I was in India last month and had the opportunity to interact with officials at some of the leading hospital systems there. What stood out was the quality and quantity of patient data that some hospital chains have acquired—and even more importantly, how these chains have leveraged India’s I.T. boom to digitize the data in a structured fashion—in one case, transactional data for 26 million unique patients in a single data warehouse.
That’s impressive. Even more impressive is how technology has helped make this humongous task almost a routine job. With the inevitable surge in data volumes in the United States due to meaningful use, insurance exchanges, etc., it would be good to pay attention.
When I dug deeper, I found that similar exercises have been done in the U.S, maybe not at that scale and as precisely since I.T. systems were incorporated earlier in the United States, resulting in an ad hoc set up. Nonetheless, there are data elements here that can be a gold mine of information. For example, many hospitals have amassed materials and data with potentially significant, embedded DNA information.
Now tie all this with the following facts:
* The power of U.S. I.T. innovation is spreading into the populous markets across the world.
* The cost of obtaining an individual genome is dropping, so it’s becoming more feasible for individuals to enjoy the possible clinical benefits derived from individual gene mapping.
* Pharmaceutical thinking is shifting away from blockbusters to highly profitable precision medication, preferably biologics.
* The individual market is becoming prominent by the day, not only in the state-sponsored domain but also in the commercial domain, creating more clamor for ‘what is good specifically for me?’
* There is a shift in focus from to outcome-based payments rather than traditional services based payments
* Protected health information is not the barrier it used to be. There are better and more secure ways to analyze the data while maintaining patient confidentiality.
So what does all this mean? I believe these factors may portend a radical shift in the health care and life science industry wherein the patient becomes the focus, not only as part of a group covered under a policy, but truly as an individual. All the variables may be in place. All is needed is something to light the fuse, and comparative effectiveness research (CER) could be that catalyst. If ever there was an opportunity for outcome-based analysis targeted at specific cohorts of patients, it is NOW.
Imagine a scenario where a potential trend/signal is identified through a subscription service that generates reports using patient data from one or more of the hospital chains that contain millions of patient records (with pre-acquired consent). Imagine a pharmaceutical company working on a molecule finds that signal to be highly useful and requests a subsequent focus study against the signal with the hospital chain providing the patients from the original cohort as trial subjects. That could save millions of dollars and multiple years in completing trial recruitments. Imagine that the outcomes identified through the original signal could be used to solidify and enhance the matrices associated with incentives such as those from the meaningful use or ACO programs. Imagine the doctors prescribing you the meds based on your genomic structure because you carry your genome on a wallet card and each doctor has a device that reads your genome and matches it against a subscription service that lists potential treatments for a given diagnosis.
This may sound like science fiction, but all the ingredients are here; it’s just a matter of putting them together using a continuous investment into CER and displaying faith in the outcomes.
Before long, we may answer that all-consuming question: Will an aspirin a day keep the doctor away, specifically for me?
Rajiv Sabharwal is director at Deloitte Consulting LLP, a member firm of Deloitte Touche Tohmatsu Limited (DTTL).
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