Get social data into EHRs to bring precision medicine to population health
BOSTON -- Personalized care depends on a lot more than a person's molecular makeup. In fact, it more often stems from larger external forces that exert a profound and often unnoticed impact on wellness: air and water quality, financial stability, the ability to get healthy groceries and even broadband internet access.
"Precision medicine is about more than the genetics and the drugs," said Vikram Bakhru, MD, chief operating officer at ConsejoSano, a Spanish-language health services and patient engagement platform.
At the HIMSS Precision Medicine Summit Tuesday, he explained how lifestyle, economic and environmental factors have huge effects on population health – and how electronic health records need to do a better job incorporating data about social determinant data.
"We are focused on the genetic components of disease, and that's important," said Bakhru. "But we have to start understand all of the other components that really matter."
As much as 70 percent of a person's health is determined by social or environmental factors, he said. But despite near-ubiquity of EHRs, that crucial information is still not being logged to help guide care and treatment plans.
"When we talk about the social determinants of health, a lot of it start with the EHR, and making sure that a lot of that information is surveyed by clinicians."
Bakhru cited a study that showed that 50 percent of the information relayed from the patient to the physician during outpatient encounters was not logged in the EHR.
The question, then, is how to harness precision medicine tools that can make social determinants of health a core focus. That won't happen without more robust connectivity – especially for those underserved populations that need it most.
"I think the number one issue you're going to see in the next 10 years is access to bandwidth," he said. "This is going to be our major challenge."
But there's reason for optimism, said Bakhru, who sees office visits increasingly supplanted by telemedicine, which has new momentum: recent policy shifts to bring down barriers to access to telehealth "are miraculous," he said, "the changes to state laws are incredible."
From there, he sees evolution toward a "new class of care" which will harness all aspects of precision medicine, genetic and social, making the most of mobile apps, connected health tools, patient engagement strategies and more.
Along the way, it's key to keep an open mind, he said.
"As we think about precision medicine, we're trying to find what works for each individual patient," said Bakhru. And as providers and tech developers work to learn what social determinants are most applicable to each of those patients – how to learn from them and how to better incorporate them into care plans – a spirit of experimentation is essential.
"If we all do things the same way we may never actually get there," he said. "You can't establish best practices if you haven't tried 1,000 different ways."