NYT Mag takes deep look at data-driven medicine

David Leonhardt, writing for New York Times Magazine, profiles Brent James and Intermountain Healthcare, the hospital network he helps oversee. Idaho native James has turned the Utah- and Idaho-based network into a world leader using data to make positive changes to medical outcomes. James’ basic process is based on the idea that if there’s variation in treatment, then that variation will produce varied outcomes. He and his people track that variation and those outcomes, “identify variation and then figure out which treatments have not been working.”

Leonhardt’s carefully choreographed piece at once runs deep into Intermountain, and wide across the entire health care reform debate, illuminating how evidence-based medicine works and addressing criticism of it. A few highlights:

  • Electronic medical records make James’ work much easier, and much more effective.
  • Simply presenting doctors with a well-considered default choice, whether it be electronically or in the form of a pre-written prescription they must choose to either sign or discard, can have a significant positive effect on outcomes.
  • Intermountain’s statistics are impressive and numerous. One example: “A protocol for dealing with one broad category of pneumonia cut its mortality rate by 40 percent over several years.”
  • Dartmouth Atlas father John Wennberg called James’ work “the best model in the country of how you can actually change health care.”
  • Intuition, a cornerstone of medical decision-making, has its place but rarely outperforms data-based decision-making.
  • Not every implementation of evidence-based medicine will work. It must be done right. This involves heavy administrative oversight and a careful persuasive approach to dealing with physicians.
  • Intermountain’s pioneering work is often rewarded by a hit to the bottom line as their hospitals reduce the need for costly (and profitable) additional procedures.

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