Electronic Medical Record Utilization in Personalized Healthcare Management

In last week’s post, we discussed about personalized medicine, the systematic changes it brings to disease diagnosis and management and technologies including genome sequencing and interpretation platform that enable customized medicine practice come true.  However, if observe closer, one would find that there’s one missing link here: how all the personalized information of patient is transferred from genomics sequencing and interpretation entities to doctors hands? Given the amount of data and information involved in DNA sequencing, it’s very unlikely to be transformed in physical paper form. Moreover, under comprehensive healthcare management approach mentioned in the last post, how do doctors manage patients’ personalized records, both in terms of disease history and relevant medical compliance information? All of those questions point to another hot topic in healthcare industry nowadays—Electronic Medical Record (EMR).

Opposed to paper-based healthcare record, EMR stands for a computer-based system that would contain every patient's clinical history, laboratory results, and treatments records. From the very natural points, we can easily list up several advantages of such digitalized process of patients’ record: Reducing redundancy in record-keeping efforts and improved operational efficiency; reducing cost of physical paper storage required by relevant laws; improving accuracy and reducing malpractice disputation and related lawsuits; and generally better facilitate preventive medical care and long-period therapy of the chronically diseases.

Little disagreement will arise to the statement that electronic information transformation is the least surprising technology we are using nowadays. Retail Chains scan the bar code of each of their merchandise and promptly get the price and product information; counter clerks at banks at every corner swipe our bank card on their scanning machines and all the transactions are conducted. Even in restaurant business, online ordering and customized orders are becoming more and more common. Actually, if you think about it, everything in our daily life is virtually informational transformed. But when the light cast on health care industry, despite all breakthroughs going on in this arena, its information transformation process is surprisingly old-fashioned,especially in U.S, a country where disruptive innovations come up into being nearly every second. Currently, less than 30% of US physicians use electronic medical records, compared with 89% or more in several countries including the Netherlands, New Zealand, and the UK. Less than 10% of US hospitals use a robust health information system that includes records and physician order-entry capabilities. In spite of the existing of relevant technologies for more than 30 years, physicians and doctors seems just boycotting with the EMR system. What’s wrong here?

Two main issues are lying here: EMR will change the usual patients’ practice and patient-physician relationship. Doctors are getting used to writing their prescriptions on paper while talking with patients. Such interactions between them are very important particular in medical treatment, since this is real people lives in sake, not simply data and objects like merchandise in supermarkets or your loan contracts with banks. The depersonalization as well as the not so user-friendly interface of current existing EMR system prohibits the adoptions of EMR by physicians and many patients who care about talks and personal involvements with their doctors.

Second, there’s a lack of standards and structured data definitions for EMR systems in the US, which slows down nationwide adoption of EMR. Without standardized data and structure, the data exchange between providers using different health IT sys­tems is severely limited. Some of them may transferable, yet much may incompatible, making physicians’ incentive of adoption such system even weaker.

There are also many other issues around EMR such as private information security and training and adoption cost. We could positively believe that government promotion and the passed law will pose great potentials in the development of the electronic medical record system; however, as long as those issues are still haunted, EMR is leaving question marked by public hesitation.

Personalized Medicine--The Framework

In the last entry, I touched on the two main hot topics of personalized heath care, one of which being personalized medicine enabled by the breakthrough of human genome project and whole genome sequencing. We know that customized medicine could tailor to individuals of their specific diseases on genomic basis, and thus cater to personal needs with more accurate efficacy. But how is this achieved? What is the systematic change personalized medicine poses on the whole disease managment process?  How technology positions as vital facilitators in each of these changing processes?  In this week’s post, I will try to answer these questions and hopefully give a broad picture of main issues around personalized medicine.

According to Personal Medicine Coalition (PMC), by using molecular analysis to achieve optimum medical outcomes in the management of a patient’s disease or disease predisposition, personalized medicine promises to introduce a new standard of healthcare, which not only involves progress of medicine efficacy but also revolutionize medical care from reactive to efficient and preventive stage. This is achieved through major changes in the process of disease treatment.

Here is a diagram showing the old paradigm of disease treatment. Under this pattern, doctors first start from diagnosing patients’ existing diseases revealed by certain symptoms. Based on the diagnosis, doctors provide prescriptions consisting selected drugs to patients, the practice of which usually relies on doctors’ experience and statistics of drug clinical trials. With complying doctors’ prescriptions, patients either improve their condition or don’t get effective treatment from the prescript medicine. The main reason causing the latter condition is that the efficacies of major drugs are always proved by the mass statistics, which are not necessary applied to each individual case. In fact, it’s almost impossible to find a drug 100% effect to every patient due to our born uniqueness of DNA and possible unique source of our disease. Since treatment time has missed by complying ineffective drugs, the disease severity therefore escalates. Patients then go to doctors for re-prescription, and switch to drugs that may not be effective again. Unfortunately, this whole process could goes to several times till effective drugs is complied, with much time consumed and severity of disease climb to unnecessary magnitude. The drawbacks of this reactive medical care is quite obvious, foremost are cost-ineffectiveness and possible missing of optimal treatment opportunity.

