Dr. Iltifat Husain’s physician take on personalized medicine is at the end of this article
“Personalized care through mobile health technologies inspires the transition from isolated snapshots based on serial visits [to clinicians] to real time and trended data” according to Ryan J. Shaw, PhD, RN, and his associates at Duke University.
In an editorial in the American Journal of Medicine, Shaw et al point out that most primary care is episodic, with physicians only seeing a tiny sliver of a patient’s behavior and health-related information. There is so much more potentially meaningful data available in patients’ everyday lives that can yield valuable insights into their disease process and help “enhance our understanding of the longitudinal effects of care delivery, medications, and health behaviors.” Having knowledge of this everyday information would be especially valuable to physicians treating disorders that have a strong self-management component, including diabetes, coronary artery disease, and obesity.
To take advantage of this wealth of information will require analytics tools, automated algorithms, and other sophisticated computing capabilities to collect valuable data from mobile apps, wearable sensors, and other sources. It will also necessitate a new care team approach, say Shaw and his colleagues, in which healthcare team members are notified if data—elevated blood glucose, for instance—are repeatedly off target. At that point, a nurse might get involved to triage patients to help resolve the problem or pass on the issue to a higher-level clinician if needed. The editorialists further believe that tapping these new data sources “supports providers’ decision-making on tests and treatments, and allows for an ongoing conversation with patients about their health.” They also point out that many healthcare organizations are already incorporating mobile health technology as part of their patient care services and in patient-centered medical homes.
Despite the potential this new approach offers, Shaw and his associates realize the challenges ahead. Most notable among them is the fact it would present a heavier workload on already overworked healthcare providers. Another challenge is ensuring that the health data collected is accurate. Even simple mishaps like a home wireless blood pressure cuff that is improperly fitted can generate inaccurate information, as can a patient’s family member stepping on a wireless scale.
Dr. Iltifat Husain’s take/rant on this:
My biggest issues with personalized medicine is the disconnect between the technology evangelists and providers that are actually on the ground. The technology evangelists will lead you to believe there is an algorithm for everything and how everything needs to be automated. The best parallel is to electronic medical records. Technology evangelists assumed that electronic medical records would help physician workflows, speed, and quality of care. All of this has not come to fruition for the physicians who work in private practice and don’t have large support teams. The same issue comes to personalized medicine. With so many quality and core measures that primary care physicians are currently being flooded with, adding more data and work is just not realistic. In fairness to the authors, it’s something they acknowledge in their paper but something everyone else doesn’t seem to.
