Skip to main content

Humans and Big Data: New Hope? Harnessing the Power of Person-Centred Data Analytics

  • Chapter
  • First Online:
Embracing Complexity in Health

Abstract

Big data provide the hope of major health innovation and improvement. However, there is a risk of precision medicine based on predictive biometrics and service metrics overwhelming anticipatory human centered sense-making, in the fuzzy emergence of personalized (big data) medicine. This is a pressing issue, given the paucity of individual sense-making data approaches. A human-centric model is described to address the gap in personal particulars and experiences in individual health journeys. The Patient Journey Record System (PaJR) was developed to improve human-centric healthcare by harnessing the power of person-centred data analytics using complexity theory, iterative health services and information systems applications over a 10 year period. PaJR is a web-based service supporting usually bi-weekly telephone calls by care guides to individuals at risk of readmissions.

This chapter describes a case study of the timing and context of readmissions using human (biopsychosocial) particular data which is based on individual experiences and perceptions with differing patterns of instability. This Australian study, called MonashWatch, is a service pilot using the PaJR system in the Dandenong Hospital urban catchment area of the Monash Health network. State public hospital big data – the Victorian HealthLinks Chronic Care algorithm provides case finding for high risk of readmission based on disease and service metrics. Monash Watch was actively monitoring 272 of 376 intervention patients, with 195 controls over 22 months (ongoing) at the time of the study.

Three randomly selected intervention cases describe a dynamic interplay of self-reported change in health and health care, medication, drug and alcohol use, social support structure. While the three cases were at similar predicted risk initially, their cases represented different statistically different time series configurations and admission patterns. Fluctuations in admission were associated with (mal)alignment of bodily health with psychosocial and environmental influences. However human interpretation was required to make sense of the patterns as presented by the multiple levels of data.

A human-centric model and framework for health journey monitoring illustrates the potential for ‘small’ personal experience data to inform clinical care in the era of big data predominantly based on biometrics and medical industrial process. Unless the complex dynamics underpinning readmissions are understood, many efforts may be directed at disease rather than at whole patient journey systems including disease. Many new technologies will emerge to enhance health journeys. It is important that appropriate anticipatory models inform their development. in order to enhance human sense-making.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Notes

  1. 1.

    The closer the t 1 model is to actual reality (the modelling relationship), the more likely anticipatory actions are to be useful. Of course ‘simple’ models in dynamic systems are constantly being adjusted with feedback. For example, my body tells me ‘I am thirsty’ at t 1 so I drink water; however, I am thirsty because I need increased intravascular volume despite increasing dependent oedema which more oral fluids will not fix. Hence, I need to reframe my anticipatory model at t 1 else I will be worse off at t 2.

References

  1. Oxford University P. Merriam-Webster Online Dictionary. The New Oxford dictionary of English; 1998.

    Google Scholar 

  2. Dimitrov DV. Medical internet of things and big data in healthcare. Healthc Inform Res. 2016;22(3):156–63.

    Article  Google Scholar 

  3. Norbury A, Seymour B. Response heterogeneity: challenges for personalised medicine and big data approaches in psychiatry and chronic pain. F1000 Res. 2018;7:55.

    Google Scholar 

  4. Hollar D. Trajectory analysis in health care. New York: Springer; 2018.

    Book  Google Scholar 

  5. Smith A. The big data revolution: from drug development to better health outcomes? Am J Manag Care. 2014;20(8 Spec No.):E4.

    Google Scholar 

  6. Tilly C. The old new social history and the new old social history. Ann Arbor: Center for Research on Social Organization. Harvard; 2007.

    Google Scholar 

  7. Kostkova P, Brewer H, de Lusignan S, Fottrell E, Goldacre B, Hart G, et al. Who owns the data? Open data for healthcare. Front Public Health. 2016;4:7.

    PubMed  Google Scholar 

  8. Krumholz HM. Post-hospital syndrome—an acquired, transient condition of generalized risk. N Engl J Med. 2013;368(2):100–2.

    Article  CAS  Google Scholar 

  9. Lakoff G, Johnson M. Metaphors we live by. Chicago: The University of Chicago Press; 1980.

    Google Scholar 

  10. Rosen R. Anticipatory systems: philosophical, mathematical, and methodological foundations. 1st ed. Oxford: Pergamon Press; 1985.

    Google Scholar 

  11. Ellis GFR. Top-down causation and emergence: some comments on mechanisms. Interface Focus. 2012;2(1):126–40.

    Article  Google Scholar 

  12. Rothman KJ. Causes. Am J Epidemiol. 1976;104(6):587–92.

    Article  CAS  Google Scholar 

  13. Sturmberg JP. The personal nature of health. J Eval Clin Pract. 2009;15(4):766–9.

    Article  Google Scholar 

  14. Sturmberg JP. Health: a personal complex-adaptive state. In: Sturmberg JP, Martin CM, editors. Handbook of systems and complexity in health. New York: Springer; 2013. p. 231–42.

