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Super-Organism Focused Healthcare

Super-Organism Focused Healthcare

About 10 trillion cells make up the human body. The joining of eggs and sperm at the time of fertilization brings together 23,000 genes. In a healthy gut alone, more than 100 trillion bacteria thrive.

Scientists estimate that the microbiome—the term used to describe all the bacteria and other organisms that live on and within us—collectively represent more than three million genes. These bacteria live symbiotically with us, providing a variety of beneficial protections while we offer them raw materials and a nice, warm shelter in which to grow and reproduce. For most of medical history, physicians studied disease states without consideration of the microbiome. Only recently have researchers viewed the human body as a super-organism, influenced as much by the genetics of the host as by the permanent bacterial residents.

The microbiome offers humans an expanded ability to thrive within their environment by offering additional functionality—such as breaking down complex carbohydrates—that would be difficult to code within our limited number of genes. Through evolution bacteria chose us, and we chose bacteria, establishing a powerful, mutually beneficial relationship.

Even today, the new medical knowledge produced in even narrow disciplines exceeds the capacity of any physician to assimilate and apply effectively. Adding the complexity of the microbiome only makes the task of assimilating the relevant medical knowledge further out of reach.

Health information technology offers clinicians tools to manage this avalanche of information. As new knowledge is obtained, this information can be codified in guidelines, order sets, and searchable knowledge bases, relieving physicians of the impossible burden of assimilating all this new information.

Excerpts from: Super-Organism Focused Healthcare. PSQH, September/October, 2012

Photo Courtesy of  Don Guerwitz Photography – Mandalay Monk, Myanmar (Burma)

Print Me a Pill

Print Me a Pill

During the first Star Trek series released in the mid 1960s, the creators introduced viewers to several magical devices – the Communicator, the Padd, the Replicator, and the Transporter. Although building the latter device requires the repeal of several of the laws of physics, the other three commonly exist today for the public to use. Smart phones are the Communicator of today allowing us to speak, text, or email to anyone around the world who might have a similar device. The Padd is my Nook – it even looks like it and makes the same sound when dropped on a desk – or your iPad or similar tablet device. Finally, the Replicator is nothing other than a three dimensional (3D) printer, a device just entering the world of consumer products.

All 3D printing works from a digital file or blueprint that directs the building of the object. Some printers use tiny nozzles that deposit layers as thin as 0.1 mm in thickness from material contained in their “printer cartridges.” Other 3D printers use laser beams or tiny droplets of glue to fuse thin layers of plastic or material dust into solid objects.

Bioprinting represents the next step in 3D printing. Instead of materials, living cells fill the cartridges of the 3D printer. Cell by cell and layer by layer, these bioprinters deposit specific living cells chosen to perform a particular function in a pattern that allows them to perform a designed task.

3D printing offers the opportunity to print pharmaceuticals specifically produced to meet the needs of individual patients. A 3D printer with cartridges loaded with the pharmaceuticals required by the patient could print a pill that contains exactly the right amount of each of a patient’s medications, thereby customizing the drug treatment for the patient.

Excerpts from: Print Me a Pill. PSQH, May/June, 2012

Photo Courtesy of  Don Guerwitz PhotographyConch Fisherman, Grenada

Web 3.0 Data-Mining for Comparative Effectiveness and CDS

Web 3.0 Data-Mining for Comparative Effectiveness and CDS

“Turbulent times” accurately describes the state of the American healthcare system. The list of critical challenges is well known—upward spiraling healthcare costs now approaching 17% of GDP, healthcare payment reform, shortage of clinical professionals, aging population, and the economic downturn. While current investments in health information technology (HIT) begin to deliver increased reimbursements to providers, these same at-risk organizations, along with payors, seek better ways to leverage HIT to enhance quality care and reduce costs.

Although much effort focuses on improvement of clinical workflows, an opportunity exists to transform healthcare delivery by implementing evidence-based clinical decision support at the point of care. Such clinical content delivered effectively within new, efficient clinical workflows directs patients toward evidence-based therapeutic plans that produce desired clinical and financial outcomes. While informaticists work on developing these clinical workflows, the lack of clinical knowledge limits the ability of organizations to leverage HIT in order to personalize therapeutic care plans.

Identifying Affordable Therapies

Comparative effectiveness research, supported by data mining, allows organizations to identify affordable therapies that enhance patient care. With the implementation of HIT, data warehouses contain petabytes of searchable clinical, outcomes, genomic, and financial data across multiple patient populations. Bringing together this data using sophisticated knowledge analytic tools and domain-specific interfaces allows researchers to discover relationships among multiple variables gleaned from previously unconnected databases.

In turn, this new clinical knowledge enables clinicians to personalize treatment for patients based upon their genetic background by linking it to descriptive patient data and outcomes. Personalized medicine transcends analysis of a population-based cohort by placing the patient within a sub-population that better reflects the expected outcome from a prescribed treatment. Embedding this personalized medicine knowledge within an EMR’s clinical decision support module facilitates the delivery of these evidence-based best practices at the point of care.

Semantic Web

Sophisticated software indexes the databases on metadata that “describe” each data point. Although the indexing allows for rapid retrieval of the data, it more importantly builds links among each data point based upon the descriptive information contained in the metadata. Discovery of these relationships is impossible without semantic web technology and the ability of computers to utilize it to read and understand metadata. Experts can utilize semantic web technology to query multiple large data sets to explore comparative effectiveness hypotheses.

Excerpts from: Web 3.0 Data-Mining for Comparative Effectiveness and CDS. PSQH, September/October 2011

Photo Courtesy of  Don Guerwitz Photography – School Outing. Hanoi, Vietnam

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