Personalized Medicine: Trading up from eHealth to iHealth
Kathy Siminovitch, MD, FRCPC
Dr. Katherine Siminovitch is a geneticist who studies the molecular mechanisms underpinning development of immunologic disease. As a Senior Investigator at the Samuel Lunenfeld Research Institute of Mount Sinai Hospital, Dr. Siminovitch aims to provide new knowledge and technologies enabling more efficacious and “individualized” therapies for major immunological diseases. Dr. Siminovitch is a Professor of Medicine at the University of Toronto and serves as the Director of the Lunenfeld’s Genomic Medicine Program and the Fred A. Litwin Family Centre of Genetic Medicine at Mount Sinai Hospital, and the University Health Network (UHN). She also directs the UHN Gene Profiling Facility and the Toronto General Research Institute Genomic Medicine Division. Link to complete bio here.
Progress in genomic science has created unprecedented opportunity to develop the diagnostic and outcome predictive markers required for individualized, more effective medical care. However, a very significant gap exists between clinical genomics discovery and its translation into effective personalized medicine. There are many reasons for this gap, but a particularly important one stems from the persistent use in healthcare of archaic informatics technology. While the rapid emergence and ubiquitous adoption of mobile digital devices and social networking tools in the world outside of the healthcare system has been nothing less than extraordinary, the healthcare system seems to have existed in a bubble, almost frozen in time. The continued widespread use of paper for medical charting and prescribing and of telephones and fax machines for appointment bookings and referrals, aptly reveal how out of sync our healthcare system is with the breathtaking pace of informatics progress and genomic discovery that are driving innovation and societal change.
An operational model for personalized healthcare demands the capacity for real-time electronic capture of health data. It is not realistic that an effective model can exist in the absence of informatics frameworks for integrating all health data – from clinical to imaging to large-scale genomic/proteomic datasets. Genomics-based personalization of medical care certainly requires next-generation decision-making tools that guide healthcare workers in bedside application of highly complex information.
The informatics bottleneck in healthcare reflects many factors, not the least of which are the often highly bureaucratic and regulatory aspects of the healthcare system, the lack of shared vision among its providers and users and the consequent use of a top-down, often non-adaptable and unresponsive “eHealth”-type approach. Knowledge of medicine and of healthcare system operations are also not as intuitive as Twitter-enabled social connection. This limit in population understanding of its workings also makes the healthcare system less subject to market force pressure. To realize the promise of personalized medicine, a from the ground-up, market-driven iHealth model is needed, whereby those most familiar with the practice of medicine entice those most skilled in IT delivery to provide contemporary, creative informatics solutions for healthcare. To translate the enormous global effort in genomic sciences to a personalized and better healthcare system, the ingenuity and vision that delivered Google, Facebook and the panoply of iDevices must first be translated into the healthcare paradigm.
This post was submitted as part of the guest commentary series: What is the biggest challenge facing personalized medicine in Canada? _________________________________________________________________________