And here is the new paradigm when personalized medicine methodology is introduced into the diagnosis and medical care process. Two key point of avoiding unnecessary process of switching ineffective drugs is (1) to deliver customized regime and drugs to individual patients with specific disease; and (2) intervene into the health condition diagnosis before symptoms emerge to design and  . The second ideal condition involves the idea that preventative measures could be taken if predisposition screening is conducted and likelihood of having certain disease is detected before it actually forms. The first one focus on the idea of delivering the right drug aiming to deal with the right roots of disease, so that the repeated switching medicine process is waved and the efficiency and cost-effectiveness is greatly improved. Both conditions increase the possibility of successfully monitoring patient’s medical treatment with more accurate and tailored information at hand. This thus brings the whole health diagnosis system to a reactive treating level to a comprehensive healthcare management level.

How could we achieve such efficient and proactive healthcare management goal? The combination of scientific breakthrough and technology become the centerpiece of the solution. Human genomic sequencing, which has been mentioned several times, is the science foundation of the whole idea of personalized medicine. Provided with whole genome sequence interpretation, doctors could conduct better accurate diagnosis to patient and even intervene at the emerging or early stage of disease formation. Such sequencing and interpretation technology is already at access to public. With its core such technology as assay chemistries, systems and software, can support SNP genotyping, gene expression profiling, which eccentrically decode people’s genomics prototyping. And more importantly, according to the bidding of Illumina, the price to have an individual genome analyzed is falling rapidly from $300,000 to $1,000 within a couple of years, which makes it much more affordable than ever before. Gene interpretation is also feasible now, the most successful business model establishing by Knome formed by a group of Harvard researchers. With those two cohesive and powerful tools at disposal, doctors and clinicians are empowered in a dramatical way that the above comprehensive healthcare managment system is no longer to be dreams.

Refference:
1. Edward Abrahams, Ph.D., Personalized Medicine: The Changing Landscape of Healthcare, American Association of Clinical Chemistry Annual Meeting, July 14th, 2007.
2. Personalized Medicine Coalition: http://www.personalizedmedicinecoalition.org/
3. Illumina, Inc. http://www.illumina.com/index.ilmn
4. Knome, Inc.http://www.knome.com/

Get THE healthcare you deserve!

Nowadays it’s not rare at all to get products or services customized only for you: T-shirts with your “Maybe I’m wired…so what? “declaration, personal fitness plan with your gym coach and even the automobiles manufactured just for you according to your order checklist. Essentially this is a world where differentiation and uniqueness is highly favorable and being chased beyond extreme. Yet, when it comes to healthcare, one of the most critical services you’ve been receiving in your life, customization turns out less than satisfactory and is just taking off on its way.

Precisely, it may not be fair to say this is a brand-new idea. Electronic Medical Record (EMR) systems with a Computerized Provider Order Entry (CPOE) have existed for more than 30 years since 1980s. BY 2001 three billion nucleotide base pairs (letters of DNA code) in human genome has been conquered by scientists through Human Genome Project starting in 1986. Our borned distinction is finally proved by science in terms of gene expression profiling and mysterious codes in our DNA. Personalized medicine, the idea of tailoring such difference with customized medications and therapies based on individual genetic profile,has been theorefore existed for near a decade with the big biotechnology business area of telemedicine. All in all, as the most important two aspects of personalized healthcare, EMR and telemedicine reveal the underlying essence of this concept-- Right treatment for the right patient at the right time.

Sounds like a really exciting start. However, in regarding of the population reaching such service and the scope of practice involved, there are indeed far more work to do. After nearly two years of the passage of HITECH Act, the adoption rate of EMR in United States is still slightly over 50% as by the end of 2010. While telemedicine practice becomes relatively mature, concerns around security of such sensitive information as one’s health record and medicine doses are increasingly drawing public attentions. And at the center of all those issues is the argument of how information and communication technologies, which triggered the personalized trend of healthcare at the first place, could be better enhanced and applied into serving for our social welfare and individual well-being. To seek anwsers to this question, it's worthwhile to further exam the history and frontier of personalized healthcare, which will be the topic of my next post.

There you go!

Welcome on board! This is Dandan's space sharing with you her keen thoughts and findings of ICT impacts on personalized healthcare. Hope this sounds intriguiring enough to you! Neither healthcare nor ICT is where my previous background lies in; but I have genuine interest in the combination of those two and would like to leverage this opportunity to immerse and build knowledge base in this arena. I'll try to squeeze time from my crazy MBA life and update posts regularly. You might not expect frequent entries from this blog, yet I'll do whatever it takes to make sure that each post is a meaningful, or joyful at least, reading experience for you. After all, this is supposed to be a crystallized mind powerstation fueling both yours and mine adventures of thinking. So, let's start out the journey!