Medical Director Cole Stanley continues his journey though the Circles of Healthcare Data Hell with Circle Five. You can find the other circles here.

Descending to our next ring, we can conjure some Soviet era central planning. Here, it’s assumed that we need everything to happen at the centre and then direction to spread by decree to the masses. Data flows one way, from the frontlines to the higher-ups, from the “do-ers” to the “knowers”, who then use their “advanced analytics”, “data linkage”, “data science”, and other fancy methods beyond that of the lowly frontline worker. The result? Useful data is locked away in a vault and few people have the keys. The frontline worker is reduced to a cog in the machine, getting a paycheque to follow directions reliably set by the higher-ups. Now it’s not to say that this can’t work up to a point, as it did during the industrial revolution and with the teachings of Frederick Winslow Taylor. But by treating people like cogs, we destroy the morale of the workforce and waste the number one resource we have, brainpower capable of learning and adapting rapidly at the frontlines (see my article Cogwheel Counterfactual). The system becomes slow to learn, and often strips data of meaningful clinical context, resulting in decrees coming down too late and not fitting the current need.

Yes, data centralization has its benefits and I fully support it for certain use cases. I am not saying that setting this up is a bad idea. The error occurs when we become monomaniacal, putting all our eggs in the proverbial central basket. With that approach, we expose ourselves to some unneeded risks, and lose out on opportunities to improve our system and engage our frontline workers. That is to say, we should not sit and wait for the ultimate central data repository to solve all of our problems, but instead should be pushing data-informed decision-making capability to the periphery.

To reiterate, it is not that creating central data repositories is inherently bad. Instead, we need to be realistic about the risks associated with this approach, and realize that we can accomplish much more and faster if we include complementary approaches. For example, as part of the initial phases of setup of the Measurement System for Physician Quality Improvement (MSPQI), a group of family physicians came up with an initial set of measures. The vast majority of these it turns out did not need any central repository or data linkage, as the data already exists in the primary care EMR. HDC has worked on making some of these available. With this in mind, we can promote uptake of these measures as tools for improvement NOW, and not miss the opportunity to get to the hard work of improving care while we wait for the perfect central repository.

CDSC exaltations

  • We can accomplish system improvements NOW without needing to wait for a central data repository with linkage
  • We should ensure measures are available and timely for frontline users to do improvement work
  • We can reduce privacy risks by focusing on de-identified aggregate data in many use cases

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