Little Data: Important to Your Future Practice?
Brent I. Fox, Pharm.D., Ph.D. and Bill G. Felkey, M.S.
There is something enjoyable about stepping into a community pharmacy that has undergone little change in store layout and appearance over several decades. It is an almost tangible sense of nostalgia, history, and friendship that washes over you as you step through the front door. Certainly we enjoy modern conveniences and market-tested layouts (especially when we are in a hurry), but it is a treat to be able to sit down at a traditional soda fountain counter while our favorite milkshake is prepared. Brent recently had the opportunity to have such an experience in the small coastal town of Ocean Springs, Miss. As his group enjoyed milkshakes, ice cream, and other treats, it was easy to contrast the physical presence of the pharmacy building with the changing world in which community pharmacy is practiced.
The healthcare space continues to evolve, partially in response to the increasingly numerous and glaring shortfalls patients experience in terms of poor outcomes. Possibly an even greater driver to the changes you are experiencing in your practice is the continually rising cost of care. A single healthcare dollar can be divided into an array of expense areas, including inpatient hospital stays, nursing home and home healthcare costs, administrative fees, and physician and clinic services. Did we forget medications? Of course not. Medications span nearly every other expense area and are an important and growing contributor to overall cost of care. Even more importantly, appropriate use of medications, while increasing medication-specific costs, can decrease overall costs. You know how this is possible: Appropriate medication use can prevent more expensive costs, such as emergency department visits, inpatient hospitalizations, and disease progression.
Today, where does the pharmacist fit in this complexity? The most important responsibility for today’s pharmacist is to ensure patients experience optimal health in their medication outcomes. Many of you likely recognize the “outcome” theme from the pharmaceutical care philosophy of practice from the 1990s. An important difference in today’s pharmacy practice environment from that found in the 1990s is the emphasis placed on delivering care that is patient centered, while working in collaborative healthcare teams. The Health and Medicine Division of the National Academies of Science, Engineering, and Medicine says that patient-centered care elevates the status of the patient (or the caregiver) in that his or her preferences, needs, and values are respected in clinical decision-making. The patient becomes a collaborator in making decisions, but he or she is not the only collaborator. The vision of innovative care models like medical homes and accountable care organizations, along with technology-based tools like interoperable electronic health records and personal health records, is that care teams work in concert to consider the patient holistically in designing, implementing, and monitoring the patient’s health. As we continue to monitor the advancement of provider status for pharmacists, we are genuinely excited by the opportunity for pharmacists to truly begin practicing in an environment that incentivizes and creates the infrastructure to apply the vast amount of medication knowledge they possess.
Big Versus Little
If we focus on the patient’s role in the emerging healthcare landscape, we can see opportunities to begin closing the loop of information that will provide a more complete view into patients’ experiences when they are not in the walls of your pharmacy, a hospital, an emergency department, or some other formal care facility. While we have previously mentioned the concept of “big data” in this space, we have not addressed its complementary term, “little data.” Big data is likely not new to you. Have you noticed that Facebook’s ads often reflect something of interest to you? Or did you get a coupon that was useful to you during your last grocery store checkout adventure? Those experiences are big data in action. Big data is what organizations (or companies) know about their customers/constituents. It is most often captured, stored, and analyzed in data repositories and is intended to support the organizations’ efforts to reach their customers by more salient methods. While the discreet data elements making up big data are “about” people, the people do not “own” the data.
On the flip side, little data is what people know about themselves. The data making up little data is created by individuals during their normal course of life. It includes social circles, shopping patterns, activities individuals enjoy (and don’t enjoy), how individuals spend their money and time, and virtually any other quantifiable facet of life. The exciting fact to consider is that information technology-based tools are increasingly enabling the average person’s ability to record this data. Have you encountered the term, “quantified self”? It can be thought of as a movement to use readily available tools to objectively measure an individual’s daily life.
Ahhhhh, you say. Of course, you are familiar with the quantified self, because you have an activity tracker that counts the number of steps you take in a day. Maybe you even use your activity tracker to monitor your sleep patterns, or a smartphone app to record your daily caloric intake. Are you sharing this little data about your physical activity with an accountability group in a friendly competition to boost time spent exercising? Think about this: Your patients also have access to these lifestyle tools and many more.
Maybe you are not interested in Mrs. DeValk’s sleep patterns or Mr. Finnamore’s number of steps per day. But what about Mrs. Sharp’s last month of asthma measures? As you work through the mystery of her uncontrolled asthma, how insightful would it be to know the timing of triggers in relation to rescue inhaler usage, or to know if she really was as adherent to her maintenance inhaler as she claims? While you were probably introduced to the big data concept in the business context, we believe little data should be a key consideration as your practice evolves.
Asthma is certainly not the only chronic condition in which your patients can easily collect routine data about their life experiences. We are still dismayed that most prescriptions in the community arrive without a diagnosis, but frequently patients or their families can assist with this information. The tools exist today that allow your patients to collect many kinds of little data that they can share with you, with the ultimate goal of improved outcomes. Can your patient’s little data be incorporated directly into your pharmacy computer system today? In most cases, no. But we have to start somewhere. Even a printout of the last month’s measures is definitively more helpful than depending on the patient’s recall of medication adherence. Fortunately, most of the tools we are describing have Web interfaces to which your patient can grant you access. So we suggest a pilot test where you find a few patients that you anticipate will be excited about capturing and sharing their data. Start small and work on the logistical considerations with these motivated users, and then decide if you want to expand to a larger group. In the meantime, you can also start talking with your pharmacy computer system vendor about your evolving needs for integrating this data into your workflow. We welcome your comments. CT