    Chapter  Google Scholar 

  15. Sturmberg JP, Picard M, Aron DC, Bennett JM, Bircher J, deHaven MJ, et al. The emergence of health - how top-down environmental and social contexts constrain bottom-up biological potentials. A consensus framework. Front. Med. 2019;6:59. https://doi.org/10.3389/fmed.2019.00059.

    Google Scholar 

  16. Dantzer R. Cytokine-induced sickness behavior: where do we stand? Brain Behav Immun. 2001;15(1):7–24.

    Article  CAS  Google Scholar 

  17. McWhinney IR. An acquaintance with particulars …. Fam Med. 1989;21(4):296–8.

    Google Scholar 

  18. Gorovitz S, MacIntyre A. Toward a theory of medical fallibility. J Med Philos. 1976;1(1):51–71.

    Article  Google Scholar 

  19. Jylhä M. What is self-rated health and why does it predict mortality? Towards a unified conceptual model. Soc Sci Med. 2009;69(3):307–16.

    Article  Google Scholar 

  20. DeSalvo KB, Jones TM, Peabody J, McDonald J, Fihn S, Fan V, et al. Health care expenditure prediction with a single item, self-rated health measure. Med Care. 2009;47(4):440–7.

    Article  Google Scholar 

  21. Idler EL, Benyamini Y. Self-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behav. 1997;38(1):21–37.

    Article  CAS  Google Scholar 

  22. Lewis S. The two faces of generalism. J Health Serv Res Policy. 2014;19(1):1–2.

    Article  Google Scholar 

  23. Reeve J, Byng R. Realising the full potential of primary care: uniting the ‘two faces’ of generalism. Br J Gen Pract. 2017;67(660):292–3.

    Article  Google Scholar 

  24. May C, Montori VM, Mair FS. We need minimally disruptive medicine. BMJ. 2009;339:b2803.

    Article  Google Scholar 

  25. Too much medicine. https://www.bmj.com/too-much-medicine.

  26. Duerden M, Avery T, Payne R. Polypharmacy and medicines optimisation. Making it safe and sound. London: The King’s Fund; 2013.

    Google Scholar 

  27. Burton C. Can we explain medically unexplained symptoms? Fam Pract. 2014;31(6):623–4.

    Article  Google Scholar 

  28. WHO. Ottawa charter for health promotion. First International Conference on Health Promotion. Ottawa, 21 November 1986. 1986: WHO/HPR/HEP/95.1. Available from, http://www.who.int/hpr/NPH/docs/ottawa_charter_hp.pdf.

  29. A Primer on Precision Medicine: US National Library of Medicine; 2018. Available from, https://ghr.nlm.nih.gov/primer/precisionmedicine/precisionvspersonalized.

  30. What is pharmacogenomics? US National Library of Medicine. 2018. Available from, https://ghr.nlm.nih.gov/primer/genomicresearch/pharmacogenomics.

  31. Benyamini Y. Why does self-rated health predict mortality? An update on current knowledge and a research agenda for psychologists. Psychol Health. 2011;26(11):1407–13.

    Article  Google Scholar 

  32. Ferrucci L, Giallauria F, Schlessinger D. Mapping the road to resilience: novel math for the study of frailty. Mech Ageing Dev. 2008;129(11):677–9.

    Article  Google Scholar 

  33. Gijzel SMW, van de Leemput IA, Scheffer M, Roppolo M, Olde Rikkert MGM, Melis RJF. Dynamical resilience indicators in time series of self-rated health correspond to frailty levels in older adults. J Gerontol Ser A. 2017;72(7):991–6.

    Article  Google Scholar 

  34. Heller DA, Ahern FM, Pringle KE, Brown TV. Among older adults, the responsiveness of self-rated health to changes in Charlson comorbidity was moderated by age and baseline comorbidity. J Clin Epidemiol. 2009;62(2):177–87.

    Article  Google Scholar 

  35. Oosterveld SM, Kessels RP, Hamel R, Ramakers IH, Aalten P, Verhey FR, et al. The influence of co-morbidity and frailty on the clinical manifestation of patients with Alzheimer’s disease. J Alzheimers Dis. 2014;42(2):501–9.

    Article  Google Scholar 

  36. Lutomski JE, Baars MAE, Boter H, Buurman BM, den Elzen WPJ, Jansen APD, et al. [Frailty, disability and multi-morbidity: the relationship with quality of life and healthcare costs in elderly people]. Ned. Tijdschr. Geneeskd. 2014;158:A7297.

