The failure of electronic health records (EHRs) to demonstrate substantial clinical and financial benefits—or be interoperable—is one of the key reasons precision medicine efforts aren’t succeeding, according to the authors of a “Viewpoint” article published by the Journal of the American Medical Association.
The author argue that the National Institutes for Health and other federal funders have seen too little return on investment in precision medicine initiatives, and that it’s time to re-evaluate the future of such measures.
According to the article, precision medicine has not proven effective in living up to goals outlined in 1999, which is when the Human Genome Project stoked expectations of medical advances. These expectations included:
- Common diseases will be explained largely by a few DNA variants with strong associations to disease
- This knowledge will lead to improved diagnosis
- Such knowledge will also drive preventive medicine
- Pharmacogenomics will improve therapeutic decision making
- Gene therapy will treat multiple diseases
- A substantial increase in novel targets for drug development and therapy will ensue
The expectations listed above have faded as research based on these assertions has resulted in disappointing results. The authors argue that massive federal spending outlays for conditions such as congestive heart failure and sickle cell anemia, using precision medicine methods, have been less effective than traditional industry research.
“The anticipation that improvements in medical care and outcomes derived from big ideas will reduce costs also seems unlikely given the high costs of applying targeted therapeutic interventions to small numbers of people based on complex and expensive technologies, as well as the inevitable overdiagnosis and overtreatment that follows from more intensive monitoring,” the author’s wrote.
Moreover, “The financial and clinical benefits predicted from shifting to EHRs have also largely failed to materialize because of difficulties in interoperability, poor quality, and accuracy of the collected information; cost overruns associated with installation and operation of EHRs at many institutions; and ongoing privacy and security concerns that further increase operational costs,” the authors wrote. “These features make the use of EHRs for research into the origins of disease, as proposed in the Precision Medicine Initiative, highly problematic. No clearly specified targets for either improved outcomes or reduced costs have been developed to assess the performance efficiency of EHRs.”
The authors argue that studies involving the use of EHRs should be re-evaluated.
“EHRs may increase health care costs due to their ability to enhance revenue capture and as a result of unanticipated security and upgrade expenses. What historical precedent is there that adoption of vast new oversophisticated technology reduces costs? Eventually, what is the definition of success and over what time frame?”the authors wrote.
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