Medicover Ab

A J Vallance-owen Mbe

There is no question that technological advances, such as the development of big data and artificial intelligence, are already driving huge changes in practical health promotion, healthcare, and health-related research, and also in academic thinking.

In health promotion, there are now a number of innovative companies which promote good health in both the non-medical and medical spaces. Data (sometimes including genetic data) is collected from interested individuals and linked to significant evidence bases to enable advice on health priorities to be delivered online. As the database of anonymised personal data grows, now increasingly including post-advice feedback from those digital customers, so does the opportunity for artificial intelligence and machine learning, in itself now enhancing the original evidence base and driving constant improvement in the advice that can be given.

If the promised improvements to health are realised, this will benefit individuals and, if the numbers scale up (e.g. if employers get involved) then, over time, there could be an impact at population level; perhaps, at last, even a start to tackling the growing cost of chronic disease in healthcare systems.

In healthcare, collection of big data is becoming big business with huge opportunities, sometimes in areas of measurement that have been little used routinely because of cost and complexity. An example is the use of Patient Reported Outcome Measures (PROMs). The principal measure of clinical outcome routinely used has, historically, been the binary measure, mortality, i.e. dead or alive. Now, with digital technology, online systems, apps, etc., it is much easier for patients routinely to report the health benefits of their treatment using PROMs, which are properly validated survey tools.

In the UK, for example, the National PROMs Programme now has a massive database covering most of the hip and knee replacements done in the UK over the last few years.

This is big data which can be used to measure patient benefit beyond ‘alive’ (particularly quality of life), the value of the procedures to the healthcare system, to drive quality improvement and to get much needed early measures of outcome for new prostheses. My company, Medicover, is now starting to use some PROMs and the potential for driving improvements in surgical care and, increasingly, in the treatment of chronic disease is high. Another early benefit has been the growing evidence that, for many people with end-stage chronic disease or terminal cancer, quality of life is as important as survivability.

The increasing collection and use of big data could also have an impact on health-related research. Randomised controlled trials have always been the gold standard for clinical research, but they are usually conducted on carefully selected populations and managed in tightly controlled settings. Many doctors in day-to-day clinical practice say that this is not evidence from the ‘real world’ which they inhabit; whereas data gathered from unselected populations in high volume through vehicles like PROMs (with appropriate case-mix adjustment), can provide real-world evidence which might be equally or more valuable to them as prescribers.

In summary, change is a constant factor. It is no surprise that pharmaceutical companies across the world have become so interested in real-world big data and I believe that effective health promotion can now become mainstream, dead or alive should no longer be the main measure of outcome, health benefit from treatment and resulting quality of life must be the new standard, and the use of real-world big data has to find a respectable place in academic research.