Precision medicine: huge promise, high hurdles

Dr. John Halamka, CIO of Beth Israel Deaconess Medical Center, traveled 400,000 miles in 2018 – jetting all over the world, from China to India to Scotland to Scandinavia. On those journeys, he's seen how care is delivered in very different ways. In China, for instance (he's been there 35 times), there is no primary care. As a result, patients can self-select any provider, leading to a scattered lifetime record across diverse provider sites. In India, where active tuberculosis is widespread, access to care is much more difficult, and treatments are often mismatched to illness. "This is not precision medicine," said Halamka, speaking Monday at the HIMSS19 Precision Medicine Summit. What is precision medicine? It's not just genomics. It's more than just social determinants of health (although those do play a much bigger role than many realize). At its core, he said, precision med is "the right care in the right setting from the right provider at the right time." That's a easier said than done, of course. There are big differences between diagnosis and treatment, and so much depends on demographics, genetics and other biomarkers, geography, climate and more.