Leveraging data can improve policy and more when it comes to big data challenges and the chiropractic industry
Hey there, fellow Chiropractic Warriors! I guess the headline caught your attention, and that’s a very good thing. Why? Because this conversation we are going to have around big data challenges, and how you understand and even leverage big data for you, your practice and your patients, may change your life forever.
Big data challenges: driving change
The world today is changing at an exponential pace. We live in the information age and all sorts of data are driving this change. With the advent of supercomputers, connectivity and all types of emerging technologies, big data is a key output of our technological advancements. So how does the chiropractic profession and individual chiropractors, and their patients, benefit from all these advancements?
Let’s start with some background context…
In 2005, Roger Mougalas from O’Reilly Media was the first person to coin the term “Big Data.” It refers to a large set of data that is virtually impossible to process and manage using traditional business intelligence tools.1 In 2010, Eric Schmidt spoke at the Techonomy conference in Lake Tahoe, Calif., stating, “there were five exabytes of information created by the entire world between the dawn of civilization and 2003. Now that same amount is created every two days.”2
Speaking of bytes, here’s a helpful table that gives context to just how big Big Data is:
| Unit | Shortened | Capacity |
| Bit | b | 1 or 0 (on or off) |
| Byte | B | 8 bits |
| Kilobyte | KB | 1024 bytes |
| Megabyte | MB | 1024 kilobytes |
| Gigabyte | GB | 1024 megabytes |
| Terabyte | TB | 1024 gigabytes |
| Petabyte | PB | 1024 terabytes |
| Exabyte | EB | 1024 petabytes |
| Zettabyte | ZB | 1024 exabytes |
| Yottabyte | YB | 1024 zettabytes |
[Author’s A.D.D. side note: I wonder who decides what the prefix is going to be before each … I’d like to be at that party for sure!]
As a refresher, bits are the fundamental building blocks of not only data storage, but all computers. Computers function in binary digits, combining 0s and 1s in countless patterns. These binary digits are known as bits, and they are the smallest possible unit for data storage.
According to a 2020 article published in the Harmony HealthIT blog, we are in the exabyte stage, but not for long. They write, “By 2025, some global estimates suggest 463 exabytes of data will be created each day. While it is difficult to picture the overall volume of data in the world, one visual is that with 44 zettabytes of data in the current digital universe, this represents 40 times more bytes than stars in the observable universe.”3
Um, that’s a lot of data … and we’ll be there in no time.
They continue, “In health care, current estimates suggest a single patient generates close to 80 megabytes each year in imaging and electronic medical record (EMR) data. Bottom line: The amount of patient health data is increasing exponentially, which means the amount of legacy EHR data is skyrocketing as well.”4
Leveraging data to help patients
So you may be thinking right now, “So what, Dr. Jay? Why should I care? How does this impact me?”
In one of my most favorite business books, “Exponential Organizations,” author Salim Ismail describes the research behind companies, organizations and business verticals that grow exponentially. How? You really need to read the book if you want the full set of answers to that question, but one thing all exponential entities share is that they are “information enabled.”
Data is information, and it helps us understand where we are, and how we can make the best decisions for the present and the future. We now have the ability to leverage this data and solves these big data challenges to help our patients and dramatically improve policy around chiropractic.
You might be saying right now, “Whatever, dude; prove it, wack job.”
OK, here are a few great examples:
- James Whedon, MS, DC, director of health services research, Southern California University of Health Sciences, and adjunct professor of The Dartmouth Institute for Health Policy and Clinical Practice, published several studies using big data to demonstrate chiropractic’s positive impact on the opioid crisis.5, 6, 7
- OptumHealth published several large-scale studies evaluating millions of episodes of low-back pain demonstrating that when the patient entered the chiropractic portal of entry, the total cost of care was the lowest among every single health care provider.8
These types of large-scale studies have profound impact on patient care delivery and policy. And, we are just getting started. With new interoperability rules put forth by the Cures Act9, as well as the rapid development of data science, we are now perfectly positioned to not just aggregate massive data sets from EHRs, wearables, mobile apps and more, we can glean significant understanding and insights though the use of artificial intelligence (AI), deep learning and machine learning.
