As precision medicine becomes a national priority, graduate medical education alumnus and Rush’s Chief Research Informatics Officer Bala Hota, MD, MPH, helps put in place new solutions for harnessing massive stores of patient and research data.
The promise of precision medicine is that, in the not-so-distant future, health care practitioners will be treating individuals instead of diseases. The present challenge is how to gather and harness the massive data store that will form the bedrock of this new approach to health care.
Building a Road Map for Health Care
Bala Hota, MD, GME, Rush University Medical Center’s chief research informatics officer, likens the colossal bioinformatics project underway nationwide, and at Rush, to the one that brought the sophisticated GPS network to the dashboard of our cars, where it now helps us find our way to our daily destinations. “First, somebody had to map out every street in the world. They had to gather all that data to build a GPS system,” said Hota, who completed both his residency and a fellowship at Rush. “You need that same approach for genomics — collecting and mapping our genomic data to disease and health. Those databases have to be built.”
Currently Hota and his colleagues are making plans to do just that, collaborating with other health care institutions to advance these efforts in Chicago. Rush is part of a consortium of Chicago academic medical centers that has applied for a grant from the National Institutes of Health to help build a diverse, voluntary national research cohort of one million Americans whose data will be gathered and shared. The plan is to enroll 130,000 individuals in Chicago alone.
The effort complements Rush’s work as a participant in the Chicago Area Patient- Centered Outcomes Research Network, or CAPriCORN, under which some of those same academic medical centers, government-funded hospitals and other partners pool data and other resources with a goal of improving care for all the area’s residents.
Context is critical. The end goal of bioinformatics isn’t just to create and digest huge amounts of data. It’s to provide patients and their doctors with relevant information at the time of care.
Bala Hota, MD, GME
Using data to improve outcomes
While these collaborations represent the future of bioinformatics in Chicago, precision medicine is already bearing fruit at Rush, Hota says. Genetic tests discern differences in how patients metabolize drugs, for example. Other advances are individualizing the treatment of cancer.
With node-negative breast cancer, for example, only about four of 100 patients whose tumors are fed by estrogen will benefit from chemotherapy. Director of Medical Oncology at Rush Melody Cobleigh, MD ’76, GME, whom Hota described as a “pioneer” in precision medicine, says her team developed protocols to identify those four patients, “so we could spare the others the use of chemotherapy.”
“We’ve been able to take the information we have and personalize treatment for our patients,” Cobleigh said. “We helped develop a test that allows us to identify patients who actually need chemotherapy. This test has been ordered by more than 20,000 physicians in 70 different countries with about a quarter of a million women benefitting thus far.”
A national focus on precision medicine
The Affordable Care Act and other federal mandates have pushed precision medicine forward, making electronic health records ubiquitous and requiring the data in those records to be available to clinicians and researchers. President Barack Obama made precision medicine a topic in his State of the Union address in 2015.
In terms of how precision medicine will “impact the total cost of care,” Hota says the answers aren’t yet obvious, in part because new technology can initially be very expensive, but becomes exponentially cheaper over time.
“The big opportunity,” he said, “is to use information to give the treatment best suited for each unique patient, thereby providing the best, most efficient care.”
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