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Can genomics encourage use of personal health records?

Will personalized medicine -- specifically, patient genome sequencing -- drive adoption of PHR services? Dr. John Halamka makes the case at Bio-IT World.

BOSTON -- From the keynote podium of this year's Bio-IT World Conference & Expo, Yury Rozenman of BT Global Services proclaimed the era of blockbuster drugs over. Personalized medicine, he said, will make drugs targeted to smaller patient groups -- as opposed to the entire population -- the norm.

Meanwhile, in a breakout session, health IT evangelist and Beth Israel Deaconess Medical Center CIO Dr. John Halamka discussed the more immediate ramifications of personalized medicine for health care providers as it related to meaningful use and personal health records (PHRs).

Halamka, through his participation in the Personal Genome Sequencing Project, discovered his glaucoma far earlier than typical patients do. Knowing his genetic data prompted Halamka to seek care before symptoms developed, which allowed him to take steps to preserve normal vision for the rest of his life.

Combined with PHR services, Halamka said genome sequencing, which now costs about $500 per patient, could provide the information necessary to keep on top of potential health issues before they become more acute -- perhaps saving patient hundreds of thousands of dollars in their lifetime.

"No one's really done the economic analysis, because there are side effects, like the worried well [saying] 'Oh my God, I have twice the risk of prostate cancer so I'd better get a total-body MRI tomorrow,'" Halamka said. "But let's hope that, as a society, we recognize the genome will have an important power of predicting disease -- you could seek wellness care and avoid treatment for sickness, and do that at a lower cost."

In the context of meaningful use and the federal push to lower health care costs by improving care quality with technology and information exchange, Halamka predicted that genomic data will enter into electronic health records as well as personal health records. Another key concept of meaningful use is decision support for physicians -- and genomic data will require decision support tools for effective action.

It's providers vs. Google, Microsoft for personal health record market share

Just 10% of patients currently use personal health records, Halamka said. It's not for everyone. For example, older, less technically inclined patients are less likely to use them.

I think personal health records will go beyond the 10% adoption we're seeing now as patients see an economic motivation to do so.
Dr. John HalamkaCIO, Beth Israel Deaconess Medical Center

Two things will drive adoption in the future, he said. One will be health plans that require more patient interaction and shared decision-making with the provider, especially new plans that charge different amounts based on the decisions that patients make.

"[As patients] have more and more skin in the game, patients will take a more active role in looking at their options, their costs," Halamka said. "Hence, I think personal health records will go beyond the 10% adoption we're seeing now as patients see an economic motivation to do so."

Another driver of PHR adoption will be features such as the ability to securely email physicians, pay bills, refill prescriptions, get specialist referrals and make appointments. Halamka uses Google Health for a few personal health monitoring apps, but he thinks that patients ultimately will find personal health records tethered to providers more useful than independent sites such as Google and Microsoft HealthVault.

He pointed out that Beth Israel's PatientSite combines elements of tethered and untethered systems, as it can import patient data from outside its system of providers as well as aggregate a patient's treatment data from within. Currently, 50,000 unique patients per month use it.

One barrier to PHR adoption could be the physicians themselves, as they must plug into one before patients can access their data. Meaningful use rules are written such that physician adoption of personal health records will likely be "asymmetrical," Halamka said, with primary care physicians going online first and specialists lagging behind.

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"Primary care [doctors] are your air traffic controllers, your patient-centered medical home, they figure out all the stuff that's going on with you," Halamka said. "If you go to an orthopedist…chances are they're not going to be that interested in your 17 cardiac medications and having a deep personal relationship with you through a personal health record."

Let us know what you think about the story; email Don Fluckinger, Features Writer.

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