AI capabilities
So just think about this scenario — every clinical, demographic and financial variable in your EHR can be exported to a data lake — a repository for data in its natural format. Then you tell a computer, programmed with AI, that you want to analyze the data to answer almost any question you want. Yes, that’s what I said.
If my team of doctors at our multiple chiropractic rehab clinics want to know which specific treatments get the best outcomes based on specific clinical and demographic variables — for instance, females with nonspecific low-back pain between the ages of 45-55 — machine learning can do that. Once we know which interventions get the best outcome, we train our doctors to leverage those interventions to continuously improve our outcomes.
The clinical improvement possibilities are endless. In fact, this scenario and many more that we can and will create like this is the perfect description of the Japanese word kaizen 改善, which means “continuous improvement.”
Now, multiply the above example by 103,469 chiropractors worldwide10, and that’s some big-ass data, and more importantly, some big-ass impact. Leveraging and publishing large data sets that have been appropriately analyzed, demonstrating the incredible outcomes we as doctors of chiropractic get in aggregate, can change policy for the better … and that’s not just good for our practices; it’s important for our patients, our communities and worldwide population health. We will get there, too…
Realistic idealism
“Dr. Jay, you are such a freaking idealist! It’s a really nice fairy-tale story you are telling, but chiropractors are always circling the wagons and shooting inwards. We will never be able to accomplish global cooperation with big data challenges such as data aggregation, analytics, publication and policy. You are a buffoon!”
Yep, you are right. I am an idealist … but a realistic idealist. And I’ve been a buffoon many times in my life; that’s for certain too. But on this point, I’m right, and here’s how I know …
For the first time in its history, the chiropractic profession has created and is executing a strategic plan (See chirocongress.org/future-of-chiropractic-strategic-plan). The Chiropractic Summit and The Congress of Chiropractic State Associations (ChiroCongress, or formerly known as COCSA), commissioned this plan. We have stakeholders of all types throughout our profession contributing to its development, its execution and its funding. I know, because I serve on the Task Force Leadership Committee, and I additionally serve as chairman of the ChiroTech Consortium (CTC).
Through the use of established, emerging and even yet-to-be-created technologies, the CTC role is to support each of the other committees’ (Research, Government Relations, Communications, Fundraising) objectives executing the Future of Chiropractic Strategic Plan. We have some of the brightest minds inside and outside of the profession on these committees and over time, you will see results. Why? Because we, as an aligned profession and all the while respecting diversity of thought, are committed to being information-enabled. And with data — Big Data — there is no stopping us.
JAY GREENSTEIN, DC, is the founder and CEO of Kaizenovate, a technology company that builds custom mobile apps for chiropractic practices, helping doctors differentiate and grow their revenue and their brand. He is also the founder and CEO of the Kaizo Health Companies, comprised of: Kaizo health, a multilocation chiropractic and rehabilitation practice; KaizoX, a sports performance and personal training company; and Kaizo Clinical Research Institute, a 501(c)(3) nonprofit that runs clinical trials to identify best practices. The Institute is part of a large multi-year NIH study evaluating emerging health-tech interventions for musculoskeletal conditions. He is a task force member for the Future of Chiropractic Strategic Plan and is the current chairman of the Federation of International Chiropractic du Sport’s World Olympians Scholarship Program. He is immediate past chairman for the Clinical Compass and a sought-out international speaker and consultant, teaching evidence into practice, leadership, business management and emerging technologies. He also sits on multiple advisory boards in health care and technology, and can be reached at Drjay@kaizenovate.com or through his personal and HealthTech Tribe Facebook page at facebook.com/groups/HealthTechTribe.
