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12 November 2015

We know about big data in health, what’s small big data?

Big data may be playing a useful role in health-trend analysis and improving health care, but let’s not forget that small data is important, too.

By Becky Slack

When you pay for your goods at the supermarket, the chances are that you also collect loyalty points. This data is then used by the supermarket to identify sales trends, understand its customers and optimise what it offers – as well as to develop special deals that might entice people back for more.

Your local council may be doing something similar with the data it holds – looking for trends in rubbish collection, energy usage and the volume of traffic to deliver better services for residents.

In health, it’s no different. Many decisions concerning the type of health care that the UK needs and how best to deliver it are being made based on vast amounts of data.

The collection and use of “big data” have grown exponentially over the past few decades, powered mainly by the availability of ever cheaper, smaller, Wi-Fi-enabled technologies, including smartphones and tablets, which enable individuals and businesses to connect to the internet and cloud storage.

As more data is created and recorded, more analysis can be done to reveal patterns, trends and associations, especially relating to human behaviour and interactions. On the whole, these are not trends that can easily be detected by the eye alone – and so complex algorithms are relied on to identify patterns that can be used to enhance knowledge and inform decision-making.

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Within health care, this data can be very useful. There are benefits for the mass population (big data) and for the individual (what the health-care company Philips calls “small big data”).

Big data in health care is used in a number of ways. It can help us to predict epidemics, cure disease, improve quality of life and avoid preventable deaths. A recent example is the response to the ebola outbreak, in which agencies used computational modelling to provide in-depth analysis of how the disease might spread. Big data is also valuable in the development of new and more effective drugs, while the processing of genotypic and phenotypic data is helping researchers to identify biomarkers that can be used to stratify disease risk.

More recently, big data has been helping governments around the world to understand their local populations and tailor the delivery of health care according to their needs, says Jeroen Tas, chief executive of health-care informatics solutions and services at Philips.

“When you look at the patterns over time from within a city of, say, 1.5 million people, and you see how people move through different risk classes, you can begin to understand what triggers those risks. Once you do that, you can predict what the health needs and costs will be and can begin to organise clinical programmes around those needs,” he says.

Small big data

The next stage in the digital revolution is to use data to understand as much about a patient as we can, as early in their life as possible. By collecting and analysing data and maintaining a constant, seamless connection to relevant health professionals, those gathering the information aim to prevent illness and disease from occurring and to address them at a much earlier stage, thus maintaining well-being in the individual and saving costs for the health service.

This is about not just electronic medical records but the full spectrum of data garnered across the health continuum – from healthy living, prevention and diagnosis to recovery, treatment and home care. It includes information on vital signs and physical and mental well-being. This kind of data can be gathered through wearable technology, apps or home-based devices that patients use themselves, as well as through the monitors and imaging systems that are available at hospitals and health centres.

Prevent, predict, heal

Small big data encourages individuals to take a more direct role in their health, including in the areas of prevention and treatment. The Philips Picture of Health report has shown how personalised health data, such as that contained within Fitbit apps, can inspire people to manage their well-being more actively. Some 79 per cent of those who track their health using apps and other self-diagnosis tools say that they have changed their habits as a result of the data provided, be it by increasing the amount of exercise they take or by eating more healthily.

Over the course of the past few weeks, I have had the opportunity to speak with several members of the Philips team to discuss what benefits this “digital revolution” might bring to the NHS. They say that when personalised health data – not only basic vital signs collected through smartphone apps but more complex data, such as blood pressure, glucose levels, and so on – is shared with doctors and other medical professionals, the potential for better, more effective and economical health services grows exponentially.     

“The most exciting [aspect] for me is the ability of data and technology to predict emergencies,” says Neil Mesher, managing director of Philips Healthcare UK and Ireland, referring to how access to huge databases of information about the state of the health of the general public will allow problems to be spotted before they occur and remedies – either medicinal or educational – to be prepared in advance.

“It’s tiny variations in the data that give the clues as to what’s actually happening. If you monitor vital signs over time within an ICU [intensive care unit], you can predict a cardiac incident, so you can intervene and actually stop it from happening. This means you don’t need to have crash teams trying to resuscitate patients, which influences how you plan your activity within your ward. The impact on the patient is also profound and it also changes the type of follow-up care that person may need. There is so much you could do with that kind of data,” he says.

It isn’t just in emergency scenarios that benefits can be realised. Better access to, and understanding of, an individual’s data can also help patients to receive a better service overall, ensuring that they are provided with the most timely and appropriate treatment available, from the best health professional for the task.

This level of detailed, data-driven decision-making is not limited to the hospital. Today, there are tools available that can also be used in the home. Philips, for example, produces a number of devices that fulfil a variety of purposes, from its fall detector pendant, which uses sensors and algorithms to detect when someone has fallen and notifies the carer or health team, to its medication dispensing service that helps people take the right medicine at the right time. Devices in the kitchen can provide nutritional advice; wearable technology can check a person’s heart and breathing and record sensitive data – such as the Philips wrist blood pressure monitor, which allows wearers to measure their systolic and diastolic blood pressure, as well as their heart rate. Meanwhile, tablet video apps link to doctors for instant check-ups.

“What we want to do is get people out of the hospital and home as quickly as possible,” says Tas. “In the hospital, if someone is in the ICU, we have very high-grade equipment monitoring them in real time. This shouldn’t have to stop when they move into the general ward or even [go] home.”

By providing patients with relevant devices, their information can be streamed to a telehealth centre and monitored, with care adjusted accordingly. “We can see rapid deterioration and heart rhythm issues. We can see if they have gained weight overnight, which could indicate they are holding fluids. This data allows us to intervene, be it [by] sending someone to their home or calling an ambulance,” he says, adding how this can help patients maintain independent living, prevent unnecessary hospital admissions and reduce pressure on emergency services.

Other benefits of using small big data include how it allows better measurement of patient outcomes, which in turn can be used to review staff and provider performance and eliminate waste and fraud.

There are challenges to realising all of these benefits. The medical industry collects a huge amount of data but often it is siloed in archives controlled by different doctors’ surgeries, hospitals, clinics and administrative departments. Meanwhile, resistance to change and fears about security and patient confidentiality have slowed down the take-up of new technologies and ways of working.

None of these challenges is insurmountable, however. Indeed, the NHS’s programme aims to take advantage of big data, by bringing together health and social information to see what is working and what could be done better. It was postponed in 2014 following fears around patient data security but was relaunched a year later, following changes to the strategy.

Speaking at an industry event at the start of the year, Tim Kelsey, national director for patients and information at NHS England, described the initiative as “an opportunity for big data analytics, but much more fundamentally for people to get to grips with their own health and care”.

Alongside its industrial cousin, the digital revolution has created fundamental and irreversible changes to our way of life. By personalising health care and empowering providers and individuals to manage information from multiple sources, we can move from a system that provides care to the sick to one that supports the entire health continuum, from prevention and diagnosis to treatment, recovery and wellness – and all in a way that will allow the NHS to address the £30bn black hole in its budget.

This article is part of a thought-provoking series on living health, brought to you by the New Statesman in association with Philips, which looks at how technology, innovation and big data are helping to improve your health and our health-care system.

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