Big Data-Hype and Promise

This issue of the journal has, as its focus, Big Data. Paradoxically, I wanted to take on this topic because I believe its value is overhyped. That is, we know what we need to do for health care delivery reform-without Big Data. To have successful health care delivery reform (defined as stabilizing health care costs while improving health care outcomes) payers need to

a. pass on a significant (not total) financial risk;

b. deliver meaningful reports to providers; and

c. encourage collaboration between providers and all payers.

Is it happening today? It is. It may not be happening rapidly enough, but the eternal optimist in me says yes. Graham Atkinson's article provides an excellent overview of the opportunities and pitfalls in Big Data. Thomas Graf and colleagues' article from a group at Geisinger details interventions using Big Data on coronary artery disease. The article of Steve Peters and James Buntrock highlights the importance of Natural Language Processing. I only hope that this small set of articles is just the beginning of articles submitted to the journal on this important topic.

The remainder of the issue highlights issues of importance to the journal. We are particularly interested, with the help of John Wasson and many others, to encourage engaged, empowered consumers. Eugene Nelson from Dartmouth has recently joined the editorial board and is the author, along with Gregg Meyer and Richard Bohmer, of the next article on the paradigm of self-care, the ultimate activated consumer. Medications are an integral component for an empowered individual with a chronic illness. Bernstein and colleagues describe an important approach to understanding and acting on challenges with medication harm. Medication side effects not only are costing the health care system billions of dollars but also result in many deaths and serious injury every year. This article is an excellent example of well-thought-through data analytics that are possible-in the absence of Big Data. Taking an international perspective, Gustavo Marin and colleagues highlight the importance of leadership for the success of any ambulatory organization. We continue to be vitally interested in community health workers, and Lee Rosenthal and colleagues continue to provide important information on this critical group of health care professionals. Likewise, Peter Shin and colleagues and, in a separate article, Sean Bruna-Lewis and colleagues provide important insights into the functioning of community health centers, another group of organizations this journal has an abiding interest in. There is a great deal of controversy regarding the implementation by the Centers for Medicare & Medicaid Services of financial incentives to decrease readmissions. A bill was recently introduced to give financial relief to hospitals serving low-income populations suffering significant penalties. Graham Atkinson provides an important perspective on the challenges of the Centers for Medicare & Medicaid Services approach.

John Wasson, Associate Editor, provides an important snapshot on individual confidence as it pertains to exercise. Mark Holt continues his in-depth examination of the amazing goings on in Texas.

-Norbert I. Goldfield, MD

Editor