The Lessons of COVID-19 Must Inform a Smarter Future in Healthcare
The need to embrace precision medicine is more important than ever
The healthcare industry will be discussing COVID-19 lessons learned for the foreseeable future. Yet one take-away stands out as a glaring issue that demands immediate attention: keeping critical patient and public health data locked away in disconnected databases and multiple data siloes is not only unsustainable, but potentially deadly.
From the point when COVID-19 arrived in the U.S., public health officials lacked critical information and proactive real-time insights into the ebb and flow of the virus — denying them the ability to mobilize highly effective localized responses.
It’s an ongoing problem exacerbated by a lack of standards and infrastructures necessary for the broad, yet secure, exchange of health information. And it has kept the world’s wealthiest and most technologically advanced nation from producing the accurate, timely risk insights required to properly manage a pandemic.
The inability to bring together key information is also what keeps the U.S. healthcare system from realizing the promise of precision medicine. Consequently, the overriding challenge remains, the predominant presence of “low-value healthcare.”
For the past decade, federal regulators have invested substantially in strategies aimed at correcting unstainable waste — equating to upwards of $935 billion annually — by shifting to “high value care” models. And while some progress has been made, the industry has, by and large, missed the low hanging fruit that could deliver substantial ROI through precision medicine.
Consider that 30% of healthcare dollars (American College of Physicians) are wasted on:
● Unnecessary services
● Inefficient delivery
● Low-value/high-cost drugs
● Missed prevention/therapy
Of all the lessons COVID has taught the world, the critical role of data to deliver real-time insights and inform care models built on precision medicine stands out the most. Going forward, the healthcare industry must embrace infrastructures and strategies that extract the promise of medicine built around the person being treated.
Opportunities and Challenges: A Deeper Look
One-size-fits-all healthcare is the primary culprit keeping stakeholders from taking hold of high-value care models. The negative impact was on full display during the pandemic, where rudimentary infection rate reports were published days or weeks after the fact — with questionable accuracy — precluding appropriate action ahead of surging localized infection rates.
Without proactive insights offering a glimpse into the future, the default public health response was often cookie cutter actions guided by state-level decisions that did nothing to address the unique circumstances of each community and micro-community at a “hyper-local” level. The result was a prolonged pandemic that cost hundreds of thousands of lives.
The state of healthcare on a day-to-day basis is no different. Consider these statistics related to prescribing practices in the U.S.:
● Trial-and-error and one-size-fits all prescribing results in more than 2 million adverse drug reactions (ADRs) a year
● 15.4% of hospital admissions are attributed to drug-related problems
● 26% of readmissions are drug related (and preventable)
Plavix perfectly illustrates how precision prescribing can improve patient outcomes and contribute to highly effective, high-value care. The antiplatelet medication is a popular coronary intervention for its ability to reduce clotting, strokes and recurrent cardiovascular events, but up to one-third of the population has a genetic makeup that changes how it is absorbed or metabolized, so there is wide variation in its efficacy. Depending on someone’s genetics, they may need double or even triple the normal dose, or it may not work at all. In others, lower doses are required to prevent life threatening bleeding, which may occur as a side effect specific to an individual’s genome.
Getting that information to front-line physicians at the point of prescribing is the challenge. Even if the information is in the electronic health record (EHR), it won’t impact decision-making unless it gets into the clinical workflow.
The evolution of EHRs needs to advance such that knowledge is infused into the process at the right time to inform physicians and ease the burnout problem. Patients are then much better off and will not hold clinicians to the impossible standard of staying on top of the latest pharmacogenetic or testing protocol.
PHINs: Empowering a Better Future
The good news is that a new class of solutions — Precision Health Insight Networks (PHINs) — is coming of age that transforms previously disconnected health data into actionable information that identifies population and individual risk and drives personalized care decisions. This type of infrastructure demonstrated its promise on a small scale during the pandemic, when it was leveraged to organize and normalize hundreds of millions of lab test results — including demographic data — from more than 20,000 order locations. [See https://cv19Dashboard.org ]
Enabling massive volumes of critical data to flow into a single dashboard, PHINs equipped public health agencies and healthcare organizations with detailed hyper-local lab testing insights. This allowed healthcare authorities to drill down to state, county, and sub-county views of COVID-19 testing rates, de-identified test results, key demographics, a side-by-side view of viral and antibody testing, as well as local-risk and age-group trending. That data was then used to identify communities where local resources would be strained in the next 5–21 days, allowing for a proactive response and defense against COVID-19.
Healthcare can build off this initial success with PHINs to advance and expand precision health models. By unearthing the insights from siloed data that already exists across multiple EHR, laboratory, and pharmacy systems, these solutions can provide clinicians with curated guidance right at the point of prescribing. These infrastructures can model alternative drug regimens that can then be shared in a collaborative manner through a medication action proposal — and lay the foundation for substantial ROI in terms of lives and healthcare costs.
U.S. healthcare is currently on an unsustainable course, but it doesn’t have to stay that way. To change current dynamics, stakeholders must embrace and adopt precision medicine practices that personalize therapies and care to individuals.
The challenges that have impeded mainstream use of these models are quickly dissolving, and the time is now for impactful change.
