Healthcare, IT and Us

Buzzzzzz. 

5:30 a.m. and my alarm clock goes off. I still feel tired and my sleeping app confirms that I barely entered REM sleep last night. I get up and weigh myself, entering the number into my nutrition and weight tracking app. Phew! Good thing my step counting app confirms I made it over 10,000 steps yesterday. While the pizza and beer I had for dinner may be a grad school staple, it’s loaded in sodium and fat, as I was reminded while recording it. Better order the salad at lunch today. I finish getting ready for my summer internship, but today I also have a Dr.’s appointment. I have chronic asthma and to be honest I’ve been so busy focusing on my internship that I haven’t really been thinking about it. However, my Primary Care Physician (PCP) tracks population health information and sent me an automated call last week saying that the area in Boston where I’m living this summer has a higher than average incidence rate, and since it’s linked to my electronic health record (EHR), the call also reminds me to refill my soon to expire asthma medication.

My normal PCP is in Pittsburgh, but today I’m seeing a specialist. I was able to use my PCP’s website to look for the most affordable and high quality specialist available in Boston that was also covered by my student insurance. When I scheduled the specialist appointment I texted my PCP and her staff was able to send my EHR to the specialist even though my PCP owns her own private practice and the specialist is employed through a large hospital system and they don’t use the same EHR system. The specialist writes a prescription, uses an app that checks for common drug interactions, and lets me know that a common side effect is nausea which can be reduced by taking the drug with meals. The order is sent electronically to the pharmacy near my work so I can easily pick it up during my lunch break. A note about the prescription is entered into my EHR and the Dr.’s office emails me educational materials about behavioral ways I can help control asthma attacks. I go to pick up my prescription and decide to buy the drug container that can send me alert texts when I’m supposed to take my meds. To be honest, without this feature I often forget to take meds because I’m so busy during school. I gave permission for my Dr. to have access to this information, so her office is able to track my compliance and send me reminder texts when I miss my meds for two days in a row.

While the above scenario is just that at this point, technology is disrupting the healthcare industry from providers, payers, device and drug makers, directly into patients’ daily lives. Healthcare remains one of the most highly regulated industries and this regulation often limits the extent that different players are able to work together. 

In 2009, as part of the American Recovery and Reinvestment Act, the Health Information Technology for Economic and Clinical Health Act (HITECH Act) was passed in an effort to “promote and expand the adoption of health information technology.” 

The act focuses around EHRs and created Meaningful Use (MU) standards that financially incentivize providers that are able to demonstrate meaningful use of EHRs. Examples of meaningful use are e-prescribing, electronic exchange of protected health information (PHI) to improve patient quality of care, and using clinical data to improve public or population health outcomes. 

PHI is covered under the Health Insurance Portability and Accountability Act (HIPAA) of 1996 which governs how and when patient health information can be shared. Given the current state of healthcare technology for most providers and other players, meaningful use of EHRs is a lot easier said than done. Most providers are not achieving meaningful use even if they are using EHRs and the integration required for the scenario presented above is still years away. However, this information is only the tip of iceberg of the potential for and current innovation in health information technology. It will remain one of the most challenging and exciting components of healthcare for years to come.

-------- About the Author: Susana Valverde --------------

Susana is currently the Vice-President of Cross Campus Relations for the BioPharma and Healthcare Club. She graduated from with a B.A. in Politics, a minor in Biology, and a public health concentration from Scripps College in Claremont, CA. After graduation, she completed an AmeriCorps Year of Service at a community health center working on population health and health equity campaigns. Prior to Tepper, Susana worked at a nonprofit focusing on behavioral health intervention studies and technical assistance for the federal Safe Schools, Healthy Students violence prevention and mental health promotion initiative. Susana is concentrating in Entrepreneurship, Strategy, & Finance at Tepper. She is also interested in Brazilian Jiu Jitsu, Bolivian Coffee, Baking, and watching historical documentaries when she should probably be doing her homework.

An overview of the Genetic Sequencing Industry

The human genome project, an attempt to decode the human genome consisting of 3.3 billion base pairs, took 13 years and approximately $3 billion. This feat promised a future of personalized medicine to unravel the mysteries of human diseases and promote longer healthier lives. It also fueled a race to develop technology that would provide scientists with the same outcome, a sequenced genome, at a fraction of the price.

Presently, a human genome can be sequenced within a few months and the now costs on average between $4,000 to $10,000. The cost may continue to drop as Sequencing Industry leaders, Illumina release new products that project sequencing costs to be $1000/ sequenced genome.

So has this technology delivered on its promise? Well, not quite yet.

Sequencing has been able to provide many insights into many rare inherited and undiagnosed diseases. Most recently, sequencing helped diagnose a mysterious infection contracted by a 14 year-old boy, Joshua Osborn, in Wisconsin.

Joshua's family was skeptical that sequencing would provide any insight into why their son had suffered encephalitis and was in coma; yet they agreed to the test. Within 48 hours of sequencing DNA found in his cerebrospinal fluid, physicians were able to identify the bacteria and eradicate it within days.

In other cases, sequencing has been able to help physicians identify mutations in cancer and aid with specific treatment options to target mutations as the most effective solution with the least amount of complications. Companies such as Foundation Medicine, GeneDx, Guardant Health, PGDx, and Personalis are all competing in this space alongside many large research institutions: Baylor, Yale, and Columbia to provide sequencing and interpretation services.

The answer to whether or not sequencing technology will help healthy patients is still unknown. Several studies (Genome wide association studies – GWAS) have helped to understand population genetics and epigenetics, but not many studies have been conducted with the purpose of understanding how genetics predicts the onset of common ailments like diabetes, cardiovascular disease, Alzheimer’s etc. The main reason being that these diseases are multi-gene disorders. Having a mutation in any one gene that is related to the disease may increase your risk of developing that disease but it cannot predict the likelihood of the disease manifesting.

However, many research and healthcare systems are trying to answer that very question. Projects are underway that will sequence and monitor thousands of healthy individuals with the goal of discerning how genetics plays a role in disease onset.

A few examples of these studies are:

Institute of System Biology - 100K Wellness Project
Genomes 2 People – MedSeq
Genomes 2 People – BabySeq
Genomics England – 100,000 Genome Project
U.S. Department of Veterans Affairs – Million Veterans Program

Only time will tell, but it will be interesting to see what data these and other research projects will collect, and then to see what innovation will spring up to capitalize on those findings to help people live longer, healthier lives.

-------  About the Author: Nina Patel --------------------------------

Nina currently is a Marketing Intern at Personalis, a genomic startup company in Silicon Valley. She is the VP of Events and Alumni Relations for the BioPharma/Healthcare Club, and has actively been involved as a co-chair for the Innovation in Health Care Technology Conference at CMU (2014).

Prior to Tepper, Nina worked as an R&D Engineer developing DNA sequencing instruments at Life Technologies. During her six years at Life Technologies she developed a passion to build customer centric solutions that improved the lives of others. At Tepper, she is pursuing Entrepreneurship with a focus on Healthcare. In her spare time, she enjoys Spanish Red wine and friendly games of bowling or Ping-Pong.