What is “Big Data” and How Is It Related to the Practice of Orthodontics?

Dr.-Puntillo-PictureBy Anthony M. Puntillo DDS, MSD

Have you heard of the term “Big Data”?  My guess is that for many orthodontists the term is likely a bit like the term “The Cloud.”  They may have a general idea of the concept, but are not entirely sure how it is or will be important to them.  In fact, there is a strong relationship between the two terms that I will discuss later in this article.  First, however let’s look at “Big Data” by itself.  According to Wikipedia “Big data is a blanket term for any collection of data sets so large and complex that it becomes difficult to process using on-hand data management tools or traditional data processing applications.”

In 2009 the United States Congress passed the American Recovery and Reinvestment  Act (ARRA) which included the Health Information and Technology for Economic and Clinical Health Act (HITECH).  [For a detailed summary of this legislation please see Kirt Simmons blog posting from July 9, 2012 “The Electronic Patient Record: How it Affects the Private Practitioner”]. One of the requirements of HITECH is that full implementation of electronic health records (EHRs) for all patients is required by 2016.  The requirements of this act specifically pertain to healthcare providers who participate in the Medicare and Medicaid programs.  That means that currently few dentists are covered by this mandate.  However, this does not mean that we are not being affected.  Since 2009 doctors and hospitals across the country have spent billions of dollars, with the help of government subsidies, converting paper based systems to electronic digitally based health records.  These new digital systems are now collecting vast amounts of valuable data related to patient care.  Much of this information was collected before the legislation, but in a paper non-standardized format that was not easily aggregated and retrievable for meaningful analysis.  The value of all of this collected digital data is only beginning to be fully understood.  Big Data from all healthcare providers is being aggregated and programs to analyze the data are being used to improve the quality, safety, and efficiency patient care.  Hospitals are examining treatment protocols and doctors are making better informed treatment decisions based on the previous care of thousands of similar patients.

As I stated earlier, the EHR requirement of HITECH does not specifically pertain to most orthodontists so why is this important to us?  Many orthodontists have or are now also in the process of converting their practices to paperless systems (without the assistance of the government money).  Several of the orthodontic specific software vendors offer cloud based systems and here is where “Big Data” and “The Cloud” come together.  The aggregation of data from hundreds or thousands of individual private orthodontic practices into cloud servers is beginning to open the door for data analysis (mining).  Just think about how valuable that information can be to our patients and practices.  Most of the research studies published in our journals today involve treatment samples of less than one hundred.  The biannual Journal of Clinical Orthodontics Practice Study generally relies on the input for a few hundred survey responders (out of a possible pool of more than 8,000). Wouldn’t it be helpful for us to know the most efficient type of Class II corrector based on the actual metrics collected from the previous care of thousands of patients treated in practices all across the country or the globe?  Wouldn’t the knowledge that your treatment times/appointments vary significantly from the national or regional averages be useful? There is little question that access to “Big Data” analytics will offer our profession the opportunity to improve treatment quality, safety and efficiency for our patients just as it is beginning to do for the other fields of healthcare.

18 thoughts on “What is “Big Data” and How Is It Related to the Practice of Orthodontics?”

  1. There is some concern that this data mining could be used by dental insurance companies to deny or reduce insurance coverage for orthodontic treatment based on a case not being “medically necessary”. Do you see a valid concern here?

    1. The “medically necessary” firestorm, a byproduct of the Affordable Care Act (ACA), is a significant issue for our profession. Insurance companies have collected statistical data on all medical procedures for years. There should be little doubt that they will attempt to utilize “Big Orthodontic Data” to limit coverage for care. If you have not yet been required to “grade” your patients to determine “medical necessity”, consider yourself fortunate.

  2. This report contradicts the concept of “Evidence-Based Orthodontics (EBO).”
    I believe your Big Data Cloud will rain Big Bias.

