Genomics and the patient-led revolution

This article first appeared in the October 2012 edition of Pulse+IT Magazine.

New Zealand’s Orion Health has grown from its early beginnings as a health integration vendor into a full-service eHealth provider almost two decades later. For founder and CEO Ian McCrae, the next decade will bring more growth for eHealth companies as a patient-led revolution, harnessed to the power of genomic information and device data, promises to radically change the delivery of healthcare globally.

Late last year, Orion Health purchased the Microsoft Amalga Hospital Information System (HIS), now known as the Orion Health HIS. Combined with Orion Health’s existing hospital solutions, the company is now able to provide a full hospital information system, including patient management, full electronic medical record, CPOE, end-to-end medication management, laboratory, pharmacy, radiology and back office functions.

When aligned to its existing electronic health record (EHR) solution, its clinical portal technology and its Rhapsody integration engine, Orion Health is now able to offer a comprehensive eHealth suite of solutions that rivals the offerings of some of the world’s largest players, including Epic, Cerner and CSC.

For Ian McCrae, the founder and CEO of Orion Health, it means Orion Health’s solutions can be considered part of a “best of breed” option or as a fully integrated option – customers can choose one of the company’s products or the whole shebang.

And considering the company’s success in the US, where both Rhapsody and Orion’s EHR, or Health Industry Exchange (HIE) as it is known there, are widely used, he should be rather pleased that a New Zealand company has come so far.

There’s a long way to go, however, and for Mr McCrae, the challenge for the next decade lies in harnessing the power of what he, amongst others, believes will be a patient-led healthcare revolution, in addition to the remarkable power that will result from unravelling the secrets of the human genome. For a healthcare software company, the opportunities are endless.

“What we are starting to see and will become the norm over the next 10 years is a patient-led health revolution,” Mr McCrae says. “We have fluffed around with reorganising providers into different groups and there have been some gains there, but I think over the next decade, the patient has to become the centre of the health system, which they are not today.”

The great potential he sees for health IT companies in the next decade is two-fold: opening up personal health records to individual consumers and allowing them to take control of their own healthcare, along with assisting clinicians in their decision-making and care provision by managing, analysing and distributing data gleaned from structured clinical data, genomics and medical devices.

“The way we see it, is device data and genomics are going to have a big part to play in the future,” he says.

“The data created from devices and genomics doesn’t have a home. You are not going to put it into a GP system. With genomics, a short-run genome is four gigabytes, so there is a lot of data, and GP systems don’t have the ability to store that much information.

“And then once you have stored it you have to understand it, to see that a person has the [genetic] potential to develop this condition, and the device data is telling you that too. What does this all mean? The poor old GP, they are getting swamped as it is. Most of the systems out there, you type data and you get it back out again, you type more data in and you get more back. The big push for us – and the area that I find most interesting because I have a couple of engineering maths degrees – is actually analysing that data and providing suggestions.”

By suggestions, Mr McCrae says you are still reliant on doctors to use their training and clinical judgement, but data analysis will allow IT systems to provide recommendations and determine key trends among populations. “The patient is gaining weight quite quickly, which would suggest they are taking on fluid and there might be signs of another heart attack, so here are some interventions that you might suggest,” he says. “You are assisting the clinician to provide better healthcare outcomes.”

Orion today

While Mr McCrae was unable to comment when Pulse+IT spoke to him, the director of New Zealand’s Health IT Board, Graeme Osborne, confirmed that the Orion Health clinical portal has been chosen as the single solution that will be used to provide a comprehensive clinical view of patient data in the country’s acute sector under its clinical workstation program. The clinical portal has also been chosen by the government of Northern Ireland to provide secure, web-based access from a single browser to patient information under its electronic care record plan, which Orion Health is also providing.

In Australia, the technology has been used to build the consumer and the provider portals for the PCEHR, as well as a recently announced trial by ACT Health to offer chronic care patients a portal to their care plans and healthcare information from Canberra Hospital. It is also being used to provide clinicians with a single view of the three clinical data repositories that NSW Health is building, one of which, a centralised imaging repository, is already available.

It is in the US and Canada, however, where Orion Health has long had its largest market. Its EHR technology was recently chosen by Catholic Health Initiatives (CHI), the US’s second-largest Catholic healthcare system, to provide the cornerstone of the organisation’s $1.5 billion OneCare program to create a shared, universal health record for patients.

It was also recently named as one of six leaders in IDC’s MarketScape vendor assessment report, citing its relationship with more than 30 HIE customers worldwide and its relationship with 49 of the 50 US state departments of public health for biosurveillance and public health reporting. According to Chilmark Research, it is the leader in the HIE market overall in the US.

Allied to the Amalga purchase and the success of its Rhapsody integration engine, Orion Health is sitting pretty. Mr McCrae says while in the past he was happy to be considered part of a “best of breed” option, where a hospital uses a range of different IT systems from different vendors, underpinned by an integration engine like Rhapsody, the addition of a full hospital option rounded off the company’s offering.

“We have three product offerings these days,” he says. “One is our integration engine, Rhapsody. We are a full vendor now for hospitals, so for example we do PAS, departmental software including radiology, laboratory, pharmacy, ERP, everything. And the third area is the primary sector with electronic health records.”

Orion in the future

While Orion Health will continue to promote its integration and full-line hospital solutions, the area that Mr McCrae sees his company leading the world in is electronic health records. They will not, however, be the electronic health records we have come to know and love.

Australia’s PCEHR aside, most countries around the world are developing EHRs that clinicians can access but that patients often don’t get to see.

“Once you have an electronic health record that doctors and others can log on to, the next thing you create is a personal health record. You allow patients to log on to their medical record, which is a novel concept – allowing patients to get involved in their care! The medical profession is taking a while to get used to it but it is happening.”

Mr McCrae admits it’s a hobby horse of his, but he does not agree with the idea that it is the doctor, rather than the patient, who controls the health record. He also doesn’t agree with building electronic health systems that better suit the providers rather than the patients.

“Ultimately you are going to serve specialised views to health providers, community health workers, eventually GPs, of a patient’s medical record rather than having little snippets all over the place that you can’t merge back together again. Even if you transfer a summary medical record around the place, the problem is that different doctors will say if the patient has diabetes they will use different codes and so then you have the problem of who is right.

“Is it the family doctor, is it the doctor who saw them last, is it the emergency department who saw them yesterday, is it the specialist or the community health worker? They might all enter in slightly different codes, so then you need a human operator to look at them all and say the family doctor is right. Then you have to reconcile all of the drugs. It is just a nightmare.

“Basically if you are building a clinical system to make people healthier, which is what we are doing, I believe, then you would not build a system with snippets all over the place. That model was built for the providers, not for the patient.

“And the patients are going to win. They will vote with their feet. If a doctor says you can’t have your lab results then the patient will go down the road where they are a little more progressive.”

Posted in New Zealand eHealth

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