CHICAGO—June 16, 2011—The American Board of Medical Specialties (ABMS) has announced the creation of a new certifying body, the American Board of Database Medicine (ABDM). The announcement was made jointly by ABMS and the American Association of Database Doctors (AADD), the leading professional organization representing database medicine specialists.
“The last decades have witnessed an unprecedented epidemic of data,” said Dr. Numbar Kruntsher, president of AADD. “Studies are published everyday, and new data is produced before the old data is even digested. Thankfully, growing numbers of dedicated physicians have stepped forward to help manage data by harnessing the power of statistics and information technology. We are delighted this work is getting the recognition it deserves, and we are confident the certification pathway will ensure that data will continue to receive the high quality of care the public has come to expect.”
The certification pathway includes a 3-year fellowship that covers data collection and handling, database design, statistical studies, and outcomes research. On the diagnostic side, the trainees will learn to recognize healthy data, identify data that is acutely or chronically impaired, and understand the life cycle of data points. On the therapeutic side, they will be exposed to techniques of data mining, data dredging, and data restoration—either back to previous functional capacity or for purely cosmetic results.
Database medicine has had great success in addressing problems of utmost public interest. “For example, after carefully examining 764,189,703 data points over a twelve year period, we have come to identify a potential harmful effect of using a proton-pump inhibitor concomitantly with clopidogrel. We have determined that this possibility comes with a reasonable probability of being true, although we must also acknowledge that even database medicine is not an exact science and the converse relationship cannot be excluded. Nevertheless, it is remarkable that we now have knowledge of this possible harm which clinicians and patients were completely unaware of, even years after these medications have been on the market. Our work has been validated by the FDA with a black box warning. We have achieved similar successes in other areas such as establishing the risk of rosiglitazone, defining the benefit of mammography in younger women, quantifying the optimal number of stents for patients with coronary disease, and settling a wide range of other issues.”
While the day-to-day activity of database medicine is generally solitary, centered as it is to on computer screens and spreadsheets, database doctors perform their most productive work in collaborative fashion. “Task force meetings are for the database doctor what grand rounds used to be for the bedside clinician,” say Kruntsher. “But a grand rounds conference could only issue one recommendation for one given patient. Task force meetings, on the other hand, generate guidelines and algorithms to treat thousands of patients never met before!”
In assessing societal needs for database medicine, Dr. Kruntsher pointed out that while much progress has been achieved in the last few years, great numbers of data points remain neglected and without access to proper databases for evaluation. Studies also show a high degree of regional variability in the way data is handled, with community hospitals and clinics in rural areas demonstrating a concerning lack of interest in taking care of data. Things are somewhat better in large metropolitan areas and in regions with high managed care penetration. But even in academic centers, where most database doctors currently practice, data is not always treated the way one would wish, he added. “In many cases, physicians lose sight of the bigger picture,” Kruntsher said.
But there is great hope for the future, particularly in the development of accountable care organizations who appear to be seriously focused on the health and well-being of patients’ data. “ACO’s are very promising, particularly in terms of collaboration between providers and database doctors,” said Kruntsher. As employees of ACOs, clinicians will be reminded to focus on data entry, which has always been a great challenge for database medicine. In return, database specialists will be able to issue guidelines with greater ease, for the benefit of both clinicians and patients. This will be of great value to patients who will be able to trust ACO’s to provide their data with a state-of-the-art, complete work-up.
“I think of it as holistic medicine,” said Kruntsher. “We pay attention to all pieces of information, not just the ones that seem pertinent.”