Kailash Yagnik, Senior Vice President-Strategy, Siemens Healthcare Private Limited in an interaction with Industry Outlook, shares his views on precision medicine development. During the conversation, he throws light on the issues pertaining to complexity with variations, modification of workflows, and more
There is a lot of buzz about ‘Precision Medicine.’ What are the factors behind this buzz?
Yes, ‘Precision Medicine’ is quite in vogue nowadays. To understand the reasons, we can first look at what precision medicine means for the stakeholders. There are four major stakeholders in healthcare
: the care provider, the payor, the government and central to these three is the fourth one – the care seeker or the patient.
To the care providers – focus on precision medicine gives ability to deliver care with higher quality, standardize care delivery process, reduce its costs, and increase its reputation in the community. For the payor (like insurance, etc.), supporting precision medicine results in overall reduction in cost of servicing the insured, to government, precision medicine would mean lesser loss of productive days of its population, and from a population health management perspective – better prediction and management of epidemics.
Lastly, and most importantly, for the patient, precision medicine means getting precision diagnosis and a precision treatment which is individualized to his unique needs and characteristics and to his clinical issue. It also means getting this effective treatment with least inconvenience like duration of hospital stays, or multiple visits to hospital or side effects of medicines & procedures, or overall cost of care, or all of these!
On one hand, there is the objective of precision medicine, while on other hand there are inherently so many variations between hospitals and clinicians on treating the patients. Is this challenge being understood & managed?
The variations in the processes do pose a challenge in delivering precision medicine. Here we will need to appreciate that some variations are inherent to the type of patient disease, anatomy & physiology, and hence, we should be referring to “Unwarranted Variations” that arise, essentially due to ways in which “man” and the “machine” impact the delivery of care. Also, managing these unwarranted variations should not be seen as separate topics, rather as an integral pre-requisite for delivering precision medicine.
These unwarranted variations stem from the specific training and habits of individual physicians and technicians, while others reside within hospital technology and equipment. The net result is that these variations increase healthcare costs, which could be up to 25 percent, and decrease quality of care.
Managing unwarranted variations requires a comprehensive, unbiased, and enterprise-wide approach. A few of the topics that care providers typically consider are:
o They accept that reducing variations early in the steps of care process greatly reduces the cumulative impact of these variations.
o They adopt local or global evidence-based best practice standards in delivering care.
o They prefer technologies that can adapt to patients’ individuality and deliver consistent results for all patient types. Example: patients who are obese, geriatric, immobile, physically unstable, etc.
o They deploy automation, as much as possible, to reduce operator related variations. Example: auto set-up of CT and MR exams, however ultrasound exams still remain operator dependent!
o Care providers have also started considering the use of AI based algorithms for “Assisted Decision Making” in order to reduce clinical variations.
Consider the following example as a case in point on how automation technology can assist clinicians. For cardiovascular artery diseases, Percutaneous Coronary Intervention (PCI), or also known as Angioplasty, is the gold standard for treatment. In this procedure, cardiologists use a catheter to insert one or more stents in order to open narrowed coronary arteries. Historically, PCIs have been performed manually, a feat of precision and expertise that is a testament to the skill of the specialists who perform them. However, significant variability exists in skills of the specialists. Some are simply more experienced and skilled than others, and this fact could influence the quality of outcome.