Advancements in genomic research have given medical professionals the ability to create highly detailed physiological profiles of individuals as well as a baseline for predicting the impact of genes on disease. And the catalyst for putting genomic principles into practice is the electronic health record, says researcher David Crockett.
As senior director of research and predictive analytics at Health Catalyst in Salt Lake City and assistant professor of pathology at the University of Utah’s School of Medicine, Crockett has spent considerable time and effort analyzing the link between electronic health records and precision medicine.
In course of his research, he focused on bioinformatics, biomarker discovery, immunology, molecular oncology, genomics and proteomics. Within that framework, he secured various predictive modeling patents as well as developing algorithms and computational models.
Over the past two years, he hit upon the EHR epiphany thinking about the potential for both electronic records and precision medicine.
“Moving from paper to electronic records was quite a leap, but now we have to think about where to make the next leap,” he said. “It’s not just about combining data sets in the warehouse environment, but how to combine the data sources. It’s not enough to have EHR data, but to think about what other factors impacts a person, such as zip code or weather.
"What is the analytics value beyond the warehouse and what is the most cost effective way to treat patients?" he added. "There is a ton of historical data and we need to leverage that.”
The thrust of precision medicine is to go beyond one-size-fits-all treatments for the average patient, Crockett said. The precision medicine model aims to use specific biomedical details to create customized treatment options that are most appropriate for each individual.
“To put it more simply, precision medicine understands each patient’s individual illness and delivers the right treatment at the right time,” Crockett said. “It is taking population health principles one step closer. If you can do it at both levels, that’s the Holy Grail.”
Both medical and information technology have taken great strides forward, but for precision medicine, the onus is mainly on the healthcare culture and willingness of providers to intervene and take action, Crockett said.
“The math and data input are relatively straightforward,” he said. “To sort people by risk from top to bottom and determining what to do is the real issue. It’s not technology — it’s culture.”
Exerting leverage
Wanda Health is a San Francisco-based predictive analytics firm that focuses on specifics of chronic disease and develops formulas to efficiently leverage precision medicine. By concentrating on the most important and expensive chronic diseases, providers can maximize the quality of life for patients while minimizing the amount of costs they present to healthcare systems, says CEO Steve Curd.
Starting with UCLA research eight years ago, Curd embarked on a system that he calls “the antithesis of big data,” collecting minutia from individuals to “infer more than you would expect about their health and creating a trajectory for any chronic condition.”
The project started with vital sign information, added weight and level of activity as well as other external factors to predict future health episodes with a high degree of accuracy, Curd said.
“We took intellectual property and turned it into a product,” he said. “It exists as an app, collects a small number of vitals and symptoms, rolls it into a database and uses the information to nudge a population of one into the appropriate behaviors and intervention to alter a trajectory of disease. The key is how we integrate that solution into the consumer’s life in a way that is as non-intrusive as possible.”
In order to effectively understand individuals and their conditions, Wanda Health is striving to interact with them on their terms and coax individuals to interact in return, Curd said.
“Admittedly it’s a challenge,” he said. “In any case, the consumer has the right to know what data is being collected and why. What we’re learning in spades is that no two people are alike. Some people resent authority and others don’t need to be coaxed. So it’s up to us to infer more about each individual’s personality.”
Remarkable new era
In a recent article, Crockett said that “we live in a remarkable era of information, when all that is known about a person — from family history and genetics to location history and environment — can be balanced against all that is known in the medical domain.”
Overall, the big-picture view of medical decision-making can allow providers to focus on both prevention and intervention techniques for the appropriate individuals while avoiding unnecessary costs or unwanted side effects for patients who would not benefit, he said.
Even so, precision medicine is “not advancing at the rate I would have expected,” Curd said, adding “but I don’t know why.” Perhaps, he said, “it is the complexity and density of the genome. There are thousands of different types of cancers. It is more complex than we thought it would be. But we are clearly headed in the right direction and hopefully we will see acceleration.”
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