The use of Big Data can deepen the digital divide and gaps in health literacy. Information, knowledge, and wisdom are very different things. Pouring on the data and information does not create knowledge. Information must be tailored, channeled, and delivered in a way that meets the patient where she is.
As high as that bar is for providers, it's exponentially higher for vulnerable patients as are the stakes.
Data and information are not enough. At some point patients require some intermediary agent to help them transform the deluge of information into knowledge in a way that is meaningful to the patient on the patient's terms. Yet, the so-called efficiencies that we enjoy allow physicians to spend less time with patients. They can bill more in less time and then move on. That's less time for doctors to explain things (by the way, the word doctor means teacher, not healer). Even if they had they time, there is no causal connection between knowledge and behavior modification when it comes to improvements in care. As Damian Mingle points out, it was 130 years after Ignaz Semmelweis call for improvements in hygiene that CDC adopted and published hand hygiene guidelines. What Mingle misses is that hand hygiene statistics for clinicians are still abysmal-the CDC places hand hygiene adherence in hospitals somewhere between 29 percent and 48 percent. This is not a win for data, it's a debacle. We've known for some time that hand washing matters, but the data is not enough to change behaviors as grave as the consequences may be.
Data science has a lot to offer medicine, but like medicine the science must be wielded with an art. The values of medicine and information technology are disparate in many ways, but they can be harmonized if the will is there. There is the distinct possibility that the best use of health information technology is to find new ways to listen to patients and enhance the doctor-patient relationship rather than dictate or placate it. Ethics, and not data science, will help to achieve that end. Big data is merely the latest instrumentality of the medical industrial complex. Without an alignment of values, we will continue to see it leveraged to put profits before patients.
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