例如，癌症患者的60％以上是65岁以上的有两点到五点其他慢性疾病，如充血性心脏衰竭或高血压的任何地方。与年轻患者的试验不会涉及健康问题的相同组合。
“你得到一个年轻的成年人，年龄在50 ...，那没有比癌症以外的任何疾病，”罗伯特·豪瑟，临床肿瘤学的（ASCO）美国社会质量部门的高级主管。“所以，一旦药物从试验开发，它结束了上并没有大规模评估人口使用。现在，我们只能从所有成年的3％学会肿瘤患者，因为他们只有3％参与药物研发临床试验“。
And, once a clinical trial ends, patients are no longer tracked, Hauser added.
Also hindering advances in personalized medicine is the compartmentalization of healthcare data at hospitals, private practices and even clinical trials.
此外，电子病历使用专有软件，这意味着它们不与其他系统进行通信。从卫电子病历，例如，是否拥有一支由Cerner公司，麦克森或史诗系统本身不共享数据 - 在世界四大EHR厂商。
"We realize the data standards wars and interoperability issues that go on amongst EHR vendors is not something that's going to be overcome in the near future," said Josh Mann, assistant director of Oncology Technology Solutions for the ASCO.
There is, however, an industry-wide effort under way to break the logjam.
例如，非营利性健康水平七个国际本月初发布的标准，使医院的医疗交流信息，包括放射图像的准则。
2010年3月起，在联邦基金$ 564万份分配给各国发展健康信息交流，这允许通过电子数据转换引擎，让电子健康档案，以通过安全的互联网连接共享信息，共享健康信息。
The federal government has developed the Nationwide Health Information Network (NwHIN), which encompasses a set of standards, web services and policies that enable the secure exchange of health information over the Internet.
Currently, health information exchanges are being adopted at the regional, or at best, state-wide levels. Some of the most significant health information sharing networks are being deployed among healthcare providers themselves or by healthcare non-profits.
例如，ASCO最近建成了一个数据分析引擎，齐心协力，从超过10万名乳腺癌患者的信息，从27肿瘤科使用不同EHR系统的做法。而仍然是一个原型，该系统确实代表在美国最大的乳腺癌数据组中的一个，根据豪瑟。
Built mainly on open-source software, the ACSO's CancerLinQ project is a "learning health system" that will eventually analyze data from millions of cancer patients via their EHRs. The prototype system ingests de-identified patient data form two dozen oncology practices.
"We architected the system in such as way as to be able to accept any data in any format and then we used machine-learning algorithms to identify what was sent to us," Hauser said.
Once in the database, the data is mapped to a standardized medical vocabulary such as would be contained in the World Health Organization's International Classification of Diseases (ICD).
虽然原型被建立，就像一个概念证明，癌症医生最终将能够咨询全面的数据库就像一个谷歌搜索。这将允许医生看病人与同类型的癌症是如何在全国各地治疗，以及他们如何表现。
虽然目前使用的NoSQL，CouchDB的后台数据库中，ASCO正在使用Cassandra的使用Hadoop为全面建设考虑。该数据库预计在12至18个月内完成。
Beyond helping an individual patient, big data will allow the healthcare community as a whole detect poor drug interactions quickly. "So this gives us the ability to look at that [common cancer] population and figure out the best dosages and cycles of treatment," Hauser said.
虽然ASCO是最大的癌症研究机构之一，它是由任何一个单独在其使用大数据在确定最佳实践方法。
克利夫兰诊所 - 4500张床位的医疗保健系统 - 使用从史诗系统和电子病历的回顾性数据分析SQL事务数据库的EHR，以提高病人的治疗。
"We think first about outcomes: what data can we collect and make available to clinicians so they know how well they're doing in treating their patient," said Dr. C Marin Harris, CIO of Cleveland Clinic.
克利夫兰诊所也开始使用Hadoop的，但它仍然是研究的一小部分，因为数据在内部限制。
“它可能会出现，如果我们只分析克利夫兰诊所的数据，我们正在针对患者的表现不俗，但事实上，如果病人去别人的急诊室的10倍，我们不知道的是，”哈里斯说。
Cleveland Clinic is working with other state health plans to collect a broader swath of patient data. Along with Ohio's other largest healthcare provider, University Hospitals, Cleveland Clinic is preparing to share data across Ohio's statewide electronic medical records exchange, CliniSync .
一旦在交易所，克利夫兰诊所将电子链接到其他21家医院已经使用该系统。
在诊所的数据分析引擎针对一个慢性疾病是糖尿病。分析引擎的搜索电子病历为A1C测试，这是在红血细胞中的葡萄糖的长期测量的结果。了解一个人的平均水平，长期血糖水平可以预测他们患其他疾病，如肾衰竭或中风的可能性。
克利夫兰诊所知道的问题是多方面的。患者必须遵循治疗方案，选择健康的生活方式，和医生必须有长期的数据来量身定制治疗。但是，正如哈里斯指出，如果患者不知道他们是如何在宏观层面上做的，它更难以让他们改变自己的行为。
“......这些信息被用于不仅将警报发送到医生还要[于]病人，”哈里斯说。“他们可以在一定程度上成为自己的医疗保健的管家。”
为了更直接地参与患者，克利夫兰诊所允许他们通过葡萄糖读者醚手动输入自己的数据，或者有它通过移动设备自动输入到个人健康记录（PHR）。克利夫兰诊所使用微软的免费HealthVault的云服务作为其PHR。然后，HealthVault的应用程序可以将数据传输到该诊所的电子病历的医生和数据分析使用。
“正确的血糖水平的最好办法是知道的what's happening with a patient when they're at home, not when they're in a doctor's office," Harris said.
Also being floated in the heathcare community are scalable, less expensive and more patient-centric community health record banks. Those banks are community organizations that put patients in charge of a comprehensive copy of all their personal, private health information, including both medical records and optional information added by the patient.
The patient explicitly controls who has access to which parts of the information in his or her individual account.
语音识别加入大数据
但是，可以将信息共享之前，需要将它做成电子健康档案。一种方法的医生和护士可以添加自己的笔记，以电子健康档案是语音识别技术。
例如，美国陆军对Nuance的龙医疗设备360与它的AHLTA EHR和Essentris，住院系统使用网络版的语音识别软件企业范围的许可证。美国退伍军人管理局也有12,000 Vista的电子病历系统整合Nuance的龙许可证。
在许多情况下，医生会使用语音识别输入的观察，预后和治疗到患者的电子记录。
Dr. Walker, with the U.S. Army's Surgeon General's Office, uses voice recognition technology as he examines a patient to populate their record. A wide-screen monitor in his exam room allows the patient to view the data as it's being input so any errors can be corrected, he said.
沃克认为，在医学上真正改变游戏规则，将接合的患者，一个谁将会通过使用移动设备的进入他或她自己的数据。并且数据可以不仅仅包括医疗信息，而且还涉及到饮食和运动生活方式的更新。
By having a full picture of a patient's lifestyle, doctors are better equipped to help patients avoid the onset of chronic illnesses. Then, once the data is in an EHR, big data analytics engines could offer physicians information about patients who may need to adjust their caloric intake, level of activity or the amount of sleep they get.
"The answer to the obesity problem is not the operating table, but the dinner table, and that's where we need to get to," Walker said. "In this country, we're putting billions of dollars into healthcare and our life expectancies are less than in countries that spend a fraction of what we do.
"We're really doing disease care and not healthcare today," he said.
这个故事，“有多大的数据会挽救你的生命”最初发表Computerworld 。