    1. Ultimately it comes down to how the data is filtered and interpreted. Greg Huang, author of “Evidence-Based Orthodontics” (Amazon) has pushed for a nationwide network of clinicians to participate in clinical scientific studies. I believe he has done so largely because much of the research being done in our profession is performed on sample sizes too small to draw truly meaningful conclusions. Data gathered from the clinical practice of orthodontics, if done appropriately, can have a positive impact on the care our patients receive. I do concede, however, that just like some of the “research” that is being published in our evidence- based journals “Big Data” could be filtered or interpreted in such a way as to promote a bias.

  3. Any Data collected through, Subgective Questiner, in a Survy is no more than Public relation to present trend & Must not be used to formulate any Rational Decision.

    Any Data presented, mostly are trying to suppoert the presented point of view, as Too many Variables & difficult to confirm any number presented by Questionere… Such Data are used in Advertising and of little valuyes to us. All the JCO Survey are no more than Decpetive Hype, Just to pacify the orthodontist . It is sad That Rational thinking Orthodontic belive in such irrevlant Hype. Any data that may have any influance on the practice must be Specific, Customized & have a specific goal. Thus one can reduce variability & Customized any strategy… To assume Universal Generic Data is of any value to indevidual Practice is nothing but Wasted Hype. Same assumption as bracket & wire alone are core of our treatment process, you can find data to support such ignorance…..please check with any B. School Marketing Dept to Confirm……. It Is time for us not to drown in irrevelant data…

    1. I would agree that today the generic data gathered from the JCO surveys is suspect and of questionable real value to the individual practice. However, in many respects, it has been the best we have had to go by. I doubt that there is a business school today that is not teaching their students about “Big Data”. I am certain that the B school grads that are managing the hospitals, insurance companies, and governmental agencies dealing with healthcare do not view the data being collected as “hype”. The point of “Big Data” mining is to use a uniform platform (i.e. the Electronic Health Record) to collect information while eliminating as much subjectivity as possible. Ultimately the data collected still must be reviewed, analyzed, and interpreted by each individual practice to determine how best to utilize the information.

  4. For a Private Practice the most critical data are:
    1- What is your breakeven number
    2- what is your cost driver, can one manage it.
    3- What is your Effeciency Ratiuo, Ratio between Estimated treatment time to Actual time.
    4- How is the Patient Flow in the treatment process, and what is your Patients Inventory
    5- What are your Profit margin…..
    Those are critical Data that effect the ortho practice…. Problem with Number is HOW TO MANAGE IT, UNDERSTAND it & APPLY it to help your operation…… Sadly Doctor are intemidated by numbers, Numbers are an efective selling points to promote any non value hype.
    Time for AAO to adopt honest survey for variable practice to help establish the best practice so one can relate their operation too… . We have enough of JUNK survey from JCO, it is doing disservice to our profession and a sad reflction on our ignorance of values of numbers & data…. Smart salesman can proove any thing with data or numbers… Time to be effective & not be absorbed & confused by hype we are smart but when it comes to Business we are LOST Good Luck Al atta

  5. Al, you are not wrong in your assessment of the situation and the real needs of orthodontists. However, the AAO is only interested in self preservation and those in power are only interested in self promotion. They have no desire or motivation to find the best people to help the membership – they will only promote those who buy into their “years in service” view of the world. Results are secondary and even ignored. This is why they have Tweeter dinosaurs who take out premolars on everyone (and make us very popular as a profession with the public) like James Vaden doing webinars on “modern treatment techniques” instead of promoting the shining stars of our profession like Sarver, Graham, Kozloski or Dischinger. The same goes for those talking about business and consulting. Only those consultants and coaches who toe the party line are given the podium and instead of getting the most successful orthodontists in the country to teach the “business of orthodontics”, the AAO would rather have party loyalists who have done the same thing for decades talk about what used to work in the “good old days”. Big Data is the least of our worries. A big, bloated, antiquated membership organization focused on self preservation while ignoring modern realities is much more dangerous.
    That’s why I’m leaving the AAO.
    I know the leadership won’t care and that this will likely be deleted within 3 seconds of posting but such is life. No longer will I give money or credit or time to those determined to see the Orthodontic Specialty follow Prosthodontists into extinction because they fear the ADA and PCDs.
    Oh, and don’t forget that the needs and wants of the AAO leadership (60+ yowm) is far removed from those of us who are under 50 and have decades until retirement. The old guys may be able to ride it out until they retire for several reasons but that model will not cut it for the rest of us. If you look at the leadership, the reason most of these old guys have the time to “volunteer” to fly around the country to spend our dues money at the Ritz and on fancy meals is because their little practices are in the crapper and they can’t compete in the modern world (DeWayne McCamish being the big exception here when it comes to the BOT). Is it smart to have people like that making decisions for our profession?? Isn’t it time to ask what we get for the 1800 bucks a year we give these folks?

