Budget or business class? Health IT choices examined

At a recent briefing on Big Blue’s strategic vision for healthcare, Neil de Crescenzo, healthcare industry leader (Global and Americas) for IBM Business Consulting Services, emphasised that the company was supporting the National Programme for IT in the NHS despite its failure to win any of the big contracts awarded over the past few months.

"It’s a very large ambitious programme," he said. “The point is how can we all make it work?”

Asked directly whether he thought the £6.2 billion programme would work, he replied: “We’re all supporting the NHS proposals to succeed.  They need to for Great Britain and for the citizens.”

He was equally enthusiastic when discussing a rather lower budget initiative IBM is nurturing in the US, the Healthcare Collaborative Network (HCN).

The network set out last year “to demonstrate the feasibility and the value of a standards-based, interconnected, electronic model of data interchange to a wide variety of stakeholders, including practicing clinicians, hospitals and other healthcare providers, public health agencies, researchers and ultimately, patients.”

Created in the wake of the 9/11 attacks with enhanced biosurveillance in mind, the network is also working out how electronic communications using common standards can help patients receive necessary and timely medical treatment and guard against medical errors.

The idea, explained de Crescenzo was to converge digital information that already exists in the health system.  “It doesn’t take billions of dollars to move this forward,” he said.  In fact the outlay is measured in thousands of dollars per facility rather than millions.

He admits, however, that progress has been made because ambitions have been constrained.  “Perfect is the enemy of the possible,” he told E-Health Insider, smiling.

And he is candid about the HCN’s limitations saying that ultimately its users will find it reaches a point where it doesn’t make the impact desired.  At that point investments of the kind being made through the national programme in England will be needed, de Crescenzo predicts.

The breaking point for those budget systems will probably be some of the highly ambitious technologies IBM itself is investing in and bringing to market.  Other speakers at the briefing gave a glimpse of the fascinating work designed to exploit increased knowledge of genetics.

For example, Dr Kari Stefansson, chief executive of deCODE, Iceland, spoke about his company’s development of the “information-rich clinical trial”.  These trials are conducted with patients whose genetic history, especially their pre-disposition to disease and biomarkers, is known.  The result is a cheaper, safer trial with more containable data.  

Dr Steffanson said a trial managed by deCODE had used 1200 subjects compared to 12,000 needed for a comparable randomised trial.  He said the company had just reached an agreement with pharmaceutical giant, Merck, to do more trials. This was “rather like a little player being asked to play with Manchester United.”

Other speakers explored the computing challenges associated with constructing an international DNA library and the pharmaceutical industry’s struggle to move from its blockbuster “one-size fits all” drugs to targeted products designed to treat patients whose genotypes are understood.

Speakers were asked to address the theme of the future of medicine, but as de Crescenzo pointed out some genetic tests have been approved by the regulatory authorities. “A five year scenario” is his verdict.