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Personalized Health Care and Health Information Technology Policy: An Exploratory Analysis

Personalized Health Care and Health Information Technology Policy: An Exploratory Analysis. Jonathan S. Wald, MD, MPH, FACMI Michael Shapiro, MS RTI International Waltham, MA. Introduction. Personalized health care (PHC) promises: T ailoring for the individual patient

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Personalized Health Care and Health Information Technology Policy: An Exploratory Analysis

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  1. Personalized Health Care and Health Information Technology Policy: An Exploratory Analysis Jonathan S. Wald, MD, MPH, FACMI Michael Shapiro, MS RTI International Waltham, MA

  2. Introduction • Personalized health care (PHC) promises: • Tailoring for the individual patient • More effective treatment choices • Improved diagnostic decisions • More targeted screening • New genomic and molecular data • Falling costs; new research; new methodsof aggregation and analysis • Greater health IT adoption • More data; increasing interoperability; improved decision support including risk stratification

  3. Focus of this presentation How are advances in PHC anticipated to impact health IT?

  4. Methods – Exploratory Qualitative Study • Focused environmental scan • Phone interviews with 15 experts (multiple domains) • Analysis & reporting • Project sponsorship • 2012 project funded by the ONC (US Office of the National Coordinator for Health IT) • Views are those of the authors, not of the ONC

  5. PHC description we used • 2008 PCAST report • “the tailoring of medical treatment to the specific characteristics of each patient… [fostering] the ability to classify individuals into subpopulations that are uniquely or disproportionately susceptible to a particular disease or responsive to a specific treatment” • Center for Personalized Health Care (CPHC) • “incorporating knowledge of the patient’s environment, health-related behaviors, culture and values.” • “Predictive, preventive, personalized and participatory”

  6. PHC impact on current practice • Genetic testing • Family history • Shared decisionmaking • Overall, modest and variable impact, so far…

  7. Anticipated impact on health IT •  demand for data sourced from health IT • demand for health IT capabilities • EHR data • Clinical decision support (CDS) • Data export & import; and aggregation • Documenting the basis for decisionmakingH • High volume data

  8. Human time/cognitive demands • Demands on clinician time are growing • More complex clinical problems • More prevention, chronic care, documentation, and administrative responsibilities for each encounter • More information per patient • More CDS to absorb • EHR use demands time • Communication with patients and caregivers

  9. Health IT policy areas • Use of remote data and application services • Liability resulting from remote computing • Transparency in CDS recommendations • Standards to improve data access, retrieval, interpretation, and scientific meaning • Alerting mechanisms for providers and patients, especially as interpretation (not the patient data itself) changes

  10. Patient engagement opportunities • Providing and consuming information about themselves • Collaborating in decisions • Documenting Online tools • Responding to family genetic information • Educating themselves, and engaging others

  11. Health IT challenges People Technology & Data Tasks

  12. Policy areas for further focus… • Interoperable framework for CDS • Standardized recording of patient values and preferences • Patient engagement • Data transparency and context • Consistent, clear privacy, security, and consent policies

  13. Bidirectional impact How are advances in PHC anticipated to impact health IT? How are advances in health IT anticipated to impact PHC?

  14. Thank you! Jonathan Wald, MD, MPH, FACMI jwald@rti.org

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