Should your doctor know you better than you know yourself?

Big Data has become one of the most popular buzzwords throughout many industries. But how does it fit into healthcare? There has been a rapid increase in the amount of data we generate in our daily lives; so much, in fact, that it has become known as “Big Data” and it is used to improve efficiency and productivity of businesses. This could soon become the case in healthcare too, where the power of Big Data is used to predict health epidemics and, in some situations, provide early diagnoses for individuals. So, is it ethical to use Big Data to improve healthcare for the masses?
There are several parties to consider here – the healthcare providers, patients, policymakers and engineers. Currently, healthcare providers want to give patients the best care they can so, according to a KPMG partner, most healthcare providers prioritise spending on new equipment over cybersecurity. This means that they are unlikely to upgrade existing security  because, without proper equipment present in the medical facilities, patients would receive lower quality treatment and thus negatively affect their reputation and revenue. It goes without saying that patients want to receive the best healthcare they can afford and expect their data to be kept confidential. In the case of most NHS patients, they don’t have much choice in how their data is secured; however, patients who use private practices can move to a practice that takes better care of them and their data.

Is prevention better than cure?

Application of Big Data in healthcare industry addresses two vital challenges; firstly, data analytics can not only assist the doctors in personalised treatment but also prevent the onset. Secondly, according a recent report, using Big Data promises NHS an increase in efficiency up to 60% whilst saving approximately GBP40 billion annually. Are these two benefits justifiable to implement  Big Data in healthcare?

group 9 1Let’s momentarily focus our attention to sepsis, a fatal condition that causes 750,000 deaths each year in the United States alone. Sepsis is difficult to diagnose and leads to death in a matter of hours. However, a study by Stanford University demonstrated that using Big Data revealed the potential for the creation of a simple diagnostic test, which could save countless lives. Imagine what else Big Data could help us achieve within the healthcare sector. Nevertheless, the use of Big Data faces criticism, predominantly from patients who are reluctant to disclose personal medical information.

Hence, the options for action are conspicuous. Firstly, healthcare providers and engineers could take the necessary steps to create efficient and accurate data analytical systems.

This is justifiable according to the utility principle as the economic benefits to medical enterprises and the advantages to patients from early diagnosis result in the greatest happiness to the majority. Furthermore, upon undertaking the Hippocratic oath, medical practitioners swear to prevent illnesses, as it is better than cure. The Engineering Council’s codes of conduct oblige engineers to prevent avoidable danger to health and adverse impact on society. Hence, the implementation of Big Data ensures that both practitioners and engineers adhere to their professional codes of conduct.

However, it could be argued that this theory disregards the pleasures of the minorities. Thus, using this framework to justify the use of Big Data could result in the exploitation of minorities that may not agree with this proposition.

The Kantian theory provides the view of the minority of patients. Kant’s first categorical imperative implies the equality postulate, which is the prescription to treat all people with equal concern and respect. According to this even the minority should be treated equal to the majorities. This could potentially lead to a solution that considers both parties where Big Data could be implemented based on the data provided by only those who consent.

What if someone else had access to your data?

Imagine a complete stranger using your medical record to file false insurance claims or to buy medication to sell on the black market. An annual survey found that the number of healthcare organisations reporting criminal cyber attacks had doubled between 2009 and 2013. Engineers need to be part of the solution by proactively working to increase the security of the software being used and raise up any major concerns to their employers.

group 9 2

Healthcare providers have to make a choice on how they spend their budget. Should they spend their money on cybersecurity, neglecting the purchase of new equipment? Should they spend all their money on new equipment? Or should they continue spending the same proportionately? Based on the post-utilitarian perspective, medical providers should prioritise cybersecurity over the purchasing of new medical equipment according to the principle of prudence. Furthermore, according to the principle of justice, policy makers and healthcare providers should treat the personal data they are responsible for in the same manner they would want their personal data to be treated. A double effect of this, though, is if healthcare providers allocated all funds towards increasing cybersecurity, there would be no money to spend on new equipment, resulting in lower quality care for patients.

