April 12, 2013 at 11:08 pm
Comments posted to this topic are about the item Bad Data Costs Lives
Best wishes,
Phil Factor
April 14, 2013 at 8:48 am
Great article. Lot of similar problems at Bolton as well.
April 15, 2013 at 7:13 am
Wonderful oped. I see manipulation of mortality stats every day. What needs to be looked at are the number of deaths in an ER. Most of the time these deaths aren't looked at as hard as a death in a regular hospital bed. Since that is the case some hospitals will move a patient to the ER "before" death so the stat shows as a ER death instead of in a hospital bed. It's not very ethical but when money is involved, ethics tend to go out of the window.
April 15, 2013 at 9:30 am
When data is bad or can be shown to be bad then a general distrust in ALL data will result.
In situations where the data is good but is telling an unpalatable story then the assumption will be that the data is bad and can therefore be ignored. Data is deemed to be guilty until proven innocent and no-one tries too hard to prove it innocent.
I have been in situations where man weeks have been lost doing a forensic analysis of a system to determine why the system was broken, how, who was responsible and what it would cost to put it right. Well it wasn't broken, just presenting an unpalatable truth.
April 15, 2013 at 10:41 am
The problem of “cooking” the data is hardly confined to healthcare.
Any time you are evaluating the performance of an organization with specific metrics you are giving people an incentive to play with the numbers.
Examples that come to mind are:
Recording order shipments that take place on the first day of the month in the prior month to kick up the order numbers for that month.
Carrying obsolete parts that can never be sold in finished goods inventory instead of writing them off because they don’t want the expense to depress profits.
Carrying uncollectable receivables on the books as assets instead of writing them off because they don’t want the expense to depress profits.
Two different manufacturing shifts recording production of materials that were in progress at the end shift so that both get credit for it, resulting in inflated production and inventory value.
Police recording reported serious crimes as minor crimes to make crime statistics look better.
Government budgets that vastly underestimate future spending and overestimate tax collections to make it appear that the budget is balanced.
April 15, 2013 at 11:45 am
Metrics, even when well intentioned, can distort. Particularly when you are dealing with something as amorphous as health treatment outcomes. A better hospital may actually have a higher mortality rate because its reputation brings a lot of more critically ill patients there... and the general disease categorization would not necessarily reflect this.
In the US (and probably elsewhere as well) there are complex standardized codes used for insurance, medicare and other issues. Doctors and hospitals MUST encode patients and this too gets to be a distorting force. Outright fraud notwithstanding, there is also a natural inclination to code as many codes as appropriate for each patient to optimise reimbursement. There are in every organization either in house or outside specialists who do the coding (not generally the doctor) because, besides lost revenue, miscoding can result in fines.
The bad thing about statistics like this is that you get what feels like solid information, clear crisp values, to multiple decimal places. But it's standing on a foundation of quicksand.
...
-- FORTRAN manual for Xerox Computers --
April 15, 2013 at 12:11 pm
The assumption behind Big Data is that, if you have perfect data, you can draw inferences from it without needing experience, judgement and professional knowhow. In the past, the quality of medical care was judged by inspection by highly experienced professionals. Review by peers. The quality of a highly advanced surgical technique was, we believed, best judged by a highly competent surgeon, for example. The person best placed to tell why a bridge fell down was an experienced bridge engineer. We now have the idea that, given the 'data', this can instead be left to a general-purpose 'manager' who knew some general skill called management. Even in my parents time, this was considered a laughable idea. It just frightens me more than somewhat. It isn't just Medicine. In the UK, education has been wrecked by an obsessional pursuit of tests and criteria by central government.
Best wishes,
Phil Factor
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