Although I am not an MD, I run in a circle of non-traditional MDs, I was with my wife, who is a Psychiatrist, having dinner with a friend, who is a Pediatrician, and we were discussing our paths into professional life. My wife attended a midwest liberal arts college and didn't take any science classes until after she had graduated, and my friend attended a liberal arts college in New York studying psychology and had a similar trajectory. I was a general college wanderer at a large state university, sampling many classes with no real major or job prospects other than I liked computers, and I was good at them.
We started talking about what subjects we studied in college that became more important in our careers. For myself, linear algebra and differential equations are not even a part of my professional life. The closest approximation of skills I used in college to those I use today is those I learned in philosophy and literature seminars I took. One was on Liebnitz, and one was on DH Lawrence. These were unstructured classes where we read a book, discussed our thoughts, and attempted to impress and ingratiate one another.
Now, as I shape my career, I find myself drawn to Bronfenbrenner's Ecological Systems Theory.
In the diagram, we have the person in the center, and we seek to use the theory to understand how internal and external forces develop the person. From a data point of view, personal data is the best. In retail, we have market basket data. In healthcare, we have claims. In marketing, we have click-through customer journey data. By law, this data is highly-protected, and secure systems govern access to this data.
The Microsystem most influences the person's development. It is their family, peers, schools, healthcare, and religion, to name a few aspects. Some data has sources.
The Mesosystem is the interaction of the components in the Microsystem. Examples might be,
"What is the relationship between religion and schools?"
"What is the relationship between parents and schools?"
"What is the relationship between religion and healthcare?"
The interactions in the mesosystem can be an important factor in a person's development.
On the Exosystem, we have the national institutions and systems that influence the microsystem. From a healthcare point of view, the most important Exosystem is the Center for Medicare and Medicaid Services. It can include laws that affect the person's healthcare. It can include the economy and business environment affecting the person's livelihood and local microsystem.
Finally, on the macrosystem, we have the overall culture. We can look at this in multiple ways - there can be a national cultural view, but in our modern world, a consistent national culture is unrealistic, and culture is local.
Quantifying each of Bronfenner's Ecological Systems is less precise as we move from the person-centered data to the cultural or macrosystem data. The challenge in the study is to make meaning from aggregations and clustering of personal and microsystem data to model mesosystem interactions. Additionally, we want to understand how the ecosystem drives the mesosystem interactions and gain insights from data we find on CMS.
For example, legal developments at the CMS level like Interoperability can affect individual patients and give them better healthcare outcomes:
The Marketplace API can help businesses develop products that give patients better healthcare access.
Finally, understanding and guiding the cultural macrosystem is crucial to overall patient outcomes. What are the changing attitudes of our state, regional and national populations? What are the dynamics of changing culture in terms of building an environment that fosters health and safety for the person?
Understanding system thinking toward Justice and Equity is my primary goal in this blog, and the work that I do to use my skills in data going forward.