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Tag Archives: EHR

Big Data Declares a War on Cancer

In 1970, cancer was the second-leading cause of death in the United States. President Nixon made fighting this disease a priority in his 1971 State of the Union address: “I will also ask for an appropriation of an extra $100 million to launch an intensive campaign to find a cure for cancer, and I will ask later for whatever additional funds can effectively be used. The time has come in America when the same kind of concentrated effort that split the atom and took man to the moon should be turned toward conquering this dread disease. Let us make a total national commitment to achieve this goal.”

DataSocietyLots of great progress has been made over the past 45 years. Many challenges remain, but the technological capabilities have vastly improved.

In his last State of the Union address, President Obama re-iterated Vice President Joe Biden’s plea for a concerted effort to use the brightest minds in the U.S. to cure cancer, and announced the creation of a national cancer moonshot. President Obama asked Vice President Biden to be “in charge of Mission Control.” “For the loved ones we’ve all lost, for the family we can still save, let’s make America the country that cures cancer once and for all,” Obama said.

The good news is that today there is a massive amount available for cancer researchers to use in their mission. The challenge is that due to the lack of reporting standards and the disparate databases, much of the data is left un-analyzed, which can lead to lots of missed opportunities for breakthroughs.

Since President Obama’s declaration, Vice President Biden has met with leaders of the MD Anderson Cancer Center at the University of Texas, which in 2012, launched the Moon Shots Program aimed at reducing cancer mortality. There are many types of cancers. While they are all driven by gene mutations in various cells, every type of cancer requires a targeted approach. The Moon Shots Program has many mini-projects, or Moon Shots, aimed at treating specific cancers.

The program’s innovation is driven by the multitude of specialists involved in the project, from clinicians to biostatisticians and programmers. The Moon Shots include research into B-cell lymphoma, glioblastoma (brain cancer), cancers caused by the human papillomavirus (HPV), high-risk multiple myeloma, colorectal and pancreatic cancers, breast and ovarian cancers, chronic lymphocytic leukemia, lung cancer, melanoma, myelodysplastic syndrome/acute myeloid leukemia and prostate cancer. It covers an unprecedented number of diseases by one effort.

Cancer is a complicated ailment with complex treatments. A single tumor can have more than 100 billion cells and each cell can have different genetic mutations. The mutations are not constant over time, which requires an evolving treatment. To understand each cancer, clinicians need to understand the kinds of mutations that are driving it. There are 3 billion code letters, or amino acids, in each cell so understanding the mutations expressed in each tumor is no small task. There are as many as 300 billion opportunities for mutation in just one tumor.

With so much complexity, there are many ways to approach cancer research. For example, scientists at the NIH have used network analysis methods to map out protein interactions to discover new biomarkers and significant players in the cell’s architecture. These discoveries help guide clinical studies and other research on gene expression.

Researchers across Moon Shots programs are using machine-learning models to predict whether a patient has various types of cancer based on the expression levels of specific genes. Implementation for thyroid cancer has been especially fruitful. Thyroid cancer usually causes a lump at the base of the neck, and around 5 to 15 percent of these lumps are malignant. By measuring gene expression at the lump the machine-learning model is able to predict with greater than 90 percent accuracy whether it is malignant or benign. The work was published in Clinical Cancer Research in 2012.

Protein data is not the only kind of information used by researchers. Scientists at Case Western University have used machine-learning techniques on Magnetic Resonance Images (MRIs) of breast cancer patients to predict if a patient is suffering from aggressive triple-negative breast cancer, slower-moving cancers or non-cancerous lesions with 95 percent accuracy. Today’s capabilities of image analytics can significantly augment the insights gleaned from lab tests. The challenge with cancer is getting a full picture.

Text stored in medical records is another powerful source of relatively untapped data. Modern natural language processing capabilities can analyze massive amounts of unstructured data and combine the results with structured research and clinical information. Combining doctors’ notes versus numerical lab tests, for example, can give context to the condition and symptoms of the patient at various stages of different cancers.

Medical records include a treasure trove of data. Factors such as family histories, clinical test results and genomic data are stored in repositories across the world. The challenge is combining all that data in one database.

“Big data is not just big. The term also implies three additional qualities: multiple varieties of data types, the velocity at which the data is generated, and the volume seen within MD Anderson,” says Keith Perry, associate vice president and deputy chief information officer.

