Electronic medical records (EMRs) are being implemented, however slowly, in many hospital and managed care systems. Meanwhile, advanced computer technology is providing the ability to identify broad developments and trends in a variety of consumer, industrial and scientific fields. And by combining these two strategies, the Mayo Clinic (Rochester, Minnesota) and IBM (Armonk, New York) have committed to riding the front edge of these ongoing waves in healthcare.
A new partnership of the two organizations – acknowledged behemoths in their respective fields – was unveiled last month, with the hope of adding a significant new dimension to patient data mining. When fully mature, the project also could provide important new approaches to healthcare research, according to Nina Schwenk, MD, an internist and vice chairperson of the board of governors for Mayo.
The primary clinical goal of the link-up, Schwenk told The BBI Newsletter, is to enable not only a "drill down" into an individual patient's healthcare history, but also a broader "horizontal" approach to patient diagnostics and treatment. Outside of the healthcare field, this approach has been termed pattern recognition and has been used to identify a variety of trends, ranging from tracking to consumer buying habits to identifying credit care scams. In healthcare, the result of the project could be the ultimate in "personalized medicine" and "best practice" case management, she said.
Schwenk said that right now, Mayo has in place the EMR strategy, with electronic entry of a person's health history at the hospital's facilities, thus allowing a comprehensive look at that history to structure a disease management plan. "So if I'm sitting in an office with a patient," she says, "and the patient has, say, lung cancer, I can access all the medical information on that patient gathered here – the type of tumor, lung specialists and surgeons [seen], test results, everything available in a single-source way. I can also then go ahead and do a literature search and figure out what's the best treatment from that literature."
With the new partnership, IBM will use that information, combined with a large number of Mayo's patients, to develop a database system, she says, which adds a significantly broader dimension to this case management approach. "Such a database," Schwenk says, "will allow us not only to look at that person's information by drilling down vertically, but also horizontally. We have 4.4 million records available electronically. So we can tell, over the last few years, how many patients have had that type of tumor – their ages, how many had the same lab abnormalities, and the types of treatment they received. And I can tell how they did with the treatment they received."
The goal of this effort: to be able to produce "a mini-clinical study" for each individual patient. With such information, she says, "I can more efficiently and hopefully better treat that patient and say, 'This treatment is going to work better for you than another standard treatment.'"
In consumer terms, this means the ultimate customization of a therapeutic plan by providing the most up-to-date information, even at the genomic level, to produce the most far-reaching version of personalized medicine. Thus, Schwenk says that the database will ultimate provide even a "genomic profile" of a patient and other patients with the same type of disease, or information concerning how one genetic type metabolizes a particular medication.
"That's going to take a while to get there," she adds, noting that the entire project will take several years to be fully developed. The project already has been under way for the past two or three years, Schwenk said, with Mayo computerizing a range of its medical information, such as records from lab tests, with the more complex information to be integrated into the program further out.
Denis Cortese, chief executive officer of Mayo, told The Wall Street Journal in a recent interview that Mayo began keeping patient records "systematically" for treatment purposes as early as 1907. This process has been done by "abstractors" who have used patient records to identify a commonality in disease patterns and treatments. Computerizing this information will create "a repository of all knowable information about how to care for a patient," Cortese told the newspaper.
Put another way, Schwenk said the database would take this medical information "into the new era of medicine."
IBM and Mayo declined to disclose the financing arrangements supporting the effort. But Schwenk said that Mayo's primary contribution would be in supplying the data, with IBM's contribution coming mainly in terms of employee time and expertise. "The data is ours and it stays here," she said. "IBM is helping us to develop a way to architect it, store it and how to retrieve it." She added that IBM would be free to market the system of warehousing that it develops out of the project to other customers. She emphasized that the data used in the project would come only from patients who authorized their information for research use and that it would only be accessible to those authorized to use it. Ensuring the privacy of the information will be a key part of the project supplied by IBM's security experts.
The effort also is likely to feed into the emphasis on personalized medicine reported by IBM Life Sciences (Somers, New York) at last year's annual meeting of the Radiological Society of North America (RSNA; Oak Brook, Illinois).
Schwenk said that the first step in the project would be to move patient information from the clinic's Rochester site into the database and then, further out, add information from Mayo's Jacksonville, Florida, and Scottsdale, Arizona, facilities.
Samuel Palmisano, chairman and chief executive officer of IBM, said that on his company's side, the resultant product could be extremely profitable to the company, in terms of growing its expertise in the field and offering broadened consultant opportunities for various sectors of industry.
Schwenk said that the benefits could be huge for healthcare and that, for Mayo, the project "puts us at the cutting edge, moving toward truly personalized medicine."