How big data will save your life

Even as patient information moves to electronic records, important data is often siloed

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For example, the drug Zelboraf was developed by New York University's Cancer Institute a couple of years ago through genetic tests to target melanoma skin cancer tumors that express a gene mutation called BRAF V600E. Researchers found patients taking Zelboraf were 64% less likely to die from the advanced form of skin cancer than patients who received only standard chemotherapy.

"Looking at your genome does help in saying, 'For you, we should give half the dose of this drug, but for this other person we'll give you a double dose of that drug,'" Shah said.

Linking EHRs with genomes

Currently, there are several projects underway to link EHRs and human genomic data. Among the most promising is the Electronic Medical Records and Genomics (eMERGE) Network.

Funded by the National Human Genome Research Institute, the eMERGE network joins researchers from nine healthcare research organizations and hospitals with a wide range of expertise in genomics, statistics, ethics, informatics and clinical medicine. Up to 10,000 patients will have sequencing performed on them in reference to 83 specific genes, with another 50,000 to 80,000 patients getting more general genotypes.

The resulting data will improve genetic risk assessment, disease prevention, diagnosis and treatment, and can be used to develop genomic-based medicines, according to Dr. Gail Jarvik, head of the division of Medical Genetics at the University of Washington.

The eMERGE network includes the University of Washington, the Mayo Clinic, Boston Children's Hospital and the Geisinger Health System. The network started out looking for genes for more common diseases, using computer algorithms with EHRs to find the diseases associated with a particular genotype.

"This year, the network moved into pharmacogenetics, and it is very interested in sequencing of genes related to treatment response or adverse response to medications," Jarvik said.

Jarvik, one of the network's principal investigators, said the network has been successful in finding disease genes, immunity genes, and eye and cardiac disorders.

The eMERGE project has developed a computer algorithm that extracts disease types from a number of different EHRs at various institutions. Researchers then input the data and look for genetic markers that point to mutations responsible for diseases.

"When you move to pharmacogenetics, there are problems you can have with drugs," Jarvik said. "A drug can be ineffective, or you may have an effective use of that drug but you may need a different dose than someone else. Or you might have a bad reaction. We want to work on all those problems."

Shah and other researchers caution that many variables affect a person's health, and genomics won't be a cure-all. But the use of big analyses can help improve patient outcomes.

Notes, images and biometrics

Genomics is only "one tiny fraction" of the myriad efforts to improve healthcare, Shah said. "For the average Joe who has hypertension, diabetes [and] high cholesterol, genomics is completely useless."

One of the most valuable tools in diagnosing and tracking patients still involves medical notes, and new natural language processing software is allowing those physician's notes to be codified into database fields that most healthcare professionals don't have time to fill out themselves.

"Textural notes are how doctors communicate with other healthcare providers about what's going on with a patient, what's the plan for treatment and what are the concerns," said Dr. Isaac S Kohane, a professor of pediatrics and health sciences technology at Harvard Medical School & Children's Hospital.

Kohane is frustrated that it's easier to find out more about shoppers' experiences with a digital camera purchase than to determine what adverse events patients had with a particular drug. So, along with several colleagues, Kohane developed free open source software called i2b2 informatics that can collect both physician notes and other unstructured data as well as codified medical data from a patient's bedside.

Dr. Robert Walker and colleagues go through the process of admitting a patient, taking vital signs, diagnosing him and offering to share information in his EHR with him. The practice uses tablet PCs, a wireless environment and Dragon voice recognition software in the office to add notes to the EHR.

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