PO Box 409095
Chicago, IL 60640
Length: 7 minutes, 16 seconds
Interviewers: Melanie Evans, Andis Robeznieks
Interviewees: Justin Starren, director of the Biomedical Informatics Research Center, and Catherine McCarty, interim director of the Center for Human Genetics, both at the Marshfield (Wis.) Clinic
[00:00:03.20] Melanie Evans: This is Melanie Evans with Modern Healthcare. I'm here with Dr. Catherine McCarty, director of Marshfield Clinic's Center for Human Genetics and Dr. Justin Starren, director of the Biomedical Informatics Research Center and associate medical director of informatics, and Andy Robezniek's a reporter for Modern Healthcare.
[00:00:25.23] Andis Robeznieks: This is Andy Robeznieks. I was going to ask Dr. Starren, how has your life changed since your electronic medical record waspassed muster with the Certification Commission for Health Information Technology? And also, would you recommend to other organizations going the same route you did with, as opposed to going with a vendor, but developing your own EMR, or EHR, if that's a route that has worked well for the clinic and is it a modelwell, is what you've done a model for others to follow?
[00:01:03.13] Justin Starren: OK, thank you, Andy. In terms of how our life at the clinic has changed since [unclear] certification, we realized already that for an organization the size of Marshfield Clinic, to continue to fund the level of development that's necessary to keep an advanced system, which is currently over a 150 full-time developers, that we needed to broaden the user base, and that meant extending our EHR outside of the clinic into the commercial space. I think the real thing that [unclear] certification has changed is that it creates immediate credibility. There is often a perception that internally developed systems are cute or quaint or idiosyncratic and might work in a particular place where they were developed but couldn't move outside the walls. By creating a level playing field, the [unclear] certification creates immediate credibility for an organization like Marshfield.
In terms of whether organizations should do internal development, I could talk for hours on that, but I realize we don't have the time. I think that most institutions will not want to do internal development, simply because there is such a shortage of informatics professionals in the country, that there isn't enough expertise in the country to actually do [unclear] development in every institution. But I think what's more important for institutions to realize is that when you buy a vendor EHR, there is still a huge amount of customization and fitting it into the workflow of the institution, which is something that requires internal expertise that sites have to invest in, that they can't hand that all off to the vendor.
I think nationally, it's a worrisome trend that a number of sites that were doing internal development have stopped, because virtually all of the current vendors' systems were offspring of internally developed systems, and the leading edge features are usually proved in internally developed systems and then moved to vendor systems. So if we lose the internally developed systems, where will our next generation of innovations comes from? And that's a concern.
[00:04:02.02] Andis Robeznieks: Thank you.
[00:04:03.20] Melanie Evans: This is Melanie Evans. Dr. McCarty, could you describe for us what is personalized medicine and how the clinic's personalized medicine research projectcould you describe its ultimate mission?
[00:04:18.10] Catherine McCarty: I sure can. I was speaking to a group of senior citizens in an elder hostel not long ago, and I was asked, well, don't we do personalized medicine already? Isn't that what my physician does already? And I said, well, yes and no. Most information that's used comes from years and years of medical research on groups of people. And we have some individualized information, and in terms of genetics, the basics of what we're made of, the closest that we get to that now is asking about family history. So, do you have a family history? And just because you have a family history, of course, doesn't mean that you have that genetic marker that predisposes you to developing disease, or having an adverse reaction to a medication. So, ultimately, what we want to do with our personalized medicine research project, first, is to set up a database that will allow research in various areas, but ultimately to impact personalized healthcare. To have that information, to truly personalize healthcare. And we're conducting research in two different areasgenetic epidemiology, or what's the relative contribution of personal behaviors such as diet, smoking, occupational exposures and interaction with genetics to increase your risk of disease, so that we could tailor, personalize, preventive health advice.
And then pharmaco-genetics, or how does genetics direct your body's response to medication, so that a medication acts as we expect it to and doesn't cause an adverse reactions. We're, at the moment, the largest population-base biobank in the U.S., so nearly 20,000 adults age 18 up have participated. We have DNA plasma and serum samples, and access to the medical records, and we're conducting research and how does genetics predict response to cholesterol lowering medications, and anti-hypertensives, and tamoxifen used in breast cancer, and then how do genetics and environment interact to increase our risk of Alzheimer's disease and breast cancer, and hypertensive heart disease, and a whole range of things.
Soand we wanted to make this resource available to other scientists, not just proprietary to the Marshfield Clinic. In fact, we're very excited to have just gotten $3.2 million worth of funding from the NIH, along with colleagues in four other institutes across the U.S. that have biobanks attached to electronic health records, colleagues at Vanderbilt, Northwestern, Kaiser in Portland, and Mayo. And we'll be working with them to develop the methods as well to move this forward on a national level. How can we make use of existing biobanks with all different medical records and different ways of documenting disease to work together as a scientific community to move this research forward, and then, ultimately, because we're working with these medical records, to impact patient care, and truly personalize health care.
[00:07:14.19] Melanie Evans: Thank you.