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Precision medicine's boring secret

By Dr. Samir Damani

Precision medicine is one of the most compelling ideas to enter the health care conversation in some time. New technologies, such as genomic sequencing and advanced bioinformatics, are allowing clinicians to pinpoint the unique composition of each patient's disease. Therapies are being developed to precisely target that disease.

These advances are important, necessary and easy to talk about. Research, cures and sophisticated medical technologies are the poetry of medical care.

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But as important as they are, these technologies do not do enough to improve health. Cures are sexy, but they're also reactive. Prevention is, and should always be, the ultimate goal. The best body shop in the world is no substitute for simply avoiding the fender bender.

The success of precision medicine hinges on two, relatively boring elements. The first is data portability – the task of simultaneously securing patient information and making it available to help them. The second is developing a culture of wellness. These goals may be global, but they cannot succeed without addressing the individual.

Portability
Electronic medical records (EMRs) are a tremendous asset. They allow physicians, clinics and hospitals to securely share data. As long as the patient is visiting facilities that use the same EMR system, their history – diagnoses, films, prescriptions, surgeries – goes with them.

But take a step outside a particular health care system and the problems start to multiply. What happens if the patient gets sick on vacation or has an emergent health issue that requires treatment at a trauma center outside their normal network?

Suddenly, the clock gets turned back to 1992: patient records have to be faxed, burned to CD or transmitted in some other archaic format. Sometimes records cannot be retrieved in a timely manner and duplicative tests are taken and films shot. Perhaps a medication allergy is overlooked.

While this may be an episodic problem for some patients, it's an ongoing crisis for those with chronic diseases or even acute conditions like cancer. They quickly learn that, if they want to have a meaningful consult with that high-priced specialist, they need to tote their medical records with them.

This process slows care, increases costs and places an intolerable burden on both patients and the health care system. At present, EMRs are an incomplete solution that provide a vision for a more patient-focused future without actually making it a reality. Precision medicine relies on accurate, timely information. The inability to globally share that information is holding us back.
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