As millions of consumers and providers add data to patient EHRs, a multitude of data will become available for the greater good. Researchers can anonymize the data and combine it with a large database containing vast amounts of information about the health of the population at a community level, nationally, or globally.
In order to create large databases, providers and state public health organizations must input and share information. To make that happen, the Office of the National Coordinator for Health Information Technology within the U.S. Department of Health and Human Services issued large grants to help states develop health information exchanges for sharing health data among providers, Medicare, Medicaid, and public health agencies. For healthcare providers to receive the incentives, their EHR systems must interface with immunization registries to transmit electronic data public health agencies deem important, electronically record and submit clinical surveillance data and laboratory results, and identify and report cancer and certain other cases to a state cancer registry.
A thorough understanding of the demographics and medical condition of a population subset could enable hospitals to develop community based preventive care programs and clinics to address the needs of chronically ill patients in the community. The combination of big-data and analytics can enable researchers, public health officials, and healthcare leaders to ask previously difficult to answer questions, and focus on population health. Population health is healthcare of the future and it is unfolding now.
The next level of population health will be biobanks containing data about the genomes of millions of people. Beginning in 1990, more than 200 scientists collaborated on a $3 billion project to sequence the roughly 3 billion bases of human DNA. Between 2002 and 2008 the cost to perform the sequencing gradually declined from $100 million to $10 million. The introduction of next generation sequencing technology in 2008 led to a plummeting of the cost over the following years until 2015 when I published Health Attitude: Unraveling and Solving the Complexities of Healthcare, when the cost had come down to a few thousand dollars. Now it is less than $500.
Large organizations are jumping on the bandwagon with programs to offer sequencing to millions. The Department of Veterans Affairs has its “Million Veterans” program; Geisinger Health and Kaiser Permanente have enrolled tens of thousands, and this year the National Institutes of Health will begin its “All of Us Program,” aiming to gather genetic and physiologic data on a million volunteers. The “All of Us Program” will extend over ten years and promises to transform healthcare.
At a cost of $1.4 billion, a National Institutes of Health program may help scientists discover links between diseases, genes and lifestyle. The anonymized data will be a huge boost to population health. At a personal level, the impact will also be huge. Medical care will eventually be 100% unique. Every diagnosis, medication, and dietary guideline will be tailored to you and only you. There are many challenges to the biobank idea, especially at a national level where the NIH wants its biobank members to be all inclusive and representative of the American population. This is a laudable goal but one which adds huge amounts of complexity. The Geisinger Health system returned the Federal grant of $50 million and decided to go it alone to build a biobank of just their members. Earlier this month, Geisinger announced a genetic sequencing will be made available for free for all patients. It will be a routine part of preventive medicine.
