Health Services Research & Development

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Director's Letter

David Atkins, M.D., M.P.H., Director, HSR&D

A Facebook post last year by Duke professor and behavioral economist, Daniel Ariely, Ph.D., noted, “Big data is like teenage sex: everyone talks about it, nobody really knows how to do it, everyone thinks everyone else is doing it, so everyone claims they are doing it.” We have probably come some distance in the actual use of big data in health care since that time, but we still might be in the phase of the Gartner Hype Cycle where expectations exceed reality. As health services researchers, our training and experience condition us to be skeptical about innovations that will supposedly transform health care and lower costs (disease management, anyone?). But we shouldn’t let healthy skepticism blind us to the real potential of big data. Health services researchers will increasingly be playing in the world of big data—characterized by data that is voluminous, varied, and real-time—thanks to several developments. First, the creation of the Corporate Data Warehouse and the VINCI environment means researchers can use national data sets rather than being restricted to studying patients in their facility or VISN. Second, a growing number of tools for using natural language processing will allow researchers to incorporate information from text records into their data. Finally, patients will be reporting an increasing amount of data directly to their health records, including patient and family history recorded by MyHealtheVet, health behaviors collected by mobile apps, and patient-reported outcomes collected by clinic kiosks or smart phones. These data will allow us to make better predictions and to uncover specific clinical patterns that were previously obscure.

Health services researchers bring several strengths that will improve our use of big data: 1) concern about and knowledge of data validity; 2) ability to use theoretical models for drawing inferences from observed associations; and 3) understanding how to turn insights into useful information for clinical care. Big Data will change how we do research and may make obsolete some of the traditional ways that VA collects data—for example, the individual chart reviews for the External Peer Review Program. But it will only increase the need for the skills of smart health services researchers.

David Atkins, M.D., M.P.H., Director, HSR&D