Even then, patients and other stakeholders would not necessarily understand or be aware of the new policy implementations. Following this, what degree of hacking occurrences need to occur before proper action is taken to prevent it?

On the other hand, another approach to this issue would be to essentially spend no money on security and instead allocate all of it to the medical equipment. While this may provide short term benefit to the medical providers, in the long run they would be negatively affected as more and more medical providers around them follow the new big data trend and implement more effective measures in improving healthcare services. Furthermore, how does one justify having better cybersecurity when the cases of big data files being hacked are infrequent and largely spread out? In this sense, is it really worth spending on new equipment instead of on better cybersecurity?

Considering our arguments, is the use of Big Data in healthcare worth the risk? What are your thoughts?

Group 9: Kevin Fernando, Subodh Sardeshmukh, Dave Sanjay Shah & Alasdair Stringer

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13 thoughts on “Should your doctor know you better than you know yourself?

  1. 1) Some specification of why patients are so hesitant to share info (aside from hacked info) would offer some clarification as to why patients would like to remain silent. E.g. Sensitive patient issues such as history of pregnancy, STDs, plastic surgery being exposed to others

    2) Reference to Kant seems out of place, the Hippocratic oath is not really a proper guideline, more as a set of rules that doctors ideally should abide by; seeing that so much of medical ethics is devoted towards finding the right balance between human decency and efficiency, why not relate it directly one of its subtopics instead? E.g. confidentiality, informed consent, beneficence

    3) Personal opinion, hence totally unjustified: The whole online patient databasing process is still in its infancy and leaves much to be improved upon – something that has the potential to save so much money (prevention costs far less than cure) should be definitely looked into. Seeing that most medical institutions are under the heavy financial burden, purchasing new equipment is straight out inefficient and completely unviable in the long run, especially with growing, ageing populations. Improving cybersecurity is a natural and necessary process that every industry has to make do with (banks and other financial institutions have done a good job so far) – the medical field just has to keep up or it risks getting completely left behind. There should be more incentives aiming to educate patients on how this information is being used, and who it will go to (especially with issues relating to(1)).

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    1. The reference to Kant’s theory was made to highlight the fact that the utility principle does not account for the happiness of minorities which in this case would include patients who do not want to disclose personal information. These patients were considered minorities on the basis of the vast number of hospitals, doctors, engineers etc involved in this problem, as their core principles and codes of conduct encourage them to strive to take all steps necessary to prevent illnesses, increase safety and protect the environment. Hence, in some sense these stakeholder are obliged to work towards the implementation of Big Data due to the significant benefits described in the blog post.

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  2. Big data, which provides early knowledge on trends and epidemics, would also provide a focus for public health education; coupled with advancements in IT, healthcare institutions are now able to spread the appropriate messages quickly and effectively.

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  3. Being the daughter of a Doctor, who also owns a private hospital, I have experienced the vast sums of money generated from selling medical drugs and supplies to patients. However, the core principle of our hospital is to protect patients from various illnesses and where possible prevent the onset. Hence, I personally, think that hospitals should spend on both medical equipment and cyber security to make the implementation of Big Data a possibility. Hospitals can take measures to educate patients about the benefits from this implementation and help generate the required data. Nevertheless, the application of the utility principle alone seems unfair to the minority. Is it possible to combine the effects of considering both the utility and Kant’s theory?

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    1. Thank you for your comment Chayani. It is possible to consider the combined effects of applying both theories. The outcome would hence be one where Big Data is implemented with data collected from only those who consent to provide them.

