Dale Sanders is vice president and CIO of the Chicago-based Northwestern Medical Faculty Foundation at Northwestern University, affiliated with 897-bed Northwestern Memorial Hospital. He recently spoke with Healthcare Informatics Senior Editor Daphne Lawrence.
DL: Dale, you’re the CIO of the Northwestern Medical Faculty Foundation — so what is your relationship with Northwestern Memorial Hospital’s CIO Tim Zoph?
DS: Tim and I function as kind of a collective CIO on the campus. So there are three entities on the campus — the hospital, the faculty foundation and the medical school, and Tim and I collectively represent the CIO office on the campus.
DL: There’s a third spoke on that wheel?
DS: There is, the school of medicine, but it doesn’t have a CIO, so I function as the de facto. Tim and I work hand in hand. I’m just one member of a very important team at Northwestern’s Biomedical Informatics Center. Tim and I are members of that team, and the dean of medicine is the director.
DL: From your work with the Biomedical Informatics Center, is personalized medicine a big topic for you, and how do you see it today?
DS: It is. And what I see happening now, with our understanding of genomics and phenotyping and genotyping, is that our ability to create knowledge from the human genome is outpacing the evolution of the electronic health record, and our ability to fold that knowledge back at the point of care. I think it’s growing two to three times faster than the evolution of health records.
The thing is, what we’re trying to do is get that knowledge of the human genome and its effect on health into the hands of physicians at the point of care. And the only way we have of doing that right now is through the EHR. But I don’t see any significant movement on the part of the EHR vendors like Cerner or Epic or anyone that’s really thinking about how we’re going to fold this knowledge in a presentable way back to the physician. So I’m really concerned that we have to start.
DS: The vision I have in my mind is like firing a cannon. And the target is personalized medicine and genomics, and what we want is the maturity of our electronic health records and the maturity of genomics knowledge to coincide sat the same time. We’re already facing this. We already have genomic information that can help in disease management that we can’t figure out how to fold back to the point of care. We already know that. We already know that there are 160 diseases that clearly have a well-known genomic basis. We know that there are certain people that you treat with certain drugs at certain dosages if they have a genomic prototype of A or a genomic prototype of B. We already have this information, but we don’t have any way to fold it back to the point of care. And what I see is the rate of that gap becoming increasingly wider.
DL: Being so well aware of this, how do you deal with it? I mean you, in real life.
DS: What it’s really forcing us to do is custom software development. Because neither of our vendors is approaching this situation proactively at all.
DL: Who do you have?
DS: We have Epic on the ambulatory side and Cerner on the inpatient side. So what we’re doing is pulling the data that we need to match against the genomic data. So we’re pulling clinical information from Epic and Cerner and we’re matching it up against our growing genomic data content, and we’re starting to build custom applications that display that matchup of data back at the point of care. And we’ve peeled away the Epic application programming interface so that we now have the ability to display data within the Epic user interface that are not a part of the application but they look like they are.
DL: So can docs in the practices see the genomic information?
DS: We’re working on it, but not yet. And the reason we can’t do it yet is that we solved the problem technically but we haven’t solved the problem procedurally. It gets back to, if companies are building this knowledge strategy around how to expose this data and how to expose this knowledge effectively, it’s people processes in technology. We have the technology reasonably well established at Northwestern. We’re building data content, we know how to peel away this Epic application programming interface so we can display the knowledge back at the point of care, but what we haven’t worked out is the processes, and the patient disclosure issues that would be required for that yet, especially with the recent passage of the genomics non-disclosure act.
DL: Did that help or hurt your progress?
DS: Actually, healthcare has the opportunity to move faster on this than we have in the past, but unfortunately what we see is a lot of the genomic knowledge being locked up behind the IRB.
DL: Can you clarify — is this for impatient or outpatient?
DS: Most of the care that we think is affected by personalized medicine we think will be on the outpatient side. Eventually we will figure out a way to display this content back through the Cerner user interface as well.
DL: Are you working with anyone on this or is it all in-house?
DS: We did this all internally with our own staff.
DL: And Epic works with you on it, right?
DS: I’ll be honest with you. Epic is not very supportive of it, and I’m not that happy with Epic’s overall support for open application programming interfaces and open services. I’ve brought this up to Judy and her team — you’ve got to open the API, you’ve got to become more services oriented and you have to make it easier to blend non-Epic content in the user interface. They’re slow to support that model as compared more open architectures like eClinical Works.
DL: So why are you using Epic?
DS: Epic is embedded here and has been for 10 years. We’re going to offer eClinical works for the private physicians as part of the Stark laws umbrella. If you open the API, you’ve got zillions of programmers that can write cool applications against that, and it makes your product more attractive, not less attractive.
DL: Okay, so exactly what ARE you doing with genomics, or is this still a process in the works?
Part II coming soon