Biomedical IT and Informatics: Where s the Revolution?
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1 Biomedical IT and Informatics: Where s the Revolution? S. Claiborne Johnston, MD, PhD
2 Disclosures I am not an informatician. I dabble. I am an early adopter. I am a consumer of biomedical informatics.
3 Agenda The revolution in IT and informatics. The stagnation in therapeutics development, healthcare, community health. Counter-revolutionary forces. Key ingredients for revolution.
4 Agenda The revolution in IT and informatics. The stagnation in therapeutics development, healthcare, community health. Counter-revolutionary forces. Key ingredients for revolution.
5 The IT and Informatics Revolution Dramatic change in the way we live. Costs have declined drastically.
6 Moore s Law
7 Calculations Per Second Per $1000
8 Cost of a Website Web development costs have decreased dramatically Improvements in infrastructure though Web standards and software platforms. iphone apps Enables individuals without training to launch a site. Explosion of blogs
9 Cost of Information $1395 $0
10 Cost of Information
11 Industries Revolutionized Banking Communications Media
12 Agenda The revolution in IT and informatics. The stagnation in therapeutics development, healthcare, community health. Counter-revolutionary forces. Key ingredients for revolution.
13 The Biomedical Arena Information intensive at all levels Trends in: Therapeutics development Healthcare delivery Community health engagement
14
15 New Medical Treatments Munos B Nat Rev Drug Disc 2009; 8:
16 Cost per New Drug Munos B Nat Rev Drug Disc 2009; 8:
17 Cost of Healthcare
18 Cost of an Office Visit
19 An Office Visit Mechanic et al. 344 (3): 198
20 Agenda The revolution in IT and informatics. The stagnation in therapeutics development, healthcare, community health. Counter-revolutionary forces. Key ingredients for revolution.
21 Counter-Revolutionary Forces Therapeutics development Barriers to pooling data (eg competition) Lack of investment on shared problems (eg, biomarker development, clinical trial design) The complexity of the problem: Does failure of drug x tell us anything about the development of drug y?
22 Counter-Revolutionary Forces Healthcare Physicians are stodgy Grave concerns about privacy and confidentiality Diversity of settings and practices Complexity of the information Financial incentives not aligned
23 Agenda The revolution in IT and informatics. The stagnation in therapeutics development, healthcare, community health. Counter-revolutionary forces. Key ingredients for revolution.
24 Key Ingredients for Revolution Opportunities Role Knowledge Funding Timing
25 Opportunities: Development Pipeline We asked a group of pharma/biotech industry executives what was the most important contribution academics could make. Answer: Identify failures earlier.
26 Opportunities: Clinical Research
27 Opportunities in the Clinic
28 DOS
29 Mac OS X Leopard
30 Opportunities in the Clinic
31 Opportunities in the Clinic NORMAL
32 Opportunities in the Clinic Notes that convey information quickly and clearly. Focus on changes, abnormalities, issues requiring follow-up. Integration of guideline recommendations, drug information, etc.
33 Opportunities in the Clinic
34 Opportunities in the Clinic Improving quality of care Continuous quality improvement, Google style Next generation clinical trials? The QUISP trial: Use of standardized discharge orders Next Gen: toggling physician choice lists?
35 Opportunities: Community Revolution in community building Wikipedia Facebook Twitter Interest in health is apparent in media Need to develop tools to improve health Through cell phones, Internet, monitoring devices, etc.
36 Know Your Role Role of Academia? Free Love
37 Know Your Role Free love model The wonders of open source Setting common standards Engine for innovation, with commercialization elsewhere. Know how to identify failures early.
38 Funding Government support limited Vast majority of NIH funding is disease focused. Informatics investments best rationalized across diseases. ARRA funding likely a blip CTSA consortium should help Need to lobby for a home at NIH
39 Funding: Industry Partnerships
40 Timing is Crucial Too soon: Too expensive: Human genome project cost $2,700,000,000 Now would cost $50,000 No traction: ipad was tried 17 years ago Too late: Too expensive: opportunities lost Wrong direction
41 Too Late Colemak keyboard: 40% less effort
42 Timing is Crucial: Case Study Profiles system Need: research networking Approach: build it. Drawbacks: Existing social networking tools work extremely well and are evolving. They include tools for communications and data sharing Would it be better to build an app for an existing social-networking platform?
43 Where s The Revolution? Organization will be critical Define the strategy What should happen now? What do we do vs. wait for industry? How do we fund it? Do we have the forces? Who are our partners? Many conspirators in this room
44
45
46 Biomedical Research Funding Dorsey, E. R. et al. JAMA 2010;303:
47 Ronald in Bangkok
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