This month’s continuing education activity, “Pressure Ulcer-Related Pain in Nursing Home Residents with Cognitive Impairment,” on page 375, is an example of the use of information collected for regulatory and clinical data sets to inform our clinical decision-making processes in the field. The data tackle and try to make clinical sense of 3 problems in which there is a wide variability and subjectivity in the practice patterns and clinical decision making: (1) pain, (2) cognitive impairment, and (3) pressure ulcer management. This work by Ahn et al demonstrates how “big data” are currently utilized and their potential for the future.
Big data are simply the use of ginormous bits or sets of data in the terabyte-and-beyond range,1 which are exponentially increasing by the minute, owing to the capacity of data collection, storage, and analysis. The use of big data is made possible by the recent explosion in computing capacity in business, manufacturing, and now healthcare.
Some examples of early adopters in data management in wound care and skin-related diseases were in the United Kingdom, where they use the General Practice Research Database, which is a large database that was established in the United Kingdom in 1987 to allow researchers to conduct large epidemiologic studies.2
The use of big data is an example of the concept of “disruptive innovation.” Disruptive innovation3 is a concept whereby the healthcare industry can transform to provide increasingly affordable and conveniently accessible healthcare by expanding the use of data, teaching workers at the point of service, and transferring skills from “highly trained but also expensive personnel to more affordable providers, including the use of technology-based care.”3 This concept was persuasively modeled by Sharkey et al.4 Not only did they make use of big data by incorporating the data from 14 nursing homes, but they also tested the concept of disruptive innovation in healthcare by measuring the utility of “training up” nursing assistants to improve quality, cost, and outcomes in wound care.
This month’s continuing education article is an example of big data and the opportunity for disruptive innovation, which is inherently more complicated given the complexities of the confluence of pressure ulcers, pain, and dementia. It is unlikely that a person trained in pain medicine will be practicing in the nursing home environment, especially with expertise in both the management of dementia and wounds. The opportunity for disruptive innovation is to specifically train the staff in recognizing and documenting the patient’s pain and treatment outcomes. We now have big data on our side. Perhaps by incorporating more national data, we can learn more about this complicated issue proposed by the Ahn et al article in this issue.
“The roots of great innovation are never just in the technology itself. They are always in the wider historical context. They require new ways of seeing. As Einstein put it, ‘The significant problems we face cannot be solved at the same level of thinking we were at when we created them.’” —David Brooks.5
Richard “Sal” Salcido, MD
2. Gelfand JM, Troxel AB, Lewis JD, et al. The risk of mortality in patients with psoriasis: results from a population-based study. Arch Dermatol 2007; 143: 1493.
3. Christensen CM, Grossman JH, Hwang J. The Innovator’s Prescription: A Disruptive Solution for Health Care. New York: McGraw-Hill; 2009.
4. Sharkey S, Hudak S, Horn SD, Spector W. Leveraging certified nursing assistant documentation and knowledge to improve clinical decision making: the on-time quality improvement program to prevent pressure ulcers. Adv Skin Wound Care 2011; 24: 182–8.
5. Brooks D. Where Are the Jobs? New York Times, October 6, 2011.