    Google Scholar 

  37. Geessink N, Schoon Y, van Goor H, Olde Rikkert M, Melis R. Frailty and quality of life among older people with and without a cancer diagnosis: findings from TOPICS-MDS. PLoS One. 2017;12(12):e0189648.

    Article  Google Scholar 

  38. Haaksma ML, Vilela LR, Marengoni A, Calderon-Larranaga A, Leoutsakos JS, Olde Rikkert MGM, et al. Comorbidity and progression of late onset Alzheimer’s disease: a systematic review. Plos One. 2017;12(5):e0177044.

    Article  Google Scholar 

  39. Martin CM. Self-rated health: patterns in the journeys of patients with multi-morbidity and frailty. J Eval Clin Pract. 2014;20(6):1010–6.

    Article  Google Scholar 

  40. MonashWatch: Keeping people healthy at home: Monash Health; 2016. Available from, http://monashhealth.org/page/monashwatch.

  41. Martin CM, Vogel C, Grady D, Zarabzadeh A, Hederman L, Kellett J, et al. Implementation of complex adaptive chronic care: the Patient Journey Record system (PaJR). J Eval Clin Pract. 2012;18(6):1226–34.

    Article  Google Scholar 

  42. Martin C, Sturmberg JP, Stockman K, Campbell D, Hederman L, Vogel C, et al. Supporting complex dynamic health journeys using conversation to avert hospital readmissions from the community: an ecological perspective incorporating interoception. In: Sturmberg J, editor. Putting systems and complexity science into practice. Cham: Springer; 2018.

    Google Scholar 

  43. Ferrier D, Diver F, Corin S, McNair P, Cheng C. HealthLinks: incentivising better value chronic care in Victoria. Int J Integr Care. 2017;17(3):A129. Available from, https://www.ijic.org/articles/abstract/10.5334/ijic.3241/.

  44. Staiger TO, Kritek PA, Blakeney EL, Zierler BK, O’Brien K, Ehrmantraut R. A conceptual framework for applying the anticipatory theory of complex systems to improve safety and quality in healthcare. In: Nadin M, editor. Anticipation and medicine. Cham: Springer; 2016. p. 31–40.

    Google Scholar 

  45. Goldwater D, Dharmarajan K, McEwen BS, Krumholz HM. Is posthospital syndrome a result of hospitalization-induced allostatic overload? J Hosp Med. 2018;13(5). https://doi.org/10.12788/jhm.2986.

  46. Martin C, Hinckley N, Stockman K, Campbell D. Post-hospital syndrome (PHS) and potentially preventable hospitalizations (PPH) in adults. MonashWatch adult cohort patient telehealth journeys. JMIR Preprints 2018. Available from, http://preprints.jmir.org/preprint/11952.

  47. Martin CM, Stockman K, Campbell D. Resilience, health perceptions, stressors and hospital admissions - observations from the real world of clinical care of unstable health journeys in Monash Watch (MW), Victoria, Australia. J Eval Clin Pract. 2018;24(6):1310–18.

    Article  Google Scholar 

  48. Rosen R. An interview with Robert Rosen. In: Rosen J, editor. (This is a corrected version [July 14, 2000], thanks to the help of Esther Wieringa). Available from, http://www.people.vcu.edu/~mikuleck/rsntpe.html1997.

  49. Mikulecky DC. The emergence of complexity: science coming of age or science growing old? Comput Chem. 2001;25(4):341–8.

    Article  CAS  Google Scholar 

  50. Sturmberg JP. Knowledge translation in healthcare - towards understanding its true complexities; comment on “using complexity and network concepts to inform healthcare knowledge translation”. Int J Health Policy Manag. 2018;7(5):455–8. Available from, http://ijhpm.com/article_3415.html.

Download references

Acknowledgements

The collaboration in the development, trialling and evaluation of the PaJR project by our colleagues Narelle Hinkley and Donald Campbell at Monash University, Australia, Carl Vogel and Lucy Hederman at Trinity University, Dublin, Ireland and Kevin Smith and John-Paul Smith, University of Queensland is kindly acknowledged.

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Martin, C., Stockman, K., Sturmberg, J.P. (2019). Humans and Big Data: New Hope? Harnessing the Power of Person-Centred Data Analytics. In: Sturmberg, J. (eds) Embracing Complexity in Health. Springer, Cham. https://doi.org/10.1007/978-3-030-10940-0_8

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-10940-0_8

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-10939-4

  • Online ISBN: 978-3-030-10940-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics