Doctors and Data

  Intelligent and extensively trained U.S. doctors make thousands of smart and highly experienced decisions concerning individual medical and health situations every day. Yet (a) the costs are the highest in the world, (b) the results are mediocre, and (c) the costs vs. outcomes in different regions vary substantially. A recent business week article stated that UCLA's costs were over twice that per patient in the same medical category as those at Duke, with about the same outcome; that the region around the Mayo clinic had about half the costs per patient as other comparable demographics. When you see a business situation that is out-of-control but with pockets of good performance; you study those pockets to find an overall solution.

It seems that the high medical-efficiency areas use a good amount of data in their medical determinations. It's good business practice to make judgments on any subject based on data, even if in some cases modification to those data-based judgments is appropriate. GIven these radically different performance characteristics, then, it may be that a big break-through potential lies in data-aided medical decisions. I'll use knee pain as an example:

• once a doctor has made a determination on the nature of the knee pain, using inexpensive techniques such as his own simple tests and perhaps an x-ray, he enters that into the "knee-pain" data base with the appropriate data.
• that data base has been developed in a highly scientific way based on thousands of experiences.
• it tells him, in our example, that using medication is the best approach, typically that medication will relieve the pain in 8-16 weeks, and that if it doesn't then to go to the next procedure. It also tells him that an MRI, a very expensive analytical tool, is not called for.
• so that is the "prescription." Several "out of the norm" possibilities may occur. If the patient insists on an MRI, then that is out of the norm and must be paid for by the patient. If the doctor insists on an MRI and the patient agrees, then that is out of the norm and something like the patient paying 1/2 and the doctor receiving no fee prevails. If an MRI is not ordered and later it is determined that, in this particular case, that an MRI should have been ordered then the doctor is shielded from malpractice claims.
• for those on some form of insurance with no substantial alternative means of funding, the data based prescription prevails. For those who have the means or desire to go further, they pay for it.
• of course it's more complicated than this simple example. But the value lies in (a) using data based decision making to achieve cost-controlled but medically sound decisions, and (b) not being a slave to the data by allowing the doctor and the patient some leeway but with associated incentivizing and protective economics and guidelines.