Q&A: Orion Health’s Ian McCrae on precision medicine initiative
Precision medicine is defined by the US National Institutes of Health as an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment and lifestyle for each person. The concept is at the heart of a new collaboration announced this week by leading New Zealand health IT vendors Orion Health, Medtech Global and CSC.
Is this announcement a formal agreement with agreed outcomes or more of an informal collaboration?
Health is changing, so in addition to a normal clinical record with data from the lab or radiology or pharmacy, you are getting a lot of extra data being added to that: genomic data, microbiomic data, device data, environmental data. Medical records are becoming huge. There is a projection that the data will grow between 2012 and 2020 … by 50-fold. I think this is an underestimate, especially when you put genomic data in there. You have massive amounts of data and you have a number of different vendor systems that can access the data, but it’s getting to the stage where it doesn’t make sense that we all try to have our own separate data sources. New Zealand is uniquely placed in that we do have very comprehensive clinical records going back 15 years or more and we all basically know each other. We have all worked together in the past so we are pretty well placed to be one of the first countries in the world to truly do what they call precision medicine.
How would you define precision medicine as opposed to personalised medicine?
Precision medicine is pretty much personalised medicine with a bit of an extension. The word came about when [US president] Obama announced his precision medicine program at the start of this year. He’s putting a quarter of a billion dollars into it initially to sequence about a million patients in the US. At the moment we treat patients very crudely. For example, all diabetics are the same, which is clearly not the case. Your genome predicts all sorts of things. I’ve just had my variant file done. I have the Irish variant of [cystic fibrosis], which four and a half percent of the population have. There is now a drug that treats that particular variant of it and there are pharmaceutical companies now targeting patients with certain variants or single nucleotide polymorphisms (SNP). Coming back to New Zealand, we are pretty well placed to do something world leading in that area. It is recognised by Medtech, CSC and ourselves, and we would expect that pretty quickly we will have a number of organisations on board. They’ve already been showing some interest in joining up.
Is the idea to get into preventative medicine, to be able to predict what is going to happen and get in there early?
Yes, absolutely. From your genome you can predict all sorts of things. It can tell you how well you will metabolise warfarin but it will also tell you some things you don’t want to know, like Alzheimer’s. That is one of the dilemmas. These are difficult things to deal with but over the next three or four years just the amount of sequencing that is going to happen is going to be huge. The price of genomic sequencing is falling rapidly.
You mentioned in your announcement the national electronic health record that the government is planning to design. How do you see this collaboration working on that?
New Zealand is ready for an electronic health record, a national one. Precision medicine is the next-generation electronic health record. Electronic health records can deal with the traditional lab results etc whereas precision medicine includes that and all of these other data sources as well. The goal then is that if we can open up this data then you can get new people innovating, producing mobile apps, allowing patient access. There are a whole lot of possibilities. Of course you have to have the right credentialing, the right privacy and all of that but that should be provided by the platform. This should open up a whole lot of innovation in the country.
Do you foresee the collaboration building an actual product or is it an open platform that wouldn’t have any intellectual property attached?
We already have existing products and applications that are live, so we would probably just extend those products. But the key thing is to make the data really accessible, with the right privacy, readily accessible so new third-party applications can be written and there can be innovation in the sector. Patients can be connected up to their medical record, device data can be added and that’s really the future. I think this is awesome. A lot of us have competed pretty fiercely in the past but I think there is a realisation now that we have to work together because this whole precision medicine thing is going to take off. New Zealand could lead the world in precision medicine. It is a logical thing for us to do as a country and I think what we’ll find is that with the three of us collaborating a lot of other vendors will join in, and we will create a very open platform for everybody to collaborate and innovate.