextual information on radiology reports can curb additional testing, opioid prescriptions, and invasive therapies.

Research on a new approach to diagnosing urinary tract infections by testing for E. coli infection at the level of the clone (substrain): GHRI’s Dr. Delia Scholes and Group Health physician Dr. Kim Riddell tested the method in a pilot study. They believe the method could result in smarter use of lab resources and antibiotics, control the spread of infections, and improve health outcomes. A grant to fund large-scale testing is pending.

The “Choosing Wisely” campaign, which Dr. Matt Handley, Group Health’s medical director for quality and informatics, and GHRI’s Dr. Diana Buist are working on at Group Health, regionally, and nationally: This approach explores how clinical communities can improve value by delivering all the evidence-based care that is needed—but none of the care that is not. Data collected among populations using “Choosing Wisely” approaches may provide knowledge to foster widespread change.

Group Health’s history is filled with many examples of clinicians and researchers working together to develop and test practical new approaches to help people lead healthier lives. Some of our most successful innovations—such as the Free & Clear smoking cessation program and our risk-based Breast Cancer Screening Program—developed incrementally over many years of committed work, experimentation, and collaboration. Looking back at lives saved and suffering averted, most would agree the investment has been well worth the time and effort. Looking ahead, we need to pick up the pace of innovation—and discover the full promise that new technologies hold. Like big data, the challenges before us are enormous but the opportunities are also huge. With our spirit of collaboration and a strong work ethic, our commitment to improve health and health care for all remains as steady as ever.

Eric B. Larson, MD, MPH
Vice President for Research, Group Health
Executive Director Group Health Research Institute