Bio Medical Database

I need to tell you what I am excited about. It involves the patient record, the human genome, medical information, statistics and a database program.

Scope “In April, the Department of Health and Human Services awarded a second round of grants totaling $267 million to create 28 new centers to assist health-care providers in implementing health information technology. The funds were part of the $20 billion allocated in the American Recovery and Reinvestment Act of 2009 to help doctors and hospitals make the switch from paper to electronic records.”

This is an opportunity to channel biomedical information into the hands of students and graduates and correlate that information with the patient record. 

From MIT’s Technology Review, “Electronic medical records provide vast amounts of medical information that can be combed automatically and used to ask questions…

...Scientists and physicians are now scouring the growing number of electronic medical records and genomic databases to figure out how to use this vast medical resource…”

More to the point of medical education, students and graduates alike experience a continuing need to reference current medical information. Current information is not easy to come by. It is expensive, closely held and often inaccessible. U of Michigan took a great stride in recording the lectures for students to review on their computers. Bravo, but the data is not indexed and it’s slow to access for a specific reference. In addition, there remain the student’s patient contacts and a need to correlate patient information with medical knowledge to develop a differential diagnosis.

Lists are hard to remember, but a modern user-friendly database program can retrieve a relevant list. The database’s – pardon the analogy -- left-brain contains the patient information, recorded as data points, whilst the database’s right-brain contains all available medical knowledge also as data points. The relational features of the database can easily match patient variables with diagnostic criteria, providing a differential diagnosis or list. Filing information in a database obviously compresses the data in that it eliminates repetition.

Other electronic medical records (EMR) applications stress “best evidence” treatments. While including up to date treatment options, this proposal stresses differential diagnosis.

Furthermore, a built in statistical application offers probabilities for the differential. Intriguingly, a more developed statistical attachment will correct itself in real-time based on outcome; this is the important aspect of the matter.

Everything I have read suggests great difficulty in analyzing the data -- data mining -- and that may be so on a central server, but on the student’s computer with a current state of the art database, the real-time statistical analysis should give an accurate picture of the outcome in relation to the clinical data, including the genomic information if available. As this data accumulates in the medical school server, over the professional life of the student, analysis should be much easier.  

I had some operational experience with an old Borland database while I was in practice. I got some of this schema done, but at that time, it was slow and limited. Today the computers are fast and there is virtually no limit to scalability.

It will take a couple of high-level database persons, a couple of statisticians and a couple of medical people who can pull together the full range of medical information in a database format, genetic data included. Students should be able to write the data fields for the patient record.

The resulting product should be open source and available to all clinicians willing to link to the medical school server. Both patient and medical information would flow both ways. Researchers can extract patient data anonymously. New bio-medical information can flow back the other way providing the clinician with continuous access and update of biomedical information.

 The educational advantages speak for themselves. Health and Human Services has the money. I believe that Medical Schools represent the only trusted vehicle for such a program.