VA’s Thoughts on “Big Data”

The ECRI Institute’s Conference on “Big Data” held November 13-14, 2013 held at the National Academy of Sciences brought experts together to discuss the use and reliability of “Big Data” in healthcare. Conference presenters and attendees represented public and private health systems providers, insurers, government agencies, researchers, and employers.

The Department of Veteran Affairs with 8.2 million enrollees, 152 medical centers, 300 veteran centers, and 827 community-based outpatient clinics, is faced with managing enormous amounts of data. Robert L. Jesse MD, PhD, Principal Deputy Under Secretary for Health at the VA, presented his ideas at one of the panels.

He sees priorities changing and medicine transitioning from a medical model of care to team-based patient-centered care. This model of care will necessitate the use of comprehensive coded data, must be knowledge driven, and available via connected health in terms of telehealth and using sensors mobile apps.

He sees certain guidelines that need to be used to effectively manage data and the patient:

  • Data must be acquired as an integral part of the work process and not through retrospective data collection
  • Solutions must make the work easier and not impose undue burden or require re-work
  • Real-time visibility must exist across the system
  • Evidence-based management must be used to deliver evidence-based care
  • Complexity of healthcare along with the complexity of data must be effectively managed
  • Consider the patient user experience in the design and development of the system


The problem in working with volumes of data is that it is difficult to work across multiple records, harness the power of population-level data, and then be able to integrate this large-scale population system analyses into the workflow of the EHR.

Panelist Theresa Cullen MD, Director Health Informatics for the Veterans Health Administration talked about the VA’s mobile health as it exists today. Apps for clinicians are currently in various stages of development and testing to enable data to come from a patient’s EHR and be available in real-time and on-the-go.

Dr. Cullen discussed how the VA’s Family Caregiver Pilot loaned iPads to 1,000 Family Caregivers of seriously injured post 9/11 veterans. The iPads were pre-loaded with VA Mobile Health Apps created to support the caregivers and the veterans. Through the apps it is possible to interact with EHRs, provide disease management support, and manage and coordinate care.

Stephan D. Fihn, M.D, Director for the Office of Analytics and Business Intelligence at the VA’s Puget Sound Health Care System, wants to see “Big Data” eventually have a number of applications. These should include high level search capabilities, the ability to intelligently aggregate data, do predictive analytics, risk modeling, perform data mining to detect unrecognized relationships, do comparative effectiveness assessments, to evaluate healthcare interventions, and provide tools to effectively manage population health.

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