Tracking the Long Arc of Big Data in Medicine

Big data may be the future of medicine but is also its past. As the scale of big-data medicine has changed, many of the hopes, fears, and challenges have not. Diagnostic algorithms, electronic medical records, and the exponential growth of published medical research offer challenge and opportunity much as they have since the computer’s introduction into medicine 50 years ago.

In the paper “Digital Futures Past — The Long Arc of Big Data in Medicine,” published this week in the New England Journal of Medicine, two Johns Hopkins history of medicine scholars track the history of digital medicine from late 1950s efforts by Cornell physicians and IBM engineers to build a computer that could calculate all hematologic diagnoses.

“What happens when human intelligence cannot comprehend the pathways of computer decisions?How does computerization of medical information change physicians’ roles or replicate the foibles of human diagnostic reasoning? What unintended displacements and transformations will computerized medicine produce next? These are not new questions, nor are they resolved by new technology,” write Berman Institute faculty member Jeremy Greene and Andrew Lea of the Johns Hopkins Center for Medical Humanities and Social Medicine.

Greene and Lea write that the promise of big data in medicine today recalls the optimism that accompanied the computer’s introduction into medicine 50 years ago, but also raises similar concerns.

Just as physicians in the 1950s feared building computers that would make diagnoses without humans understanding their decision making process, there are similar fears today that machine learning might – instead of eliminating lapses in human judgment — harden errors and biases into rhythms of care.

Around the same time, physicians began to see the advantages of storing patient records digitally rather than on paper, but systems often broke down and patient care was compromised. Today, electronic health records have eclipsed paper records in U.S. health care, but Greene and Lea say “studies document lingering clinician unease with the integration of computer systems into the clinical world. The promise of producing new, lifesaving forms of health data has yet to be fully realized,yet the EHR has altered doctor–patient relationships, increased the amount of time clinicians spend documenting their efforts, and been identified as a leading source of physician burnout.”

The authors also cite the double-edged sword of today’s digitization of medical information. While online repositories make vast amounts of medical literature available at the touch of a keyboard, their contents date back only to 1963. As a result, vitally important medical information circulated before that date can go unseen, with grave consequences.

“At every scale of ‘big data,’ computers have offered elegant technological fixes to social, professional, and informational challenges — while introducing new problems,” write Greene and Lea.“Then as now, computers offer a means to transcend the human mind’s limitations in a world of expanding information and generate concern about entrusting life-and-death matters to unseen algorithms.”