Analytics, decision-support, and an array of other health IT tools are helping advance the development of treatments tailored to individuals' needs.
National Cancer Institute's Buetow is ready for a 'big shift'
IT also is being used to personalize the way doctors manage patients once they leave the doctor's office, particularly those with chronic conditions and recovering from surgery and illnesses. The Cleveland Clinic is doing this by equipping patients with chronic illnesses including diabetes, hypertension, and heart disease with in-home, IP-enabled, wireless monitoring devices.
Patients conduct basic medical tests--measuring blood glucose, breathing, weight, and blood pressure--and the data's transmitted to an online health record (Microsoft's Web-based Health Vault) and then sent to Cleveland Clinic's electronic medical record system. Special rules and algorithms are used to assess whether the patients' readings fall within normal ranges. If they do, the results are sent to doctors in weekly reports. If a reading is abnormal, doctors are alerted.
It's all meant to address problems before they turn into symptoms severe enough to prompt a doctor's visit. "The goal is to get better control. If you can control the glucose of a diabetic, you reduce complications and mortality," says Dr. C. Martin Harris, CIO at the clinic.
Cleveland Clinic is also taking a closer look at how patients recover after surgery, using Web-based surveys describing how they're progressing. For instance, a patient recovering from knee replacement surgery completes a questionnaire every three months in which he or she describes the range of motion of the replaced joint. Patients must reach specific range of motion benchmarks at certain intervals if they're going to achieve full long-term mobility, Harris says.
Data from patients' questionnaires are entered into their e-health records, and responses charted over time to show doctors visually how patients are doing and if interventions such as physical therapy are needed. This sort of continuous patient monitoring is likely to become standard procedure as more healthcare providers use e-medical records, Harris predicts.
Yet progress comes slowly. It'll be mainstream practice "not in the next three to five years, but perhaps a bit later," says Harris. It could even become a government mandate as part of the requirement that healthcare providers demonstrate the "meaningful use" of health IT in order to take part in federal assistance programs, he says.
Beyond The Bedside
Many of the newest personalized medicine efforts are focused on giving analytics and decision-support tools to doctors and other clinicians. But medical researchers also are still focused on the more complex efforts to analyze genomic data and use the results to create individualized treatments that doctors will use in the future.
One such initiative is Cancer Biomedical Informatics Grid, or caBig, a biomedical informatics network that the National Cancer Institute launched in 2004 with the mission of developing more personalized cancer treatments and getting them into doctors' hands faster.
EMRs are a step toward personalized medicine, Partners' Glaser says
Researchers at the about 100 academic and community-based cancer centers that make up caBig use the network to share data and research results. They can make use of the data in analytics, data-mining, decision-support, and other software tools. Members are using the network's data and software today to identify the best patients to participate in clinical trials of experimental cancer treatments (see story, "Cancer Institute Network Aims To Personalize Cancer Treatments").
Increased use of e-medical records should make more patient data available for research, says Ken Buetow, director of the center of bioinformatics and IT at the National Cancer Institute. Ultimately, Buetow expects the caBig network, combined with doctors' growing use of electronic data, will shorten the time it takes for research findings to show up as clinical treatments. "We think this could be one of those moments for a big shift," he says.
John Glaser, CIO at Partners Healthcare, which operates several Boston-area hospitals, including Massachusetts General and Brigham and Women's, sees that shift coming. As the use of EMRs become more pervasive and the amount of digitized clinical data increases, it will be easier to provide patients with more personalized care, says Glaser, who also is an adviser on the U.S. Department of Health and Human Services' Health IT Policy Committee. EMRs make data on patients easier to search and analyze. Doctors using them also are more likely to use decision support tools, Glaser says.
"Science is moving rapidly," he says, and health IT helps capture and disseminate to doctors perspective and research findings that are impossible for even the most diligent physicians to keep up with.
Once the use of EMRs is standard practice, the federal government is likely to put greater emphasis on personalized medicine initiatives, Glaser predicts. In the future, healthcare providers could be rewarded in terms of patient outcomes, and personalized medical treatments are one of the most likely ways to improve outcomes and improve healthcare across the board.