Custom CareCustom Care

Health-care-services provider Kaiser Permanente is in the midst of rolling out electronic health records and decision-support systems in its regional groups throughout the country. Kaiser has been conducting surveys on paper to help assess patients' health risks for a number of years, but like Geisinger, it's moving this process online, says Dr. Andrew Wiesenthal, a pediatric infectious-disease physician who's also associate executive director of the Permanente Federation, the umbrella organization for all U.S. Kaiser groups.

Today, Kaiser patients can go online to schedule appointments and request drug refills. As the electronic health-records system rolls out, patients will be able to go to Kaiser's member Web site and access their lab results and medicine profiles, as well as summaries of their visits, and get personalized reminders to schedule flu shots, for instance. These capabilities will be available to patients in most Kaiser regions within 18 to 24 months. California may take longer because it's Kaiser's largest region, with 3 million patients and 5,000 physicians, Wiesenthal says.

Beyond these customized services, Kaiser is adding decision-support capabilities to let doctors provide the personalized care the Mayo Clinic envisions, Wiesenthal says. Kaiser doctors will have proactive electronic access to research and evidence-based medical findings from Kaiser internally, as well as from outside researchers and medical journals. So, if there's a major finding by a medical journal showing that all congestive heart-failure patients should receive a specific drug to prevent further cardiac problems, Kaiser doctors would receive an electronic pop-up message informing them of the new findings whenever they enter the electronic health record of a heart patient.

This is good news for patients, because they'll receive the full benefit of new medical knowledge or treatments. Health-care industry studies have shown that it can take up to 17 years for new medical findings to be incorporated into routine medical practice, in part because of the large volume of new information released by researchers, medical journals, and drug companies each year, as well as the time constraints of busy doctors. But as technology advances and as new discoveries are made--that certain medications don't work well with patients with certain enzymes, for instance--that data can be added to existing electronic prescription systems, giving doctors up-to-the-minute information they can use in planning treatments, says Brandon Savage, director of GE Healthcare, a maker of diagnostic-imaging equipment, and a former physician.

Perhaps the ultimate goal of personalized medicine is to prevent people from developing debilitating, and sometimes incurable, diseases in the first place. Diagnostic tools and equipment could, for example, allow early diagnosis of tumors or possible Alzheimer's, Savage says. This might include MRIs that look at a brain's chemistry and pick up on changes even before symptoms of the disease are noticed. In this scenario, patients could be treated earlier and possibly delay or avoid the most debilitating symptoms of the illness.

The technology being used to deliver personalized medicine also stands to have broader benefits, including improving patient safety by finding new correlations between diseases, drugs, and side effects, says Mayo's Schwenk. And this translates into better health care for the masses.

Continue to the sidebars:
"Bioethics: Watching For The Dark Side"
and "Insurers Customize Health Coverage