AHLA. E. Big Data, Big Promise and (Potentially) Big Problems. Kent Bottles Principal, Healthcare Consulting PYA Knoxville, TN

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1 AHLA E. Big Data, Big Promise and (Potentially) Big Problems Kent Bottles Principal, Healthcare Consulting PYA Knoxville, TN Kristen B. Rosati Polsinelli PC Phoenix, AZ Legal Issues Affecting Academic Medical Centers and Other Teaching Institutions January 23-24, 2014

2 Big Data, Big Promises, and (Potentially) Big Problems Kent Bottles, MD Chief Medical Officer, PYA Analytics Thomas Jefferson University School of Population Health January 23-24, 2014 AHLA Legal Issues Affecting Academic Medical Centers Washington, DC Page 0 Big Data Viktor Mayer-Schonberger & Kenneth Cukier, 2013 Big data refers to things one can do at a large scale that cannot be done at a smaller one, to extract new insights or create new forms of value, in ways that change markets, organizations, the relationship between citizens and governments. Causality is replaced by correlation. Not knowing why but only what. Page 1 1

3 The Amount of Data Available is Truly Big The International Data Corporation reported that the amount of digital data exceeded 1 zetabyte in In 2011 this number was almost 2 zetabytes. Google s Eric Schmidt claims that every two days we create as much information as we did from the dawn of civilization up until the year Page 2 Sizing Up Big Data Steve Lohr, NY Times, June 20, 2013 Bundle of technologies Web pages, browsing habits, sensor signals, social media, GPS location data, genomic information, surveillance videos Advances in data storage and processing Machine learning/ai software to find actionable correlations from the big data Page 3 2

4 Jeffrey Hammerbacher All industries are being disrupted Moneyball, 538, Large Hadron Collider McKinsley: Big Data: The Next Frontier for Competition $338 billion potential annual value to US healthcare o $165 billion in clinical operations o $105 billion in research and development Page 4 Jeffrey Hammerbacher Oracle: From Overload to Impact Healthcare executives say collecting & managing more business information today than two years ago Average increase 85% per year Frost & Sullivan: US Hospital Health Data Analytics Market % of US hospitals use data analytic tools % of US hospitals will use data analytic tools Page 5 3

5 New York City s Office of Policy & Strategic Planning 1 terabyte of data flows into office every day. 95% success rate in identifying restaurants dumping cooking oil into sewers. Doubled the hit rate of finding stores selling bootleg cigarettes. Sped removal of trees toppled by Sandy. Guided building inspectors to increase citation rate from 13 to 80% for buildings likely to have catastrophic house fires. Page 6 Big Data Viktor Mayer-Schonberger & Kenneth Cukier, 2013 To analyze & understand the world we used to test hypotheses driven by theories. Big data discards theories & causality for correlations. Univ of Ontario premature baby studies. 1,260 data points per second. Diagnose infections 24 hours before apparent. Very constant vital signs indicate impending infection. Page 7 4

6 Big Data Viktor Mayer-Schonberger & Kenneth Cukier, 2013 Google Nature article predicts flu spread in USA. Compared 50 million search terms with CDC data on spread of flu from 2003 to million different mathematical models. 45 search terms had strong correlation with spread of flu. H1N1 crisis in 2009 Google approach worked. Page 8 Algorithms Mine Public Data Atul Butte combined data from 130 studies of gene activity levels in diabetic & healthy tissue. Butte identified new gene associate with Type 2 DM because stood out in 78/130 studies. Algorithm looking for drugs & diseases that had opposing effects on gene expression. Cimetidine for lung adenocarcinomas Topiramate for Chrohn s Disease Page 9 5

7 Algorithms Mine Public Data Russ Altman used algorithms to mine Stanford Translational Research Integrated Database Environment & FDA adverse event reports database. Patients taking SSRI antidepressants and thiazide are at increased risk for long QT syndrome, a serious cardiac arrhythmia. Page 10 Predicting sepsis Predictive Analytics Eric Siegel, Wiley, 2013 Sisters of Mercy Health System predicts septic shock based on vital signs observed over time. Detected 71% of cases with low false positive rate. Predicting death US health insurance company predicts likelihood person will die within 18 months to trigger end of life counseling on living wills and palliative care. Riskprediction.org.uk: predicts your risk of death in surgery based on your condition. Page 11 6

8 UPMC Predictive Analytics Eric Siegel, Wiley, 2013 Predicts patient s risk of readmission within 30 days of discharge Heritage Provider Network $3 million competition to predict number of days patient will spend in hospital over next year BYU & University of Utah Correctly predicted 80% of premature births based on peptide biomarkers found as early as 24 weeks Page 12 Predictive Analytics Eric Siegel, Wiley, 2013 Blue Cross Blue Shield of Tennessee Claims data analysis predicts which health resources individual member will need in the coming year. Multicare Health System in Washington State $2 million in missed charges a year identified using algorithm. Page 13 7

9 Big Data for Cancer Care Ron Winslow, WSJ, March 27, 2013 ASCO. Database of hundreds of thousands of patients. Prototype has collected 100,000 breast cancer patients from 27 groups who have different EMRs. Recognition that big data is imperative for the future of medicine. - Lynn Etheredge Less than 5% of adult cancer patients participate in randomized clinical trials. Page 14 Big Data Viktor Mayer-Schonberger & Kenneth Cukier, 2013 Recombinant data. Danish Cancer Society study on cell phone/cancer. Cellphone users from 1987 to 1995 (358,403). Brain cancer patients (10,729). Registry of education and disposable income. Combining the three databases found no increase in risk of cancer for those who used cell phones. Not based on sample size; based on N=all. Page 15 8

10 Systems Biology Yields New Therapies Michael Snyder sequenced his genome that showed he was at high risk for Type 2 Diabetes. Blood tests every two months of 40,000 molecules. After seven months showed he had developed DM. Early detection, early treatment. This study is a landmark for personalized medicine. - Eric Topol Page 16 Systems Biology Yields New Therapies Dr. Lukas Wartman of Washington University developed Adult Acute Lymboblastic Leukemia. Sequenced cancer cells & healthy cells. Discovered normal gene in overdrive producing huge amounts of protein. Drug for kidney cancer shut down the malfunctioning gene. Whole genome sequencing. Page 17 9

11 Big Data Viktor Mayer-Schonberger & Kenneth Cukier, 2013 Dictatorship of Data Relying on numbers when they are far more fallible than we think. Robert McNamara s body count numbers in Vietnam. Michael Eisen tried to buy The Making of a Fly on Amazon in April Two established sellers offering the book for $1,730,045 and $2,198,177. Two-week escalation to a peak of $23,698, on April 18. Unsupervised algorithms priced the books for the two sellers. Page 18 Page 19 10