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Monday, January 26, 2015

An Epic development

How about some Mayo with your Epic?
Mayo taps Epic for EHR, revenue cycle management
Healthcare Dive Mayo Clinic announced this week that it would be abandoning its three current EHR systems in favor of a new contract with EHR giant Epic, which will now be the healthcare icon's sole EHR provider and strategic partner, according to a Mayo press release.

The plan is to deploy a single, integrated Epic EHR and revenue cycle management system at Mayo's main campus. Jilted in the deal are GE and Cerner, who were the providers of Mayo's current systems...
That's truly a big deal, particularly given this Mayo news:
Precision Medicine: Mayo Clinic Expert Describes Next Steps to Help More Patients

Rochester, Minn. – “Precision medicine” is becoming a national catchphrase after President Obama highlighted it in his State of the Union address. But what exactly is it? Richard Weinshilboum, M.D., acting director of the Mayo Clinic Center for Individualized Medicine, describes this new, rapidly advancing frontier in medicine and outlines 10 changes that would speed development and help more patients benefit from a personalized approach to health care:

What is precision medicine? In precision medicine, also called individualized medicine or personalized medicine, physicians use knowledge about a person’s personal genetic makeup to help determine the best plan for disease prevention, diagnosis and treatment. The mapping of the human genome in 2003 by U.S. scientists jump-started medical genomics; the Human Genome Project was an immense international collaboration that took 13 years and cost $3.8 billion. The National Institutes of Health’s National Human Genome Research Institute, which coordinated the project, estimates economic growth from that project at $798 billion.

"We are now poised to apply genomic technologies developed with the findings of the Human Genome Project into everyday patient care,” Dr. Weinshilboum says.
“However, if the U.S. is to remain the world leader in health care innovation and delivery, we need another national genomics effort that will accelerate scientific discovery and clinical implementation while continuing to encourage the rapid technological innovations and entrepreneurialism that have gotten us to this point."

What would help the U.S. continue to lead in precision medicine? President Obama’s call for a national initiative to advance individualized medicine, including increased funding to the National Institutes of Health to support advances in precision medicine, is an important step, Dr. Weinshilboum says. Other moves that would help include:

  • Adding bioinformatics to medical school and graduate school requirements to give physicians and other health care providers the tools they need to use genomic material.
  • Updating and expanding government regulations to keep up with the growth of genomic technologies and potential treatments, including providing alternative tracks for the development and use of medications for small subsets of patients.
  • Revising insurance guidelines to support genomic-based therapies.
  • Standardizing biobank activities, using the same terms and templates so biobanks are more universally useful.
  • Creating annotated, safe data repositories where all institutions can pool data and benefit from shared data while protecting patient privacy.
  • Developing a next generation of electronic medical records that can securely store genomic data or easily interact with secure genomic data storage warehouses to facilitate incorporation of genomics into routine medical care.
  • Using genomics to identify drugs that could be used as specialized cancer treatments.
  • Improving incentives for researchers to collaborate and work in teams.
  • Creating a national clearinghouse to match patients with genomic clinical trials.
  • Bringing together federal and state regulators to develop a clear pathway toward the approval of next generation-based sequencing tests.
What are some precision medicine terms that people might start hearing more frequently from physicians, researchers and policymakers?
  • Whole exome sequencing, also known as exome capture: A laboratory process that determines, all at once, the entire unique sequence of a person’s exome. The exome consists of all of the protein coding genes in a person’s DNA. These genes, which contain the instructions for how a cell behaves, account for an estimated 1 to 2 percent of
  • Whole genome sequencing: A laboratory process that determines, all at once, the entire unique DNA sequence of a person’s genome. There about 6 billion “letters” in every human genome; everyone is unique.
  • Genetic variants: Each of us is about 99.9 percent the same, genetically speaking. Even so, that 0.1 percent adds up to about 3 million individual genomic variants that differ between any two people. A major challenge in individualized medicine is finding the handful of variants that may lie behind a person’s cancer, diabetes, or Alzheimer’s disease, for example.
  • Bioinformatics: A research field that focuses on the interpretation of genomic data and seeks to build sophisticated systems that help scientists and physicians quickly locate variants that play roles in diseases. This is a rapidly growing area: Scientists and physicians can now generate data much more quickly than they are able to interpret it.
  • Next Generation Sequencing: Also known as high-throughput sequencing, next generation sequencing describes several new DNA sequencing technologies that allow scientists and physicians to decode and catalog large numbers of genomic sequences in a rapid and cost-effective manner.
It has been asserted that only ~10% of "health" is attributable to clinical interventions, as I noted in my August 13th, 2014 post. e.g.,

So, if we can bring genetic assay-driven therapeutics into the applied clinical settings, the percentage will change dramatically (notwithstanding that vexing socioeconomc Upstream issues will remain). Assuming, of course, we'll have a sufficient number of genetically adroit clinical staff -- and that the Epic EHR platform will be up to the genomic data management and workflow tasks.

And, one should add, that such new "omics" interventions will be affordable.


From THCB:
Three Recommendations for President Obama’s Precision Medicine Initiative

...[A]nnouncing the initiative is one thing.  As with all policy discussions, the devil is in the details – and there are three details specifically that could make the difference between political rhetoric and a policy that truly improves the health of American citizens.
  1. Focus on the entire process of the disease – starting with prevention. Because most chronic diseases show few symptoms until the disease has significantly progressed, treatments for cancer and diabetes patients are primarily at the disease management phase. However, we are acutely aware that the best way to “cure” cancer or diabetes is prevention, and prevention requires better early diagnosis. Unfortunately, we still lack convenient and accurate ways to diagnose for various cancers and diabetes. Given the high costs of treating advanced-stage chronic diseases, precision diagnosis of risk factors or disease progression will materially lower the costs of health care...
  2. Strategically target diseases. Particularly in cancer and type-2 diabetes, two of the fastest growing disease segments in the United States, there is a significant opportunity for precision medicine to improve early diagnosis and treatment, and lower the costs of care. Remember, we tackled HIV and AIDS issues over the past thirty years with a precise target (HIV) and with research focused on quickly translating basic science to clinically effective and safe drugs. Because cancer and diabetes are systemic diseases, affecting multiple aspects of a human body, focusing on translational science based on specific types of cancer or specific aspects of diabetes may in fact accelerate not only the understanding of the diseases but also improve the treatment methods at each stage...
  3. Set standard definitions and metrics. One of the major challenges in migrating toward precision medicine is lack of a common clinical language and metrics that help us to refine our interpretations and focus our messages to physicians and patients. Because cancer and diabetes are still treated in the realm of intuitive medicine, different physicians can provide different opinions on these diseases. Although we need to appreciate individuals’ genetic and biological uniqueness in discussing chronic diseases, precision medicine cannot establish deep roots without more commonly accepted definitions and associated metrics...
Indeed. Recommendation #3 resonates with me in particular.

More to come...

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