30 Apr Partners HealthCare CIO touts integration of genetics and electronic health records
Editor’s note: John Glaser was a keynote speaker at WTN’s annual Digital Healthcare Conference May 7 and 8.
Boston, Mass. – John Glaser has been recognized as a healthcare visionary, and that’s because certain trends become clear to him early on.
Glaser, vice president and chief information officer for Partners HealthCare in Boston, is one of the leading advocates of marrying electronic medical records with information gleaned from genetic tests. As such, his influence extends far beyond technology deployment in the integrated health system founded by the academic medical centers Brigham Women’s Hospital and Massachusetts General, and even beyond his service on the College of Healthcare Information Management.
In Glaser’s view, it’s becoming increasingly clear that physicians can deliver better care if they understand a patient’s genome and the information it yields about potential disease exposure. Based on a patient’s genetic make-up, providers can determine if the patient is at greater risk of disease because of mutations that have occurred.
“To the degree we can predict this, we’re in a much better position to say, `Listen, I think you’re at risk of the following, and here’s a treatment you ought to consider, or here are some lifestyle habits you shouldn’t engage in because you’re at greater risk,’” he explained.
Listening to Glaser expound on the integration of EMRs and the human genome, it’s hard to imagine a downside, but there are ethical concerns related to data privacy.
In his view, however, the benefits should far outweigh the risks. Based on genetic research, for example, Glaser said it’s also clear that some people are poor metabolizers of certain drugs. For them, a normal dose would be too toxic and result in a negative health event, and genetic tests can be used to determine the proper dosage.
Similarly, a genetic test can reveal which treatments will or won’t work for specific cancer patients. “I might have a treatment for lung cancer that works for 90 percent of the patients, but not for you,” Glaser said. “Rather than start you on a course of treatment that is destined to fail, I can do a genetic test and be much more targeted in which therapy to apply.”
There still is work to be done on genetics versus environment but as genetic tests become more affordable, Glaser is confident that information gleaned from them will become part of the patient’s clinical data. That data, he said, increasingly will be stored on EMRs and influence the data stored on personal health records.
Not only will physicians apply diagnostic logic to determine when genetic tests are needed, patients won’t be shy about requesting them. “It might tell you that you are at elevated risk of stroke, and as a result of that you have to really watch your blood pressure and watch what you eat,” Glaser said. “You might want to use that in a personal health record to track your blood pressure and your diet. I think there will be a very active market where consumers will go off and get their own testing done.”
The integration of EMRs and genetic data, including any predisposition to disease, raises ethical considerations. The nightmare scenarios for consumers are that current or prospective employers would gain access to information on disease exposure and use it to deny job opportunities or promotions, or health plans would use the information to deny insurance coverage.
Glaser knows the discussion will include data protection. He said the solution would combine technology, workflow, and law – with the latter reflected in current Congressional legislation to prohibit discrimination in employment or insurance based on genetic test results.
On the technology side, Glaser said special privileges would be needed to access the data, and patients would have to grant special authorization to the caregivers that would view their genetic test results. In addition, mechanisms for locking people out and the normal authentication schemes would need to be in place.
“I suspect that over time, people will treat genetic test results as being no different than a cholesterol level or a family history,” Glaser predicted. “Over time, it will be accepted that way, but that’s not where we are today.”
Another dilemma, one the healthcare industry already is wrestling with, is the degree to which genetic tests are really different from other tests. A doctor already knows that a patient with a body mass index of 35 or higher is at risk of diabetes and heart disease; they don’t really need a genetic test. The same reasoning applies to patients with a family history of either condition.
In healthcare circles, Glaser is well-traveled and well-published, and his insights have been sought by the nation’s leading medical IT organizations. He is the founding chairman of CHIME, which has established a scholarship in his name, and past president of the Healthcare Information and Management Systems Society. He also has served on the board of the American Medical Informatics Association.
Glaser, who claims to be blessed with a high tolerance for stress, still unwinds with racquetball and writing. He has published more than 90 articles and two books on the strategic applications of IT in healthcare, but his advice to fellow CIOs boils down to fundamentals.
At the end of the day, he said, there is a small number of things CIOs must do well, starting with an understanding of organizational business strategy and what technology can do to support it, and the ability to form a strong IT team (including vendors) that can execute a given project.
At times, IT is not relevant to business strategy, but other times it can be a major contributor. “In a way, it sounds simple, but in a way it’s pretty complicated,” said Glaser, who holds a Ph.D. in healthcare information technology systems from the University of Minnesota. “It’s complicated because the strategies can be fuzzy or the strategies can be volatile, and it’s complicated because it’s hard to tell whether IT will really help something.
“It’s hard to have good ROI data, so you have to make a lot of judgment calls and use your instincts.”
Even with all the uncertainty that comes with technology deployments, Glaser is convinced that healthcare IT can be used to improve health outcomes – provided technology’s role is kept in perspective. “I don’t think there is any doubt that it is a phenomenally powerful tool that can help an organization,” he said. “I don’t think very many people say, “Oh, we better stay with paper because this [electronic] stuff is nothing but a drain of money.’
“On the other hand, you have to be a little careful with it because the tool, itself, doesn’t improve outcomes. It’s how well you implement it and revamp [processes] and train workers.”
Partners HealthCare, which has earned several industry awards for the innovative use of IT, was in the forefront of clinical decision support, a combination of applications and systems and process transformation designed to help physicians make sound patient-care decisions. Innovation is part of its cultural DNA, which creates management challenges as Glaser must carve out a budget for innovation, and weigh those requirements against immediate IT needs.
The trade off between the operational needs of today and the research demands of tomorrow is constant, but he believes that tension can sharpen decision-making for himself and his successors. “There is an organizational wherewithal and knowledge and competence here,” he said, “that will live long after I’ve left the scene.”
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