The next precision medicine breakthrough is about apps, not EHRs
Whatever may become the killer app for precision medicine might not be apparent just yet, but one thing is clear: The future of more personalized patient care is not in an EHR.
I went into our HIMSS and Healthcare IT News Big Data and Analytics Forum in Boston last week with the understanding that precision medicine is going to require new and emerging technologies. But while the idea that EHR vendors will come to dominate hospital’s population health-enabling technology purchasing decisions is a possibility, I now think the same seems unlikely for precision medicine.
“Do I really believe that the next precision medicine breakthrough is coming within an EHR? No,” said John Halamka, MD, CIO of Beth Israel Deaconess Medical Center. “It will come from third-parties … twenty-six-year-olds working in their garage to link innovations to EHRs using FHIR APIs.”
EHRs haunted by design
Anyone remotely involved with health IT knows about the meaningful use usability conundrum. EHR vendors engineered their products to meet the federal government’s criteria at the expense of innovating slick software that delights users and, as a result, the products have left so many clinicians frustrated.
“EHRs are not designed for treating patients, not designed for biomedical research, they’re designed for getting paid,” said John Quackenbush, a professor of Biostatistics and Computational Biology at the Dana Farber Cancer Institute and Harvard School of Public Health.
Neither are electronic health records particularly apt tools for integrating with external data sources, Adrian Zai, MD, research director of Partners eCare said.
“It’s not to say you can’t pull interesting information out of EHRs,” Quackenbush added. “But you have to think carefully about it.”
That’s a critical point. EHRs and the data they house will be essential pieces of precision medicine — but, ultimately, just one of the tools clinicians, researchers and patients use.
And those outside data sources will only proliferate. Anupam Goel, chief medical information officer for Advocate Health Care, said more and more patients will bring their own data to medical appointments.
“Pretty soon if patients are carrying records wherever they go it won’t be one locust,” Goel said. “It will be a swarm of locusts.”
Simply put: EHRs lack of usability and data integration functionality are going to become more problematic moving forward.
Precision medicine first movers
Actually getting to precision and personalized medicine is going to take time, but early-adopter hospitals, notably BIDMC and Providence St. Joseph Health, are already working on technologies outside the EHR that advance precision or personalized medicine.
Providence St. Joseph Health is creating personal dense dynamic data clouds that include genome and microbiome data, self-tracking information, lab results, said Chief Clinical Officer Amy Compton-Philips, MD.
“By looking at all of that we’re coming up with the actionable possibility that can change outcomes based on the signal we have,” Compton-Philips said. “The challenge is getting the signal out of the noise.”
Providence St. Joseph Health starts with what it knows about a person, then if need be can add in health coaching, much like a nanny, whether it pertains to Alzheimer’s, diabetes, cancer survivorship or other conditions.
“If we can head off the huge portion of disease that is chronic illness, we can change the industry,” Compton-Philips said. “This transforms what living healthy is all about.”
Beth Israel Deaconess Medical Center, meanwhile, built the BIDMC@Home app.
Think of it like a next-generation portal that takes a more Facebook-like approach, based on EHR data, Halamka said, and it is designed to keep users well.
The app includes a care plan that, for instance, might have fields about exercise, taking medications, adhering to a low-salt diet and can alert patients and caregivers when a user with congestive heart failure gains several pounds in a weekend.
BIDMC@Home would then nudge the patient to ease up on the salty snacks, and let clinicians know they could be accumulating fluid and in danger of winding up in the ER soon.
“We include enough analytics to deliver insights to the patient and make it really easy to communicate with the care team,” Halamka said. “Analytics will live outside the EHR but be based on data within the EHR.”
Shaping the future
I heard a number of similar phrases used to describe the future, including precision medicine, personalized medicine, precision health, even precision care but regardless of what you call it, all this work is really about transforming the next generation of care delivery.
“The future of precision care is bright,” Halamka said. “Our data is not totally sufficient to provide every patient with a customized care plan but for some disease states it is clear enough that if we can take IoT data, pair it with decision support and third-party products, we can do more than just EHRs alone.”
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