In principle, the idea has been around for a long time. Since the Egyptian Imhotep – credited as the earliest named physician in history – first codified healing 4,500 years ago, medicine has always taken notice of presentation and symptoms.
Today, though, clinicians are doing far more than looking and listening. The preventative and diagnostic elements of medicine are increasingly anchored in one of a number of rapidly developing scientific and technical fields, including genetics and proteomics (the study of an organism’s complete set of proteins).
These new techniques ensure better imaging, improved searching of patient databases or identification of biomarkers to predict health risk, provide targeted earlier diagnosis and can be used to monitor disease activity.
The genomics revolution is providing new insights into the complexity of diseases we once thought of as single conditions. In the 1920s, for example, there were only two diagnoses for patients with bruising and fatigue: leukaemia or lymphoma. Now we know of around 38 types of leukaemia and 51 types of lymphoma, and the number is increasing each year.
Each type is characterised by a distinct molecular profile, and the exquisite diagnostic guidance these profiles provide enables more specific, personalised treatment to be given.
This example highlights the explosion of knowledge and the pace of innovation that is inherent in personalised healthcare. It also highlights the extent to which fulfilling the promise of personalised healthcare will depend on applying information technology to underpin the convergence of the many technologies that have a part to play in its delivery.
At GE we think that healthcare IT (HCIT) will be the game changer for personalised healthcare – increasing consistency, advancing protocol-driven, evidence-based medicine and delivering knowledge and healthcare at the bedside. An HCIT infrastructure of comprehensive electronic health records, tied into patient-specific care, will improve healthcare productivity and reduce medical errors.
We know the potential gains from fully integrated HCIT as the backbone of any healthcare system are enormous. Take the healthcare organisation, Intermountain Healthcare, based in Salt Lake City, for example. By optimising processes it was able to streamline operations, improve clinical quality and achieve 80 per cent evidence-based care across its facilities, compared with a US national average of between 10 and 20 per cent.
Currently, however, most HCIT is deployed in isolated systems and settings that do not interoperate. This makes the systematic evaluation and enhancement of care across medical cultures and practices difficult, to say the least. Standardisation of information exchange between differing vendors and computer systems is a key challenge. Vendors and payers recognise that interoperability is important. Vital and detailed work, and good progress, has been made over the past 10 years in the development of global standards.
Although complex, interoperability is not the really tough challenge for HCIT. Much harder is the semantic problem of how to interpret a diagnosis, preventative methodology or treatment in one culture, and apply the information in a different medical culture, or language.
With all these challenges, healthcare presents the most complex requirements for IT of any sector. Its intricate workflow interactions make digitisation more than just a technical or financial issue. That is why there is a compelling need for evidence-based evaluation of HCIT systems, to define their net benefits.
Politicians talk of “meaningful change”. Healthcare systems will offer it not by simply setting out to replace paper-based systems and records, but as a first step towards higher-performing practice that will improve healthcare productivity at an appropriate cost, for as many patients as possible.
If we are going to make the change, insurance companies and reimbursement agencies that meet the health bills, and governments, have no choice. They must work with industry throughout the world to provide a consistent regulatory framework and incentives for healthcare providers to adopt broad-based and integrated HCIT.
Dr Alan Davies is Chief Medical Officer, EMEA, for GE Healthcare.