In this series, the potential implications of technology that works at the point of care in real-time are discussed. In a prior blog, the power of the physician at the POC is profound, directing the flow of 2 trillion dollars in discretionary treatment protocols. The disparity of treatment for coronary artery disease in different portions of the nation was discussed, based on data in the Dartmouth Survey of healthcare. In this edition, the power of the physician at the POC is discussed in the context of the emerging new area of personalized medicine.
Personalized medicine is when the specific lab, imaging and genetic testing indicate a better fit for one medicine than another. The Pharmaceutical industry is rapidly developing new medications to improve outcome of patients in oncology diseases, hepatitis, diabetes, rheumatology and other conditions. These personalized treatments produce better outcomes but carry an enormous cost to the patient and third-party payors. For example, new treatments for hepatitis can be 20-50x more expensive than standard treatment but is twice as effective. Darrell West, a member of the President’s Council of Advisors on Science and Technology adds: “Implementation of these regimens creates a situation where treatments are better targeted, health systems save money by identifying therapies not likely to be effective for particular people, and researchers have a better understanding of comparative effectiveness.”
Cost is not the only obstacle to the era of personalized medicine. A second major hurdle to better information management of the medical record is the fact that much of the data resides in the unstructured portion of the medical record. Recent implementation of EHR has made digital compilation and maintenance of disease registries more feasible. EHRs still provide only a small portion of the medical data in structured format, between 20-30%, with the remainder inaccessible to electronic analysis. Unstructured data in the medical record also takes the form of nursing and physician progress notes, consult notes, admission notes, discharge summaries, pathology reports and operative reports.
The implications of this emerging era of personalized medicine will have profound impacts on other segments of the healthcare industry like pharmaceutical and IT companies. According to Pfizer Chairman and CEO Jeff Kindler, “The changes we’re making recognize the end of the era of ‘blockbusters’—medicines that meet widespread primary health care needs and therefore generate billions in revenues…. We are focusing on addressing many specialized needs of many smaller groups of people. This personalized medicine approach means new opportunities for people who are sick, for physicians and for our shareholders.” Personalized medicine may change the investment calculus in pharmaceutical companies that rely on blockbuster marketing while enhancing investment opportunities in smaller, newer companies that develop more targeted medicines that can justify a higher profit/cost basis.
Personalized medicine will also tremendously affect the medical informatics industry. The need to correlate latest developments in oncology research literature with a dynamic patient condition has stimulated the application of IBM artificial intelligence (Dr Watson) for future clinical cancer management at Sloan Kettering and MD Anderson, according to the Washington Post, June 27, 2015. Dr Watson is designed to work outside of the EHR, after clinical data has been extracted and sent to Dr Watson for backend analysis. It is not designed to work at the point of care in real-time.
Technology however exists today that can accomplish much of what Dr Watson does but at the point of care in real-time within the EHR. Hiteks NLP technology is capable of developing this comprehensive patient-specific picture suitable for personalized medication recommendations. In its document improvement application, it has shown the capability to use algorithms at the point of care in real-time to influence clinical decision support. Treatment algorithms to support personalized medications at the point of care can be utilized by Hiteks application in a plug and play format, making it easy for the end-user to employ the latest clinical trial outcomes. This is in contrast to Dr Watson, which is not modular, requiring extensive rewriting of code to accommodate latest knowledge.
In a white paper in January, 2014, IBM CEO Virginia Rometty said she wants Dr Watson to generate $10 billion in annual revenue within ten years. This revenue is based on the limited market that Dr Watson is designed to address, back end analysis. Hiteks Real-time technology can accomplish everything that Dr Watson can but in real-time at the point of care and at a significantly lower price point. The financial estimates for this market might even exceed the Dr Watson targeted market.