On Feb. 25, the White House hosted a summit to update the public and the healthcare industry on progress made in the first year of the Precision Medicine Initiative. Shafiq Rab, MD, CIO of Hackensack (N.J.) UniversityMedicalCenter and winner of the 2015 CHIME Innovator of the Year Award, attended the summit and spoke with Becker's Hospital Review about what the initiative means for both patients and providers and how precision medicine will fit into a value-based system.
"What we're realizing is that most of us are healthy for 90 percent of our lives," Dr. Rab says. "But our hospital can't just be present in our patient's lives for the 10 percent of the time they need us. We need to be there for the other 90 percent to prevent them from needing us."
But, there are barriers to achieving that degree of value for patient care. For all the talk of a shift to value, physicians are still incentivized to operate in a fee-for-service mindset. Additionally, that value can't be attained without knowing the patient, and not in the old-time sense of the word — hospitals need data on everything from family history and the social determinants of disease that might apply to them, to the way their genes determine how they might react to certain pharmaceuticals.
"If you don't know the whole picture, how will you ever be open to taking the risk? It's not going to happen," he says.
Healthcare is delivered similarly to cable television in some ways, according to Dr. Rab. An individual might pay for 1,000 cable channels, but only ever watch five of them, and the cable company has no incentive to change that. Similarly, 80 percent of patients might benefit from a generalized healthcare treatment, but there's still a large chunk of the population who won't, because it's not directed at them. This is not precision medicine.
"That's what needs to happen and if you can do that, you won't be giving unnecessary tests, you won't be prescribing unnecessary drugs, your patients will get better, faster andyou'll save money," Dr. Rab says. "That's where we have to be, and we aren't there yet."
HackensackUMC has taken steps in this direction, some of which Dr. Rab admits are experimental. Trying to innovate in big ways as a healthcare system sometimes involves throwing ideas at the wall just to see what sticks. Hackensack's initiatives have in part been geared toward trying to get all patient data into one place to help develop risk assessments that lead to predictive analytics about outcomes.
Even for hospitals not completely sold on precision medicine, adopting practices that help advance care delivery by more efficiently gathering data on patients has the added benefit of acting like the groundwork required for later expansion into more individualized care and treatment. At Hackensack, this included putting the system's EHR in the cloud and developing a mobile app connected to the system's network, Dr. Rab says. Just putting all of the data together so that it could be viewed as a cohesive story, rather than bits of information kept in different places, helps to move a health system toward improving value.
"We're trying to look at this data and answer questions like, 'Why do our ACO patients have 58 percent lower readmission rates than our other patients?' 'Are outcomes better for our patients when their physicians speak the same language as they do?'"
For both patients and providers, adopting technology that can be used to improve care is contingent on finding answers to questions like these, Dr. Rab says. And those providers who don't prepare now will have a hard time adjusting in three to five years, when disruptive technologies are taking off. Those who have invested in a precision medicine framework can handle and use the greater breadth of patient information that will become available. Cultural changes can't be legislated, Dr. Rab says, so when they happen those who aren't prepared will have to catch up. Even the parties with the least to gain from working together, such as EHR vendors, are beginning to play ball, Dr. Rab says, citing agreements by companies like Epic, Cerner and Allscripts to get on board with interoperability and standards.
"When [Fast Healthcare Interoperability Resources] came along a couple of years ago, no one cared, then very quickly it became more and more clear that to support precision medicine and advancement is to support FHIR and do all the things that come along with it," Dr Rab says. "That change is coming. Hope is on the way and everyone in healthcare should get ready for it."