One of the ambitious objectives of the MD Anderson Cancer Center is to collect and combine patient information including a profile of their genetic makeup, clinical histories, test results, treatment courses and treatment responses. This data will be interpreted by the massive data analytics, which provide real-time decision support to rapidly improve clinical outcomes. This is a much more challenging task than meets the eye.

When the startup Flatiron Health launched with an ambitious goal to improve cancer treatment, one of the largest obstacles they faced is the inconsistency of records from various Electronic Health Record systems (EHRs).

With over $100 million in backing from Google Ventures, Flatiron is facing this basic problem: when measuring the level of a single protein commonly tested in cancer patients, a single EMR from a single cancer clinic showed results in more than 30 different formats. There are over 100 different kinds of protein and genetic tests, biopsies, and other diagnostic methods used in cancer care. And all the various EMR systems out there report these metrics in different ways. This is an incredibly complex data integration problem. So much so that Flatiron purchased Altos Solutions, which makes an EMR service for oncology practices. This allows the company to control the data collection process.

Finding cures and treatments for various types of cancer is truly a Big Data problem. And the ability to collect, store, share and analyze the data cohesively is still in relevant infancy. This isn’t a problem you can solve with just one approach. Whether using network analysis, text mining or other machine learning techniques, the task is a true inter-disciplinary challenge that requires numerous types of expertise and really Big Data.

Big Data and machine-learning don’t hold all the keys, human analysis and contextualization is key. Yet these technologies are starting to shine the light on how humanity will fight one of the most potent killers on the planet. President Nixon’s initiative gave us the Frederick Cancer Research and Development Center, an internationally recognized center for cancer research, and has achieved many breakthroughs. President Obama’s initiative has the potential to revolutionize the state of cancer treatment. We’ll make a comparison in 45 years!

Why Is Healthcare Struggling with Patient Engagement?

Banks, airlines and other consumer industries have long since figured out how to engage customers using technology. But not so with healthcare, according to a report from Chilmark Research.

Linda Barlow

Linda Barlow

The report — based on interviews with healthcare executives, clinicians and technology suppliers — found that basic patient portals tied to electronic health records (EHRs) are the foundation for a majority of digital patient interactions. However, some provider organizations have yet to adopt these basic patient portals, placing patient engagement behind other enterprise priorities.

One of the primary problems facing patient engagement technologies, “Technology vendors currently serving the market have done a middling job of rolling these products out to their customers,” said Naveen Rao, analyst, Chilmark Research.

Read more about how technology vendors are lagging with patient engagement technology in this article from Healthcare IT News. Then, let us know what you think. Should patient engagement be considered the lynchpin of a successful modern healthcare IT strategy? How can providers and vendors work together better to ensure success? Sound off in the comments section.

Four benefits of electronic health records

Leaders from industry, academia, and health care discuss the rollout of this technology at The Atlantic’s sixth annual Health Care Forum

Today The Atlantic Health Care Forum brought together leading policymakers and industry experts in medicine, public health, and nutrition to have conversations about the state of the nation’s health care system. The event was sponsored by Siemens, Surescripts, WellPoint, GSK and PhRMA. Real World Health Care attended to share insights from the panel “Health Care Tomorrow: Examining the Tools and Technologies that Will Revolutionize the Future Health Care System.”

Jamie Elizabeth Rosen

Jamie Elizabeth Rosen

Much of the discussion centered around electronic health records, which are increasingly being rolled out in huge hospital systems after the federal government incentivized their adoption to the tune of billions of dollars five years ago. Four themes emerged from the panel, which included top executives from Johns Hopkins Medicine, athenahealth, PhRMA, and Carolinas HealthCare System.

 

1. Enhancing collaboration.

Electronic health records facilitate a team-based approach to hospital care, as well as allowing for better coordination between hospital systems. “What we’re going to see is it’s going to drive team-based clinical care because everyone in the system will have access to the same medical records,” said Dr. Paul Rothman, Dean of the Medical Faculty and Vice President for Medicine at The Johns Hopkins University and Chief Executive Officer at Johns Hopkins Medicine. “You’re going to see an [increased] level of collaboration not only between delivery systems, but also between the patient and the health care provider.”

However, Ed Park, Executive Vice President and Chief Operating Officer, athenahealth, warned that the decades-old technologies that many hospital systems are using are limited in their capabilities. “The current crop of [electronic health records] are documentation tools instead of care management tools,” he said, adding that they are primarily for use by insurers and lawyers. “What I fear is health systems beginning to buy their way into their own prisons that are built of their own IT…as opposed to dealing in an open environment,” he said.

