Electronic health records enhance genetic research and clinical care

The awareness of technologies potential to improve health and health care is going viral. From the iPad, to mobile phones, telemonitoring and e-prescribing, we are slowly entering a brave new world of digitized health care. Now a new paper in the American Journal of Human Genetics introduces an intriguing new application for electronic health records (EHR, also called electronic medical records, or EMR). Researchers at Vanderbilt University propose that EHR could improve not just routine clinical care, but also genetic research. An integrated EHR could allow researchers to relatively quickly and effortlessly identify patients with certain conditions of interest, Crohn's disease or multiple sclerosis, for example, who could then be screened for certain genetic variations suspected of being involved in their disease. Normally the location and screening of such candidates is a painstaking process that increases the time and money required to perform research. EHR could significantly streamline this initial process, though informed consent would be needed before actually enrolling prospective candidates. The Vanderbilt researchers used an existing DNA databank called BioVU to locate genetic variations linked to five disease, then turned to an EHR to identify 10,000 patient records suitable for use in a case control study.

Other's are already combining research techniques with EHR systems in ordered to bring patient-generated outcomes data into clinical practice. A company called Dynamic Clinical Systems has worked with the Spine Center at Dartmouth Hitchcock Medical Center in New Hampshire to develop and validate a tool for integrating patient reported outcomes into the clinical encounter. Before seeing a specialist, the patient answers a series of questions using a computer touchpad. The results are added to previous responses, and printed out for the specialist to review during the clinical exam. Questions have been extensively validated through published research, and the results allow clinicians to gain a much more nuanced understanding of the patient's health experience, and which treatment options might be best suited for that particular patient. It also creates a uniform, longitudinal record of patient experience over time that can be used to track improvement (or decline) in mobility or quality of life.

And imagine if you EHR could be monitored electronically for certain diseases or symptoms to track slowly unfolding disease outbreaks, or environmentally-related illness that might not otherwise trigger public health surveillance networks.

Combining a means of sharing health information with genetic data that is linked to specific patients obviously raises legitimate privacy concerns. But the ability to rapidly gather detailed data about hundreds of patients, both as a means of informing clinical practice, public health surveillance or health research, is a potent approach worth pursuing.