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  4. According the kant’s theory, even the minorities should be treated equally. Even the docters would want to give the best medical treatment that is possible to save a life. Keeping this in mind, a docter would want to know more about his patients medical history and therefore big data would be very useful for a docter to provide a better service.Also a patient would not know what information is neccessary when he consults a docter and therefore will miss out on providing some information. If there is big data in the industry, a docter can access to all the neccessary information required and provide a better medical service.
    Cyber security has been a major concern in many industrys. As far as in my knowledge, health industry havent come across many cyber security crimes. The reason for this could be that the advantages of hacking a health industry is low. BUT when the big data is introduced, cyber crimes may increase becuase they can benefit by hacking the big data and making money out of it. Therefore cyber crime could increase after the implementation of the big data. But since this is not proven, in my opinion, i feel that the hospitals or the industry should allocate their resources on implementing big data but only after they meet the requirements for a good quality health services. Till they reach a good facility they should invest on equipments, because treating the patients should be the first priority than investing on “big data”. Big data could also fail and it is still not practical because everyone would not want to disclose their information. Therefore to treat all patients equally they should invest on medical equipments before they invest on “big data”. Because investing on new equipments guarantees better health services which is also the ethics of many docters nd hospitals around the world. Whereas big data does not guarantee you success.

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  5. We first need to appreciate the delicate balance that exists between operational and the strategic risk that is posed by usage ‘big data’ techniques. It is also paramount for one to analyze the increased reputational risk that exists if certain legal or social boundaries are distressed. As you mentioned, another key issue is the trade-off that exists between improvements in customer service and business operations. If this balance is not stricken perfectly then the health care can run into the risk of patients experiencing the ‘creep factor’. How do you define this balance and where do you draw the line? The issue with ‘big data’ goes beyond addressing the privacy concerns. The field of ‘big data’ to some respects can be visualized to be in its infancy. This issue raises so many opportunities the consequence of its use cannot be foreseen. Due to this uncertainty, where do we define what is right or wrong?

    Furthermore, it’s crucial to analyze the impact of ‘big data’. The first problem is the feasibility of anonymization and data masking. The large data sets that flow through in health care might require some form of ‘anonymization process’ to prevent the potential of leaking information about the individuals. The larger the data the higher the chance of errors in maintaining some form of anonymousness. This will inherently lead to more stringent cybersecurity, which is a financial burden. This then raises the question is ’40 billion pounds saved’?
    Another key problem is regarding bodies of low sensitivity data. This can lead to potential inference attack. Information such as birthday, gender and postcode are all that is required for someone of malicious intent to uniquely identify the majority of citizen data in publicly available databases. The ambiguity will in inference attack lead to a situation where an individual might have given permission to have their data used in an anonymous fashion might be unaware of such attacks. This slip up may lead to detrimental problems in the protection of private information. Where does one define ‘private’ information?

    Also, how can we protect the people? As we are currently in ‘information age’ we can see that some people do not care enough about their own privacy. A prime example will be the information published on social media. Translating onto the health care system, another issue that needs to be raised is the dilemma that exists is that what the patients trusts you to do does not always equate to what is legally allowed. This expresses the legal issues on breach of confidentiality.

    Moreover, the ‘big data’ uses automated techniques for evaluation. The huge amount of data leads to a multitude of interesting clusters and combinations in data. This is a very powerful tool when dealing with high volume and the high degree of variation in data. The risks of this are imminent. For example, patient segmentation and profiling can easily initiate discrimination based on age, gender, ethnic background, health condition and so on. These are limits that we humans can perceive, however, has technology reached a point to draw a clear distinction? Even deciding not to do anything with the knowledge is a decision with consequences already.

    Finally, the medical professionals need to evaluate the value of knowing the answers to specific information-driven questions to attain the required information. This brings a need to a new code to be developed as the intent of an individual can become the antecedent to big data analytics. While we analyze the implementation of this model of ‘big data’ in healthcare, we should always keep in mind that “Why do you want to know it” becomes the foundation before “what do you want to know.”

