The next medical breakthrough will come from third party, cloud-hosted precision medicine services that will provide clinicians with real-time decision support in the form of guidance, showing possible treatment choices and objective rankings of safety, quality, efficiency, cost and availability.
That’s where individualized medical care is going in the not-too-distant future, according to John Halamka, MD, chief information officer at Boston’s Beth Israel Deaconess Medical Center.
With the emergence of RESTful application programming interfaces (APIs) leveraged by HL7’s emerging Fast Healthcare Interoperability Resources (FHIR) standard, cloud service providers, and machine learning, he believes the industry “suddenly has the perfect storm for innovation.”
Halamka, co-author of Realizing the Promise of Precision Medicine: The Role of Patient Data, Mobile Technology, and Consumer Engagement, told a HIMSS18 session on Wednesday that innovative third-party apps, modules and services will layer on top of existing electronic health records.
However, he insisted that EHRs—in their own right—will not serve as the most valuable tools for personalized care tailored to individuals.
“Epic, Cerner, Meditech, athenahealth, eClinicalWorks—they’re all fine, but do I believe that they are going to be the place where we see these innovation? I don’t,” said Halamka. Instead, he contends that “26-year-olds in a garage” will create “novel apps (that) deliver far more usability and utility.”
His vision is of a thriving app ecosystem that produces “Lego building blocks” that will “sit around the EHR and provide this additional functionality,” creating individually tailored programs to treat a variety of diseases.
“We’ll leave in place the EHRs we have, but surround them with these kinds of components so that our clinicians and our patients will have a similar experience with cloud-hosted services,” he explained. “It’s a bit like the iPhone and the App Store. The EHR is the iPhone, and the iPhone is only valuable today because of the thousands of apps we can buy and add to it.”
In this scenario, Halamka envisions EHRs utilizing FHIR Clinical Decision Support Hooks to send salient patient data to a cloud-hosted service provider that curates the medical literature and not only provides a library of evidence but grades the evidence for accuracy, impact and relevance.
“Every patient experiences disease differently, and so we really need to understand—if a patient has certain signs and symptoms—what would be a predictable course of treatment that is effective, giving the right patient the right care in the right location at the right cost at the right time,” he concluded. “That’s the thing that we want precision medicine to do.”
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