Rapid Learning in the Library of Babel

Rapid Learning in the Library of Babel

George W. Sledge, MD, FASCO

Jul 29, 2011

The great Argentinean writer Jorge Luis Borges wrote a prescient story called “The Library of Babel” (well worth the read), in which the Library contains every book ever written or which could ever possibly be written. Information theorists apparently love this story, for it points to the central problems of data collection, storage, organization and use that haunt the Information Age we live in. The Library, which contains everything, is ultimately pointless: in the words of the anonymous narrator, it is “illuminated, solitary, infinite, perfectly motionless, equipped with precious volumes, useless, incorruptible, secret.”

I thought of this when I read a recent report of an Association of Community Cancer Centers (ACCC) meeting entitled “Mounting Data Requirements Swamping Oncologists.” The problem faced by doctors is straightforward: everyone wants data, in increasing amounts: every insurer, every hospital system, the government, vendors of every sort, and (yes, us too) ASCO. No two data sponges suck up the same information; the very lack of consistency is confusing, and sometimes infuriating, but always time-consuming and expensive. At the same time, the amount of data attached to individual patients continues its mad proliferation: megabytes giving way to terabytes and petabytes as we slice and dice our patient’s anatomy, physiology, genomes, proteomes, and what have you. And it is a given that it will only get worse, as the technology continues to evolve and as those who want data demand ever more.

And where does all of that data go? Into the Library of Babel, one suspects, where much is rendered ultimately useless even as it takes on a permanence of its own, independent of doctor and patient and practice. How many lessons regarding patient care, and how many hidden research agendas, are shelved in the Library of Babel? What progress might we make, and what time and effort might we save, if its contents were organized for our common benefit?

ASCO has decided to attack this issue through the development of the Rapid Learning System for Oncology, which would bring together our efforts in Quality (such as QOPI), Guidelines, and Health Information Technology. We have, within the past year, created a Quality Department, with the recently recruited and highly talented Robert Hauser as Senior Director. This department brings together many of the threads we will weave into a Rapid Learning System. We are committed to bringing our strengths in this area to bear on the problems and challenges we face in this area.

This isn’t an easy task, nor (we fear) a cheap one. The Library of Babel is huge, and getting larger and more confusing with every passing day. But we must, as a profession, take a stab at controlling our own destiny in this arena, or we face the prospect of being overwhelmed, or worse, controlled by data miners divorced from the realities of patient care and the genomic revolution.

If you want to get some sense of just one piece of this puzzle, a good place to start would be the July issue of ASCO’s Journal of Oncology Practice. This thematic issue concerns the use of Electronic Health Records (EHR) in oncology, and has several thoughtful, and thought-provoking, articles on the subject. The first two articles are by current and former Board members Peter Yu and Bob Miller: the Board of Directors has been paying careful attention to these evolving issues, and we have been fortunate enough to draw on the wisdom of these two tech-savvy clinicians. EHR is being heavily pushed as part of health care reform, in the hope that it will aid both standardization of care and quality improvement, and in doing so reduce cost. So far it has not done so, but it is clear that it is here to stay, so we had best make the best of it. The JOP article suggests several ways forward.

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Comments

Robert S. Miller, FASCO

Aug, 05 2011 6:02 PM

Dr. Sledge, I appreciate your drawing attention to the special thematic issue of the Journal of Oncology Practice devoted to electronic health records in oncology. Readers of this blog might want to take a listen to an illuminating podcast interview with Dr. Yu entitled "Why Meaningful Use Matters" at http://jop.ascopubs.org/site/podcasts/index.xhtml.


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