Personalized Medicine Tools

INFORMATION SYSTEMS
Personalized Medicine Tools
CDS access has blown open the doors of the hospital to include any and all points of care.

We are in the midst of a painful rebirth of clinical decision support (CDS) solutions. Not long ago, “provider” meant “physician,” and “clinical decision support” meant spontaneous consultations between doctors in hospital hallways or perusing a new journal article between patients. That is no longer the reality of CDS. Today, the definition (definitions, really) of CDS has exploded. We now talk about a broad spectrum of providers, including physicians, nurses, physician assistants, therapists, home health providers and, in some settings, social workers, financial advisors and other non-clinicians. Soon (if not already) we will (correctly) include the patient and family/friend support network in our definition of provider. Today and in the future, CDS access has blown open the doors of the hospital to include any and all points of care across the care continuum.

Vendors are scrambling to create dozens of solutions, all supported by frequently updated evidence-based content delivered to numerous locations in order to meet a huge variety of needs and capabilities for a spectrum of users — and all with only minimal negative impact on provider workflow. Plus, they all have to be integrated.

Thus, the creation and implementation and maintenance of impactful CDS is highly complex and extremely challenging. And it will be significantly harder with the arrival of personalized medicine.

Therapeutic Approaches
Healthcare reform is full of buzz words, concepts for which 10 people will give you 12 different definitions, and personalized medicine is one such example. While there are many definitions, at its core, personalized medicine means analyzing and utilizing specific cellular (structural and physiologic) and molecular (genetic) characteristics of an individual patient’s individual disease in order to determine the most favorable therapeutic approach. From chronic diseases to acute infections, to congenital physiologic syndromes, we are in the brilliant dawn of the age of personalized medicine.

Already, many leading medical centers have created offices or departments of personalized medicine. These providers are beginning not only to understand patient risk profiles in genetic terms, but they also routinely evaluate non-responders (such as cancer patients whose malignancy has failed to regress in the face of standard treatment) for genetic clues as to other potential treatments. They analyze the genomes in newborns’ disease to identify at the molecular level the life-threatening protein disorders in order to provide life-saving intervention.

From the original $3.8 billion price tag and 15 years to complete the first mapping of the human genome, we now routinely uncloak an individual’s genome in 24 hours for thousands of dollars. It will likely be in this decade that emergency departments routinely perform genomic analysis on certain patients during their emergency evaluation. My teenage daughters will likely have their individual genomes on whatever replaces their smart phones before they graduate college.

Big Data
And the enormous volume of information gathered from personalized medicine, learned daily will fill e-journals and e-books at an expanding rate. In addition to the exponential growth in knowledge and data, personalized medicine will add new roles to the “provider” pool. Geneticists, genetic counselors, personalized medicine advisors and others will more and more frequently interact with patients and their clinical caregivers. And the care continuum will further expand to include a variety of laboratories and patient care sites focused on personalized medicine.

It has been hundreds of years (thousands, actually) since our medical knowledge was limited enough to allow a physician to “work without a net.” Today, without truly impactful CDS, patients are not receiving the highest quality, most cost-efficient care (if they were, preventable deaths would not be the third leading cause of mortality in American adults.) Personalized medicine offers the world of today and tomorrow what penicillin offered the pre-antibiotic world: a leap in care that will save millions of lives and improve the lives of tens of millions more.

Personalized medicine in not an evolution in care, it’s a revolution. This revolution will only benefit patients in America and across the globe if it is available for use by the expanding group of “providers” across the growing “continuum of care.” Now, that’s a real clinical decision support challenge.

Peter Edelstein is chief medical officer, Elsevier Clinical Solutions.