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  6. It was mentioned in the article that “using Big Data promises NHS an increase in efficiency up to 60% whilst saving approximately GBP40 billion annually”. I think one of the most important considerations is to understand how this figure compares to the costs of improving cybersecurity in the healthcare industry? Could the savings from using Big Data cover the costs for the required level of security and if not what additional investments would be required and how they will affect hospitals’ ability to purchase new equipment? I feel that investment in equipment should remain the primary focus as it is crucial for giving the patient the best treatment possible and quality of treatment should not be sacrifised for improved cybersecurity.

    At the same time implementation of Big Data can provide clear benefits in terms of efficiency of work in the hospitals as it will be easier to “predict health epidemics and, in some situations, provide early diagnoses for individuals.”

    Article raises an important issue of minorities who would not want to provide access to their sensitive data. I think that the mentioned solution where “Big Data could be implemented based on the data provided by only those who consent” is an appropriate approach in this case, which will leave almost everyone satisfied. In this case it will be necessary to ensure that everyone is familiar with potential benefits and dangers of implementing Big Data.

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    1. Thank you for your comment Eldar. You had a very valid point about the savings being sufficient to cover the costs of improving cyber security. It is something that we did not take into consideration.

      I also have to agree with you on the fact that using data from only those who consent would leave almost everyone satisfied and hence could be a possible solution to this problem.

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  7. The arguments presented suggest Big Data could save money, increase efficiency and save lives however at the risk of sensitive information being stolen and leaving a minority who do not want to be part of Big Data displeased.
    That ‘cyber attacks had doubled between 2009 and 2013’ clearly demonstrates there is a risk of theft, and leaves the questions: what are the rates of cyber attacks now, 4 years later? How much information is stolen? And how much can this risk really be reduced?
    Judging from the news, the frequency and severity of cyber attacks is great and the defense is inadequate. Simply that patients are ‘reluctant to disclose personal medical information’ combined with the security risks suggests that at least within the healthcare sector Big Data should not at present be used. While this does consider the impact of cyber security there is another question, what of information being bought and sold. This is particularly relevant to the relationship between the healthcare sector and insurance. Where are the lines drawn when it comes to the legal selling of information?
    Looking benefits being considered one is the ‘increase in efficiency up to 60% whilst saving approximately GBP40 billion annually’, this is of course important and in many sectors this would be the primary concern. However healthcare is a sector unlike others, it does not merely sell a product. It is perhaps one of the most personal, individual and human sectors, in that it is more involved with its “customers” (read as patients) emotionally, psychologically and physically than most sectors and people share details about themselves with healthcare professionals that they would not share with anyone else, which in the wrong hands could have significant repercussions.
    For me the fact that the healthcare sector is so personal and yet more consideration is often given to efficiency and cost is probably the greatest reason that Big Data should not yet be used within the healthcare sector. I feel that significant progress needs to be made surrounding the moral and ethical issues and clarity needs to be give to exactly the what the primary purpose of the sector is.

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  8. Even if healthcare providers consider implementing Big Data, how adverse are the implications of the financial compromises (in terms of medical equipment) the enterprises need to make in order to make it successful?

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    1. Thank you Parimal for your question. Though implimenting Big data has adverse financial implications, in the long run it will save enormous costs. These costs primarily include mitigating diagnosis. Secondly, for instance, if there a breakout of any disease, it could cost much higher for conventional methods to minimise the widespread. Therefore, it justifies the initial costs of implimentation.

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  9. Are you sure that the utility principle disregards the pleasures of the minority? If I recall correctly, the utility principle takes in to account the pleasures of ALL parties involved.

    I would assume that true healthcare providers would put the interests of their patients first before anything else, providing the best healthcare possible for their patients. Thus, healthcare providers should spend their budget proportionately towards cyber security and new equipment. With regards to the minorities who are not comfortable with sharing data, perhaps healthcare providers can educate them on their practices and use of data, how is their data being protected, etc.

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