The Six Dysfunctional Pillars of Connected-Precision Medicine

Let's face it, from both a physician and patients perspective there's been a lot of irrational exuberance during the past decade or two regarding Precision Medicine, Translational Medicine, Connected health and the HIT, Digital Health, Mobile Health, HIMS, population health, telehealth and all the other subcategories of silicon based EMR, wearable's, diagnostics and treatment telemetry devices which have advanced in numbers, conferences and investments if not in improving clinical value=outcomes/costs.

How will we finally know if Precision Medicine has truly arrived to the benefit of patients and their physicians? The answer is that several technologies which have existed for decades must not only merge but actually function towards improving the quality or costs (value) of the four patient outcomes produced and manufactured between patients and their physicians (prevention, medical, surgical and palliative). Only when the cycle of population health data collection, tabulation, revelation and reapplication is functional will Precision Medicine have arrived. The components of the cycle of Precision Medicine must include;

1) HIT EMR/EHR and billing systems which are standardized and integrated via common encoded API allowing providers to communicate and share data in real time. Interoperability and encoded decentralized data sharing (think blockchain) would also reveal the preventative, medical, surgical and palliative outcomes of the entire population of patients according to all contributing and non-contributing variables contained in the patient records. Currently EHR companies sell patient data for profit to ancillary industry's and refuse to or reveal that data to benefit patients or their physicians.

2) Mobile Devices for diagnostics and treatments used by patients must be standardized and integrated via common encoded API into the patient population HIT accessible for both physicians and their patients.

3) Clinical Research Data, especially that funded by taxpayers will be available online in real time as it is charted for all the world to parse. Federal Laws passed in 1994 and 2007 to upload reproduced research results without delay to the www are currently being ignored by researchers and industry.

4) Physicians, Institutions and Therapists will compete capitalistically based on the quality and price of the clinical outcomes they produce with patients. Population and outcome data will improve under performers via quality control. 

5) Pharmaceutical, insurance and medical device corporations will compete capitalistically based on the quality and price of the outcomes their products produce with patients and their physicians. Pharmaceutical and Insurance Incs will provide seamless drug formulary integration and prices into all EMR's EHR's and mobile apps for patients and their doctors to use at the POINT of CARE. Pharmaceutical Management Groups (PMG's) will stop blocking price and drug formulary data from doctors & patients relieving the scourge of prior authorization rationing.

6) Data revealed from the above standardized interoperable decentralized EMR/EHR and billing population health data will be used to develop new digital, mobile, behavioral, molecular, somatic and genetic modes of diagnostics and treatments to improve the quality and costs of the four clinical outcomes.  Precision medicine will then improve patient outcomes and costs consistent with Moores Law.

When the above cycle of data Collection, Tabulation, Revelation and Reapplication (CTRR) is completed and functional improving clinical value=outcomes/costs, true precision medicine will have arrived. Although fully developed from a technology perspective, to date none of the 6 individual components of the precision health cycle are functional. As long as optimizing value=outcomes/cost solutions are proprietary and revelation of 'proprietary' patient data may diminish the EBITDA of the big 5 (insurance, pharmaceutical, med mal, hospital, EHR) industries then blockchain type based decentralized interoperable encoded population health benefiting patients and physicians won't happen. Despite enormous investments in established technologies (and yearly multi health tech society conferences) during the past 20 years, precision medicine improving the quality and costs of outcomes or enabling access to quality affordable healthcare has not arrived for patients or their physicians.