By Cindy Atoji
March 11, 2008 | Thomas Miller has a vision for a new health care frontier that combines molecular imaging, molecular diagnostics, and informatics. Miller, who is CEO of workflow and solutions for Siemens Healthcare, says recent advances in these fields have created precise diagnostic tools capable of assessing and treating a growing number of diseases. These new tools provide physicians with an understanding of diseases at the molecular or genetic level, enabling them to tailor effective treatment to the individual. Digital HealthCare & Productivity recently spoke with Miller about how the health care IT network can become more efficient by using these patient-centric medical tools that transform data into knowledge.
DHP: Can you tell us about this change in R&D?
Miller: Health care is evolving, entering a new era, one created through the marriage of in vivo and in vitro diagnostics, arming physicians with the tools that enable early intervention and treatment in a way that improves clinical efficiencies, effectiveness, and outcomes. This includes collaboration between radiology, pathology, and informatics to integrate molecular imaging with relevant molecular diagnostics services. Traditionally, imaging and molecular diagnostics have been specialty silos, but now technological advances are breaking down these walls, for example, the electronic patient record. In vitro diagnostics and medical imaging can be integrated in such a way that 1+1+1 will be more than three.
DHP: Can you give us an example? How exactly would integrated diagnostics work?
Miller: Let’s take the example of a patient with high PSA (Prostate-Specific Antigen) level, that’s a test that is highly sensitive but not specific. But combined with other in vitro diagnostics, maybe genetic markers plus imaging, you may increase the specificity, avoiding unnecessary biopsies and even better, avoiding prostectomies, which come with a lifelong sequel of very expensive care.
DHP: What is needed for facilities to achieve integrated diagnostics in terms of IT and workflow tools and solutions?
Miller: Providers need to start looking across episodes of care into the integration of care. This means having a team-approach to medicine that is enabled by having the right testing as well as having information technology underlying that testing which can help bring it all together.
The area of information technology (IT) has a subtly to it which needs to be appreciated before you can understand how it can contribute to integrated diagnostics and personalized medicine. If you perceive information technology as simply being an electronic repository of information, you will actually make health care less efficient. If someone sends an email, for example, with a huge file attached to it, you often print it out to look at it. So you want IT that’s work-flow driven and that can anticipate the needs of the physician and the patient for that particular episode of care.
DHP: Are the pieces in place today for the most part, or are you talking new workflow tools and technology?
Miller: The interesting components are already starting to be available. We have, for example, already started sharing molecules between our molecular imaging group and our diagnostics group. You have very inexpensive blood tests which show the existence of some protein which indicates that something in the body may be awry. Imagine having an imaging label tagged to that exact same protein which shows what the origin is in the body — where it’s located. You can start from something inexpensive and maybe non-specific, and increasingly go toward something which may be a more expensive technology, but becomes very specific and guides the physician, ultimately, to the correct treatment.
With respect to IT, we have an integrated workflow engine with a service-orientated architecture so pieces of information can be mined from all over the enterprise of care and brought to any physician and customized for the institution. So the foundation elements are all there. But have we brought them all together to attack every single clinical problem? No. But once the foundation is there, as new medical knowledge is acquired, for many diseases, we have a bit of almost every bit of technology to guide a patient from the screening to the cure.
From a hospital standpoint, you need to make wise, long term choices about IT infrastructure and start to approach the problem in a longitudinal, disease-by-disease manner. Don’t try to do it all once and start to lay it as a best practice in the organization. It’s a big change.
DHP: What are some barriers that still need to be addressed?
Miller: I think there are three issues or barriers, the last of which is probably the most difficult. The first is that medical knowledge increases at such a quick rate that it requires training — people need to adopt new ways of practicing medicine, and that always takes time. The second thing is the silo orientation of many health care providers has to be broken down. Information technology can help do that.
The third barrier is the more difficult one. In industry, we learned many decades ago that longitudinal accounting systems allow us to make the right decisions. In other words, there are things you would invest in upfront in the design and manufacture of the product which would reduce costs later on, once the product is in the hands of the consumer. The analogy to health care is that if our health care system measures its cost only in episodic pieces — there’s a cost for a test, image, or procedure, rather than in total costs, from initial screening to cure — we will make sub-optimized choices. It may mean paying more for more testing but the more accurate characterization of diagnosis will lead tremendous savings from the therapeutic side. That’s a major change in how we look at how health care is accounted for.
DHP: Do you believe the integration of molecular imaging, molecular diagnostics, and informatics will lead to true personalized medicine?
Miller: If you look at standards of care, they have been statistically developed for the average patient, whereas the change to personalized medicine means that you would like to characterize the patient individually.
This trend is also accelerating due to new drug developments. Drugs that are being developed today tend to work on narrower sub-population of patients. Without adequate diagnostic testing to go along with it, these drugs become ineffective. Whereas targeting the right subpopulation, they are highly effective. So I think we’re sitting on the necessary tools to enable personalized medicine, which has a benefit not only to the health care economy but also patients.