Have you ever found some of the most confounding questions and off the wall answers come to you at the water cooler?

I had been reading an article in the paper on the rising cost of running the UK’s primary health care provider the national-health-service (NHS).

The NHS was founded by the then Labor Government after World War II, in 1948.

It is an institution that has weathered many storms during its history and continues to be reported on. Quite frankly the issues around Obamacare pale into comparison when considering how to keep this British National Institution running well into the 21st century.

Now I must say, I am a technology entrepreneur, not a doctor. I am a lay person, who has been listening to the debate since he was a child.

The NHS is an incredibly large organisation. It serves as the primary health care provider for the majority of the population of the United Kingdom. And it serves the needs of the individual from birth to death.

The information generated by this institution is staggering. We talk about Big Data. Well, around the NHS we are talking about Big Data in mega supersize quantities by the volume, variety, velocity and volatility.

To give some context to healthcare big data.

When we talk about volume we imagine health care records for every patient and kept updated throughout that patient’s live. We can also mean all the documents, invoices generated by a hospital or other healthcare centers. Truly the list is endless.

So we now have our second term, variety. We have a wide range of data within our system. We never know just what we may need, so for safety’s sake we store a wide a variety as possible.

The third term is velocity.  Information is coming to us from doctors, nurses, suppliers, medical instruments – once more it’s endless and it’s coming to us in varying degrees of speed.

For example a patient’s bi annual checkup means two updates to their healthcare record.

If we look at hospital purchase ledger that could be daily. If we look at a hospital patient, their notes could be updated  hourly. If a patient was in intensive care then we could be looking at data coming to us in real-time, which would mean high velocity.

The last is volatility – this is where we track decisions that have been made. Maybe a different course of treatment was taken after a second opinion.

So that’s the potential nature of health care big data,  but what does it mean to the NHS?

The critical areas of concern, for the NHS is the delivery, effectiveness and cost of health care. In my humble opinion an effective big data initiative could help greatly in meeting these areas of concern.

Now I am an engineer not a doctor, but even I can see that it’s all about the patient.

To be in the data context, it’s all centered about the patient’s health care record. At the inception of the NHS this would have been on paper by now though and it’s been 66 years, this should be electronic.

However even better be health care record in a format that would facilitate exchange between systems. Whether such a health care record or format exists is not in the scope of this blog.

Here we are in the art of the possible…

Just as we can have exchange of financial information between financial IT systems (we call it XBRL) we also have a counterpart in health care called HL7 – CDA (Health Level 7 – Clinical Document Architecture).

HL7 – CDA, like XBRL, is based on eXtensible Markup Language (XML).

The goal of CDA is to specify syntax and supply framework for the full semantics of a clinical document. It defines a clinical document as having the following six characteristics:

  • Persistence
  • Stewardship
  • Potential for authentication
  • Context
  • Wholeness
  • Human readability

Now let’s play a game of what if?

What if we could use HL7-CDA as a means to encompass the medical record of a patient?

What if we could map the records of medical care provided to the patient, outcome of that care and cost of care?

What if we could report on health care cost using XBRL and link this to the HL7-CDA document?

Well I suppose we could if we used XML databases, but what would be the point?

Maybe with a synthesis of different XML datasets, taxonomies, predictive analytics and visualization we could have a go at answering these questions:

  •  How did the hospital meet the care requirements for the patient?
  • What costs were incurred by the hospital?
  • What were the care outcomes?
  • Where is the cost efficiency for the hospital, if any?
  • What drugs/treatments were used?
  • What was the cost in developing those drugs/treatments?

Now for countries without a state funded health service we could also be asking -

  • What is the variation in health care insurance premiums?
  • Was the patient covered adequately by their health insurance?

Clearly a lot of questions and one to be answered by a powerful health analytics system with a serious architecture!

Watch this space…

Thank you for reading.