The Digital Divide

The idea of precision or personalized medicine is gaining a lot of attention. In his State of the Union speech, President Obama launched the Precision Medicine Initiative “that will help deliver the right treatment to the right patient at the right time.” Additionally, I recently came across a press release announcing the appointment of a renowned biomedical researcher to lead the new UCSF Institute of Computational Science. This institute will be a “core element of UCSF’s campus wide efforts in what is known as precision medicine – a growing field that aims to take advantage of new advances in computer technology to convert hundreds of trillions of points of molecular, clinical, and epidemiological data into diagnostics, therapeutics, and insights. Reading about these initiatives is inspirational but is seemingly generations away from how medicine is practiced in the community.

According to the HIMSS Analytics Database only ~3% (198) of all hospitals are at Stage 7(complete EMR), whereas almost 70% are somewhere in between Stage 3 and Stage 5. At these stages there is minimal analytics capabilities and seemingly light years away from computable and data driven precision medicine paradigm. Although the rate of adoption has certainly accelerated for hospitals under the Meaningful Use program, the scenario is markedly different for primary ambulatory care. A recent infographic published by CMS shows that almost 50% of eligible professionals received penalties for failing to meet Medicare meaningful requirements. In response, the American Medical Association (AMA) released a statement, ‘the Meaningful Use program was intended to increase physician use of technology to help improve care and efficiency. Unfortunately, the strict set of one-size-fits-all requirements is failing physicians and their patients. They are hindering participation in the program, forcing physicians to purchase expensive electronic health records with poor usability that disrupts workflow, creates significant frustrations and interferes with patient care, and imposes an administrative burden.” As a practicing community physician, I witness clinicians struggling to adopt “modern” EHRs with substandard features for text processing, ineffective decision support rules, and non-existent population health analytics. Overall, these EHRs reduce physician productivity and impair patient care. It is no surprise that approximately 50% of physicians were penalized for failing to comply with Meaningful Use.

How and when will we bridge the gap between the “precision medicine” at large academic centers to the reality of community medicine? According to a synthesis study, it takes an average of 17 years to make a proven medical innovation part of routine care. Furthermore, at the end of that period, only 14% of research knowledge actually has been adopted. To put that in perspective, our community health systems are operating at a pre-mobile phone level and the versions of precision medicine will diffuse out to the community by 2035. The current model allows for science to diffuse from academic centers into the community. However, in order to truly achieve improved healthcare outcomes, this process needs to be driven into the community (where the majority of patients are seen) rather than diffused. We must decrease the time that these innovations are “brought to market” and we must have an infrastructure in place that facilitates community health systems and providers to implement these innovations. It is not enough to have innovative and forward-looking initiatives but there must also be established pathways and methodologies that bring these initiatives to the community in a timely manner.