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At a conference last week at Rockefeller University, sponsored by I.B.M., a panel of health care experts discussed the innovations that promised to be the most intriguing and the most necessary over the next decade or so. They chose one grand pursuit in clinical care - the probable rise of "predictive medicine." The idea is that advances in genetics would make it possible to know from birth a person's genetic predisposition for, say, obesity, heart disease or cancer, and that knowledge could be used to tailor treatment or alter personal behavior.
Yet the panel spent more time on the need to bring patient records and prescriptions out of the ink-and-paper era and into the computer age. "The problem I see is that we have so much information and we need to be able to translate that information into care," said Dr. Edward D. Miller, dean of the Johns Hopkins University medical school.
Last week's dialogue was a brief chat in a larger national discussion about how to make the transition to electronic health records and the implications of such a move. To date, the impetus for bringing information technology to health care has centered somewhat narrowly on reducing administrative costs and medical errors - both of which are huge problems.
An estimated 31 percent of this year's total national health care bill of $1.79 trillion is spent on administration. Electronic record-keeping would eliminate enormous amounts of paper-shuffling, which could save hundreds of billions of dollars and many lives. An estimated 45,000 to 98,000 people die each year from medical errors, including those attributable to misunderstood handwritten prescriptions and hospital charts, or lost laboratory test results.
But digital patient records are merely a first step toward a broader vision. Those records could become building blocks in a nationwide biomedical computer network for assembling and distributing up-to-the-minute epidemiological studies. The network could show researchers and physicians what treatments work for people with similar characteristics, ailments and, eventually, gene markers. To protect privacy, personal identifiers would be stripped out of the national network.”
There are plenty of technical obstacles and privacy concerns that would have to be overcome. Yet such a network is part of the 10-year plan being promoted by the National Institutes of Health, among others. "The dream is that every physician will be able to tap into that national biomedical network from his or her desktop computer," said Dr. Eric Jakobsson, who heads the Biomedical Information Science and Technology Initiative at the National Institutes of Health.
The presumed benefits would be improved quality and higher standards of health care. But such a network would also provide the basis for far more efficient markets in health care - and would have the potential to shake up both the pharmaceutical and health insurance industries.
http://www.nytimes.com/2004/11/22/technology/22newecon.html
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