 

2. Enabling patient-centered care.

Electronic health records enable patients to reap greater benefits from telehealth. “Having your information on your iPhone: that’s not far away,” Dr. Rothman said. “[Patients are] going to do EKG’s at home. They’re going to be measuring their blood sugar at home. The patient will have control of the data.”

Electronic records also hold the promise of helping to solve age-old problems in the U.S. health care system, including keeping contact with patients to encourage them to take prescribed treatment regimens. “There is almost $350 billion a year in inefficiency because of lack of compliance and adherence with medications,” said John Castellani, President and Chief Executive Officer, PhRMA. “If you could just get an improvement in whether patients take the medicines that are prescribed, you could capture this great savings.”

“You have kids who have kidney transplants, and you can give them reminders on Facebook that they have to take their medications,” Dr. Rothman added.

 

3. Targeting therapies for increased success.

Electronic medical records can help health care providers ensure that they prescribe the treatments most likely to work for their patients.

“What I think is the promise of electronic medical records is our ability to find subsets of diseases through the broad diseases we treat,” Dr. Rothman said. “Asthma isn’t one disease. Obesity isn’t one disease. Diabetes isn’t one disease. We are going to be able to find subsets of diseases and target therapies [that work]. That’s when you’re going to see efficiency and return on investment.”

 

4. Harnessing the power of big data.

Our health care system has already begun to see the benefits of ‘big data’ with examples such as the discovery of drug side effects and interactions through mining consumer web search data. “We have to use the technologies to bring down the cost of the drug discovery process,” Castellani said.

“Just taking care of the patient, we capture data,” said Dr. Roger Ray, Executive Vice President and Chief Medical Officer, Carolinas HealthCare System. “That allows us to know when a patient…may be at risk for hospital readmission. Having the ability to mine [data]…makes a difference for patients.

“We all, each of us, remember with longing a simpler time when we could scribble and walk off and our job was done,” he added. “What we know now is that’s not very good for the patient. We had no standardization allowing us to help patients avoid lots of different bad outcomes they could have.”

 

Have electronic medical records impacted your health or that of your patients? Share your thoughts in the comments section.

Taking the Digital Leap Saves Community $20+ Million in Preventable Health Care Costs

Hospitalizations dropped by almost 3,000 people over a two-year period in Cuyahoga County, Ohio, thanks to a variety of quality changes and investments in electronic health records (EHR). This tool collects and shares critical health information about individual patients and populations across health care settings.

The nearly 11 percent drop in hospitalizations for common cardiovascular conditions (diabetes, high blood pressure, heart failure and angina) was reported in the 10th Community Health Checkup by Better Health Greater Cleveland, a regional health improvement collaborative that works with health care systems, health plans and employers to foster quality health care that’s more affordable.

Why does this decline matter? Because it shows that through efficient use of EHR, primary care is getting better in this community and has implications for advancing the quality of patient-centered care across health systems.

The report demonstrates that practices leveraging EHR are finding that they can more effectively measure care and identify opportunities to enhance service as a result: “The changes are helping people change the course of their health, and they’re adding up to measurable impact on the community – in health, care and cost.”

Better Health also notes that EHR makes a huge impact for the better when it comes to health outcomes for patients: “We have documented large differences between our EHR- and paper-based systems in terms of achievement and improvement of our standards in diabetes and high blood pressure.”

Indeed, a 2011 paper published in the New England Journal of Medicine confirms this trend, finding a 35 percent higher achievement for composite care standards for diabetes patients treated by practices using EHR compared with practices using paper-based systems. EHR sites were also associated with a 10 percent greater improvement of care and a 4 percent improvement among outcomes.

“EHRs have been well shown to improve patient safety, especially through e-prescriptions and clinical decision support,” says Dr. Tim Kowalski, President, Health Action Council Quality Forum. “They also help to improve care coordination via medication reconciliation, enhancing the exchange of health information and through the use of patient registries. And, they help to reduce redundancy via awareness of previous evaluations and various test results.”

Dr. Kowalski adds: “As health care purchasers we are demanding that health care providers demonstrate quality improvement, customer experience improvement and cost-effective care when we consider which provider groups to feature to our employees and their dependents. As we move from a world of fee for service payment to population health outcome-based compensation, this will become increasingly important.”

Have you seen examples – beyond those demonstrated by Better Health – where care is improved and costs are reduced when EHR are incorporated in the system? Tell us more.

Categories: Cost-Savings