When Thomas Insel, MD, recently announced he was stepping down from his post as director of the National Institute of Mental Health, some were surprised that he was leaving to join Google. But in reality, the move makes sense. Insel himself described in a blog post that big data companies, such as Google, have a keen interest in the $3 trillion healthcare system.
Of course, the term “big data” gets thrown around a lot these days, and for behavioral health providers, it might seem like a distant strategy far off in the future. Many providers are still taking baby steps with “small data” elements in electronic health records, so any thought of distilling terabytes of data into their daily work might seem far-fetched. But big data is already here—even for behavioral health.
In general, big data is essentially a combination of information that might come from several sources in several different forms, and it’s typically used for specific and complex analyses. For example, an acute care hospital might run an analysis of years’ worth of emergency room data to find the common variables among patients with asthma who were admitted for an inpatient stay. That’s big data.
Additionally, many large healthcare systems are starting to form consortia to combine their clinical data sets and run even larger analytics projects to discover patterns that might be clues as to how they might improve care. The federal government is now funding the creation of networks to gather large amounts of healthcare data as a first step toward the development of what is known as “a learning health system,” in which providers and researchers routinely share data to learn more about prevention and treatment.
And this is just the tip of the iceberg in big data.
One promising example of big data research in behavioral health is the Knowledge Network, a partnership led by the Centerstone Research Institute (CRI) that involves behavioral healthcare providers, researchers, policymakers and analytics experts who have created a national data warehouse. Tom Doub, PhD, CRI’s chief executive officer, says the network brings together community mental health providers interested in technology, research and policy work.
“We realized that we had this remarkable resource in terms of data available to us,” he says. “We developed data-sharing arrangements, deidentified the data to be compliant with HIPAA, and built a data warehouse with half a million patients, 4.5 million prescription records, 2 million diagnoses, and 23 million service records. It is a very substantial archive of mental health data.”
Doub says researchers are starting to probe the data to look at variations in care.
“For people presenting with the same diagnosis of schizophrenia or depression, the kind of care they get varies a great deal,” he says. “That is probably not a surprise to most people in the field, but we haven’t had good ways to talk about it. We’re trying to understand what that means.”
Combining information into big data projects has great value for research and policy purposes. Doub has been surprised to find, for example, radically different care approaches between two organizations in the same state, with the same payer, same regulatory requirements and same cultural environment.
“And there is so little transparency around that,” he says.
Behavioral healthcare is often described as a cottage industry, and part of the reason is there is no transparency about provider performance. Such transparency is already occurring in medical health disciplines and seems imminent for behavioral health’s future.
“There are going to be outcome standards and public report cards we have to be accountable for, and as we move toward pay-for-performance models, in order to survive, providers are going to have to do a good job of creating value and managing populations,” Doub says. ‘You can’t just deal with people coming in the door. You have to go out and find people who are at risk and make sure you keep them out of the emergency room.”
But there is optimism. Doub says organizations that want to calculate an analysis of their own data on a smaller scale now have more options than a few years ago. He says that Centerstone, CRI’s parent company, has a large amount of internal data and resources to mine that information and has increasingly been able to capitalize on it.
“But when we started, there weren’t a lot of good roadmaps for how to do that,” he says. “There were roadmaps in other industries, and that’s where we looked for inspiration. But there were no out-of-the-box solutions to address the data questions we had.”
The best place to start, Doub says, is in establishing one data point to investigate through big data analysis, rather than trying to align a lot of misaligned information.
“Trying to reconcile why two versions of the same spreadsheet are different is a colossal waste of time, energy and money,” he adds.
Networks of behavioral providers are finding ways to pool their data to look for actionable insights, however. For instance, the Florida Council for Community Mental Health used a commercialized analytics tool developed at CRI to analyze aggregate, deidentified data from its provider members statewide and identified cost, productivity and outcomes findings.
Another positive change Doub has noticed is that more managed care companies are open to sharing data with behavioral health providers, such as hospitalization data that a treatment center might not have access to otherwise.