Precision Medicine: Help Pave the Way

Published - Written by Xia Bi, MD; Sanjeev Bhavnani, MD; Laura Nicholson, MD

Take the Precision Medicine Survey

The fields of precision medicine and digital health have the potential to transform medicine by increasing access to health-related data at the touch of a finger, seamlessly sharing electronic medical records among institutions, improving the efficiency of healthcare delivery, and providing access to unprecedented granularity of patient data. Despite technology’s promise to improve patient care, real transformation hinges on effective training for the next generation of physicians and innovators in these rapidly evolving fields. Determining their needs, and the requirements within educational programs, is of highest priority.

Portable ECG monitors in cellphones and smart watches is one example of a digital tool that has been developed. A recent study showed that a commercially available smartwatch coupled with a deep neural network algorithm can identify atrial fibrillation with reasonably good accuracy. Although these devices are more versatile in their portability and ease of access than traditional ambulatory heart rhythm monitors, the impact that new technology will have on patient care remains to be seen.

Another promising tool that is advancing personalized medicine is the use of genetic testing to guide cancer treatment. For example, oncologists have begun using a recurrence score based on the 21-gene expression assay to estimate the likelihood of benefit from adjuvant chemotherapy in hormone-receptor–positive, human epidermal growth factor receptor 2 (HER2)–negative, axillary lymph node–negative breast cancer. The recent TAILORx trial showed that women with midrange assay scores could avoid chemotherapy without significantly increasing the risk of recurrence. Applying precision medicine to achieve an individualized approach to diagnosis and treatment has been long sought after but largely not met. Further advances in gene sequencing technologies coupled with clinical studies will move us closer to the goal. 

In March 2017, NEJM Resident 360 organized a panel discussion on the ever-evolving role of digital technology in changing the practice of medicine. In Transforming Healthcare: The American College of Cardiology 2017 Roadmap for Innovation, panelists and participants from around the world were brought together to address important questions in healthcare innovations, ranging from the development of wearable sensors and sophisticated diagnostic tools to cost containment efforts and quality control strategies. 

Many questions were raised by the panel. Notably, how can students and residents get involved and where can they acquire the skills to get started? As no set syllabus or course curriculum exist, intellectual curiosity is the most important educational driver — continually asking questions of those around you while acquiring skill sets in engineering, clinical investigation, public health, and bioinformatics.

So, how much do you know about the advances in personalized medicine? Are your patients adopting new healthcare technologies? How are providers incorporating these new told into their practice? To better understand your perspectives and attitudes, investigators at the Scripps Clinic in San Diego have created the Precision Medicine Survey to inform the development of precision medicine education and research curricula. Please click on the link and tell us what you think to help pave the way! 

Xia Bi is currently a second year internal medicine resident at Scripps Green Hospital in San Diego, California. She completed her undergraduate training at Johns Hopkins University and medical school at Jefferson Medical College. She also has a master's degree in Bioinformatics at the University of Delaware. She is interested in applying translational medicine and personal genomics to the clinical setting.

Sanjeev Bhavnani MD is a cardiologist and physician-scientist in healthcare innovation and practice transformation at Scripps Clinic and Research Foundation. Dr. Bhavnani was a Qualcomm Wireless Health Scholar where he was involved in the design of next generation digital medicine clinical trials. As a principle investigator on several studies, he has designed trials using nanosensors, wireless mHealth and smartphone-connected devices, handheld ultrasound, lab-on-a-chip technologies and cloud-based data platforms across various patient populations; and to assess the impact of new technologies on healthcare quality, costs, and outcomes.

Laura Nicholson, MD, is an internal medicine specialist who provides care to people who require hospitalization. Her clinical interests include evidence-based practice, inpatient medicine and palliative care. As a faculty member of the Scripps Clinic and Scripps Green Hospital Internal Medicine Residency Program, Dr. Nicholson oversees all resident research and provides support and insight into research design and execution.