    1. Toni,
      Your comment,Integrity & courage is greatly Apprecited…. our AAO are Dynasor….. they do not give a care about future of pofession… The ADA, & AAO are going downhill & taking our profession down with it… For Last Ten year I had been screeming, Change, Control the Perk.. Sadly nothing change.. We love our professon and You can see the decline in the market… We have a moral obligation To present truth… At B. School I was told Organization like AAo only change when Bankrubty is alternative… If 30% of member stop Paying the dues here gone AAo….
      I value your honesty & integrity Please stay in touch through my direct E. mail
      Stay strong & keep good work If I can be of help or Support let me know Al.

      1. Al,
        To be clear, I did not make the comments that you are referring to regarding the AAO. Those comments were made and should be attributed to Dr. Ben Burris.
        Thank you for your interest in the topic of Big Data.

        1. Many people writing like they were promised a “Rose Garden.”
          Perhaps they need to review their “choices” and the term, “self responsibility.”

          1. Hallo Sir,
            Are you happy by the status of our profession?The stressed economy , is the beginbig of decline…. our cost of service escalated, our fees became a barriers for new start… & our margin is shrinking…. we used to finish our cases in 24-30 months with assured stability now we CAN Not, saY 40-50 mos, …. The profession is in decline more sadly new Graduate have NO JOB, or future…. No Bank to loan them money & Hard for them to to serve their debt… We can not Blame All of this on AAO, It is time for ALL of us to start change strategy & learn we are in a business & it is impossibvle in current market to manage any business with NO BUSINESS knowleedge BS. do not help& end up as a cost.& waste………This is our profession We must be Honst & not afraid to tell Truth… Sadly New generation of our Children will eiter live with relapsed Mal-occlusion or Can not afford Treatment… Remmbver England That is the Furure. I assure you if we do not change solo practice most of them will exit market soon & DDs will treat ma-occlusion with invisalign & wires of mass distruction to gather with miracle Bracket… ARE WE SMART.? Time to change & improve, Our Future aee No good… we need change leaders……. Al Atta DDs, Msd, Mba

          2. I hear complaints but no solutions. What are you going to do about it?
            If you were an officer on the AAO Board, what would you do? Do you have
            experience in managing an organization? Perhaps you need to move to a
            location where the economy is better.

          3. Blah, blah, blah… All I hear is more excuses. What do you spend the 25 million dollar annual budget on??? Spend it on proper advertising and lobbying instead of allowing all the fat cats to sit around and talk and we will be better off. 25 million dollars a year the AAO spends on what exactly? Pull your head out and smell the new reality.
            My solution is to leave the AAO and look after myself and my practice because the AAO will just look after itself and those with vested interests.

          4. Show me the ads and where you would place them.
            Remember, there are 100,000+ general dentists and about 10,000+ orthodontists.

          5. Actually there are more like 140,000 primary care dentists. Jeff Behan and VisionTrust have put out some excellent PSAs that you should check out.

          6. We All are wasting time & energy and NO SOLUTION. We are Smart & Professional Every one decide what to do & how to spend our Money. PLease Do not Stress our AAO, They doing best they Can, with Conestrain they Have… Changes come from bottom up . We All will Survive.
            Rgarding Advertising, Sadly We spread our lack of knowledge assuming that advertising will present return benefit This is old STUPIID Concept. ONE have to advertise a BENEFIT that customized to the practice…. to build competitve advantage… to waste money on PR Add saying we arte great or advetise Quality & price is No Value. This is my last comment as we are wasting our enegy good luck. Stop learning marketing & business from those who sell their experience learn from expertise…..good luck. Al Atta

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