Dr. John Halamka, the CIO of Beth Israel Deaconess Medical Center and a professor at Harvard Medical School, recently co-authored a book with Paul Cerrato titled Realizing the Promise of Precision Medicine and published by Elsevier.
Additionally, Halamka serves on one of the advisory committees for the government-funded Precision Medicine Initiative.
Ahead of a trip to Africa, where he’s conducting work with the Bill and Melinda Gates Foundation, Halamka chatted via phone about various aspects of precision medicine and its future.
This exchange has been lightly edited.
Why is precision medicine the latest buzzword in healthcare? Why is there allure around it, both from a provider and a patient perspective?
Here’s the challenge: I’ve been a doctor for 30 years. I was trained in the early 80s as an apprentice. If you were to come to me with a unique set of symptoms, I would evaluate your needs based on data I collected 30 years ago. What we should think about [is] … how your genome and preferences fit together.
I am 55. I care for those older than me, those younger than me and those my same age. You witness firsthand how the existing healthcare system doesn’t necessarily provide the right amount of care at the right time.
Shouldn’t we start moving in this direction to reduce healthcare costs and improve quality? That was the genesis of it all. The reason it’s a buzzword is because everyone’s asking, “How do you reduce total expense and improve value?”
How does big data play a role in precision medicine?
To me, the challenge is not so much the quantity of the data but turning the data into wisdom. If you wear a Fitbit and I got your pulse for a year, that’s a lot of data. But what do I do with it? How do we take all of that, synthesize it and provide a list of alerts, assignments and actions of what doctors can do? The challenge of big data is synthesizing all our sources.
Many doctors consider electronic health records the bane of their existence. How are EHRs barriers to precision medicine advancements? Do they ever help advance the field?
The EHR, as a piece of evolution, is a reasonable step to turn our paper-based processes into electronic ones. But by no means is it sufficient. We lost the hearts and minds of clinicians. We have to show them that the EHR is your friend.
[EHRs are] a step. Everyone recognizes they’re insufficient for their purpose, but there’s a vision over the next decade. Maybe we’ll have more of a Facebook approach, where teams of your carers develop a care plan with you.
How does patient engagement tie into precision medicine?
I would never, ever compromise your privacy. You could go to your patient portal right now and discover your sodium was 139. It’s not totally helpful.
Patients are an equal member of the care team, but the tools to empower patients aren’t quite there. Instead, they have websites where they can read a lot of data. Info is great, but what if we said, “Here’s some advice from others who have had the same issues”?
You’ve spoken openly about how this approach was crucial for your wife when she was diagnosed with breast cancer. Could you discuss how big data helped her, and whether her experience is likely to become the norm going forward?
There are a lot of clinical trials out there. How about clinical trials for Asian women, age 50, with stage 3 breast cancer who have been estrogen positive?
We really just don’t have the evidence. Especially in cancer, it’s becoming more and more common to diagnose based on the genomics of the tumor.
Not only are there great organizations working on this idea, but if we can aggregate enough data about patients with cancer, we can advise those in the future based on the experience of those in the past.
What does the future of precision medicine look like, and what’s standing in the way of us getting there?
I’m an eternal optimist. I always believe the future is bright.
In the last eight years, we had a lot of regulatory drivers that brought us to EHRs. I can say with relative certainty that in the next three years, you’re going to see deregulation and watering down of previous regulation. The private sector will now be given some reason to innovate. After meaningful use, it’s probably time to give customers and the private sector the opportunity to innovate. You’re going to see a lot of 26-year-olds in garages creating apps to layer on top of EHRs.
There are several barriers.
One of the things I’ve been asked to solve in Africa is, How do you identify who the patient is? Name, birthday and demographics aren’t so helpful in common names. We’ve designed some ways to take biometrics of individual patients. In effect, your body is the token. In the U.S., let’s figure out who the patients are. Whether matching patients or patient-controlled medical records, we need a strategy.
Healthcare doesn’t spend a vast amount on technology. And as we have the challenge of more and more data, there are also more and more security risks and threats.
Sometimes, as with the Chicago healthcare information exchange, there was not a technology problem, but a psychology problem. In Chicago, there’s still a lot of fee-for-service and there is a sense of competition. Sometimes clinicians don’t share as much data as they should because of politics or psychology. If you’re paid for outcomes and quality, that will overcome some of the psychology barriers.
Photo: farakos, Getty Images
By adopting a precision medicine approach to pregnancy management, we can help empower today’s expectant parents in their individual pregnancy journey and provide physicians with the tools to provide optimum care.
Varda Shalev, MD, MPH
The OpSus Healthcare Cloud by CloudWave is more than a cloud built for healthcare.
Frank’s source: https://medcitynews.com/2017/11/halamka-precision-medicine/
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