The Road to Precision Medicine

The term “Precision Medicine” has been in the news of late. For those of you who missed it, here is a blurb from the whitehouse.gov website:

“Precision medicine is an emerging approach to promoting health and treating disease that takes into account individual differences in people’s genes, environments, and lifestyles, making it possible to design highly effective, targeted treatments for cancer and other diseases.”

For many of us who have been in this industry for years, the idea of individualized medicine is not an epiphany. It is the promise of any electronic medical record and a vision that could not be realized without the help of computers and software, as the amount of information and orchestration would not be possible for a human care provider alone. We have been building software systems in healthcare for decades trying to harness the power of technology to improve how we care for patients and yet the dream of individualized care has eluded us.

So the question is, what has been stopping us? The answer is not a simple one.

On one hand, computers and software have been leveraged in healthcare in several significant ways. Computers allow for smart pumps, MRIs and other amazing diagnostic and monitoring tools. They allow us to move information around, store it in a digital format for quick retrieval and analysis; to some degree, over various populations. But all of these things still require a human operator to use them in a trusted way. In other words, they are “tools” that we can use like a hammer to drive a nail. How does a tool become something more than a tool you might ask? Consider an anachronistic little tool some of us used to use quite a bit, the paper map.

PaperMap

Using a paper map is a good metaphor for healthcare. It is difficult to use a map and drive at the same time, dangerous in fact. Maps need to be understood and you have to figure out the shortest way and guess where the traffic might be good or bad. At some point in our recent history we replaced the paper map with something that does all of this for us, a personal global position system or GPS. We tell the GPS where we want to go and the GPS tells us when to turn, routes us around traffic and knows exactly when we will get there. Every now and then there is a road block or we forget to update our maps and we have to take over, but by and large we rely on this technology to guide us while we drive the car.

Any early adopter that bought a GPS when they were “new” has stories of GPS misadventures.

gps

When you were trying to find a Starbucks and ended up at a person’s house in a residential neighborhood. (I thought about ringing the doorbell and demanding a Caramel Macchiato…). Or you are late for a meeting because the GPS took you to an address 45 minutes in the wrong direction. But for each misadventure there were hundreds of successes and today the GPS (whether a standalone device or an app on our smart phone) is, barring operator malfunction or poor reception, nearly infallible. As a result we have grown to trust the GPS. Trust that it knows what’s going on and will provide us with guidance that will drive (pun intended) us toward our desired outcome.

What will it take to build software that healthcare providers can rely on in a similar manner?

It will require that we create a software ecosystem that delivers highly relevant clinical and administrative guidance that can be trusted by human providers. Like GPS, this ecosystem should support care delivery, not seize control, so providers are still in the driver’s seat.

For a software application to earn this level of trust, it will need to be a true clinical application. The goal of this series of posts is to describe the characteristics of a true clinical application and discuss what it will take to move our industry into the future.

When we started Clinical Architecture over seven years ago, we chose the name of the company based on our belief that the healthcare industry needed someone that was dedicated to establishing foundational components for healthcare, a “clinical architecture” for others who share our vision to leverage. Our product Symedical, which was designed to allow software systems to “understand” information they acquire, host, share and exchange, regardless of the format or terminology, was a fundamental first step in this process. And, there is more where that came from. We are committed to be a catalyst for change and, like any catalyst, we are aware that we cannot do it alone.

The first step towards getting somewhere is to decide that you are not going to stay where you are.

In the next few weeks, as I share these thoughts, I ask you to let me know what you think.

 

>>Read Part II of The Road to Precision Medicine

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