A Need to Know: Adding DNA and Geomedicine Data to Patient Records

12/24/13

It takes a lot of patience to be a patient.

There are about 1.2 billion physician office visits annually in the United States, according to the National Center for Health Statistics. The center, which has collected data on this subject for decades, also reports that patients wait an average of just “north” of 11 minutes to see a doctor or healthcare provider.

You will have to get out your calculators to discover that Americans spend about 25,000 years just waiting in doctor’s offices each year.

But please don’t quote that number to a friend who has just been to a hospital emergency room, because the wait to see a doctor is much longer there.

These are serious lost opportunity costs. If we care about what the nation’s real healthcare tab is, just add another $1.9 billion a year (minimum wage rates in the US in 2013) x (25,000 years).

So why do we have to wait so long in a doctor’s waiting room?

And why do we have to fill out a “Patient Interview Form” every time we see a doctor? It’s another example of lost opportunity costs for physicians and their patients. I have probably filled out the patient interview form no less than 20 to 30 times in my lifetime. You’ve probably had similar experiences. Did you ever wonder what actually happens to the data collected on these forms? Shouldn’t we as patients be asked to contribute our baseline information just once, and then simply update the data as needed?

Couldn’t we also use our valuable waiting room time to contribute some useful contextual environmental information into our brand new electronic medical record, rather than just reading four-year-old magazines?

It’s clear that if we are to continue to be patients with patience, we need to realize greater value in our waiting.

Today’s healthcare system is a complex and challenging ecosystem. Reducing the complexity and simplifying the experience through basic process innovation could make a huge difference for our current healthcare delivery system.

An innovation that I have been championing for a number of years is a concept called geomedicine—linking public health knowledge with personal healthcare. What drives us into the physician’s office in the first place is not always that obvious or clear. We already know from medical science that environmental impacts and exposures are responsible for 5 to 15 percent of what ails us, yet nowhere in my modern electronic medical record is a place where I can provide what I call my “place history.” I can’t think of a single physician who has asked me for a complete list of all the places where I have lived, which means some important information is missing in their evaluations. To most practicing physicians, environmental health is a deep and murky information hole—they have no place for such data in their existing protocols for examining patients, let alone their medical records.

How long will it take for mainstream medicine to accept the fact that our environments actually do impact our everyday health, and that we need to start linking relevant data to better inform the diagnostic, therapeutic, and treatment hunches physicians use to help us regain our health?

One of the biggest recent advances in medicine is the ready availability of DNA information for patients. Yet many physicians are clearly skeptical—mine sure are—of the value of the DNA reports that patients like me are beginning to order and bring into their offices. Clearly it’s a new type of information, and the current information workflows are not prepared—there isn’t actually a place where they can store this data. Making DNA a part of a more comprehensive and organized approach to individualized patient care will require even more patience from both patients and physicians. If I had had my DNA reports in my physician’s hands—or better yet, in my electronic medical record—20 years ago, they all would have suggested lifestyle changes that would have allowed me to better manage my genetic risks.

So what does DNA have to do with geomedicine? In essence, geomedicine is our environmental DNA.

Almost every day, we hear about scientific claims that generally link health conditions to environmental factors. In fact, medical science reports that the environments we live in could explain as much as 35 to 50 percent of what makes us sick. In the absence of the easy availability of this information, we will continue to choose to live in the places that may actually contribute to the demise of our health. The challenge is to find innovators who have process change tools and ideas on how we can use all the relevant information and knowledge we have at hand to evolve the workflows that reside inside our physician’s practices. Improving the information workflows in doctor’s offices will not be easy, but I believe it’s worthy of heightened innovation and investment. Our well-being depends on it.

Bill Davenhall has worked in health and human services since the early seventies. He has directed many initiatives involving the use of information systems in healthcare and human service delivery organizations, and is currently the senior health advisor for Esri, the Redlands, CA-based GIS software developer Follow @

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  • http://blogs.forbes.com/danmunro/ Dan Munro

    First quote in my annual “Top Ten Healthcare Quotes for 2013″ is this one:

    #1 – “When it comes to health, your zip code matters more than your genetic code.” Dr. Tony Iton – The California Endowment Health Journalism Fellowships 2013 [as tweeted by @taralohan here at #cehjf13]

    http://www.forbes.com/sites/danmunro/2013/12/22/top-ten-healthcare-quotes-for-2013/

  • Robert B.

    I would love to see a geo spatial prescription analysis. How are treatments varied over a region. Do they over prescribe one type of antibiotic over another. How successful are treatments vrs region. This could be anonymized and logged in through a portal like bulletin board which patients would volunteer simple info symptoms, description, and diagnosis to a table which applies a zip code not direct location. Hospitals could be another field or just shown as a layer on the map. Then results could be queried by timestamp or location or table headers. I think they called it Google Health….til that went under

  • Eek

    Really