Progress in individual genome mapping is opening the way to a more personalised, targeted approach to medical treatment, using metabolic pathway diagnostics.

Big Data “should enable ‘precision’ medical treatment”
Interview with Jean-Pierre Thierry, member of the Healthcare Information and Management Systems Society (HIMSS) oversight committee, on the occasion of a presentation on the ‘World Healt IT 2014’ event, which is due to take place in Nice next April.

There’s a lot of talk nowadays about Big Data in health. So where in fact are we on this?

When you look at the ICT sector, you can’t help but notice a style of communication which favours ‘buzz’ or even ‘hype’. What we need to do is identify what’s really happening behind catch-all terms such as ‘Big Data’. Under this term there are two different approaches emerging. Firstly there’s data mining for analysis purposes and secondly there’s Big Data with great emphasis on the ‘Big’, which is very relevant to the health sector today. The volume of medical data which makes up a person’s traditional medical file has vastly increased, especially now that it includes medical imaging. And now that gene studies are starting to become widespread, they are also going to generate considerable volumes of data. Moreover, we’ll have to keep the raw data over a long period so that we can re-examine the databases in the light of advances in medical research.

How are advances in genomics now impacting medical treatment?

As regards the healthcare sector, there’s one thing that needs to be clearly understood: it’s not simply that genomics is going to generate huge volumes of data, we basically need to be able to analyse it, and in particular to look for correlations between certain mutations or between the presence of genes and certain illnesses, cancers being a prime example. This new approach should translate into a truly new approach to performing diagnostics. Whereas generally we used to make an analysis per organ, we’ll now be able to use metabolic pathway analysis, concentrating on the mutations that were present before the illness set in, and on the mutations that we find in the cancerous tumours. We’ll be trying to correlate the presence of these genes with the illness so that we can develop targeted therapies and also provide each individual person with specific prevention advice. What we’re talking about here is technology which could allow us to ‘personalise’ illnesses and patients, or alternatively start out from an average profile and then personalise the approach to treating each individual. This process of ‘individualisation’, which should enable ‘precision’ medical treatment, will mean that we are able to identify ten or twenty different illnesses where before we used to diagnose just one.

Is France ready to adjust to this change in the doctor-patient relationship?

France has high ambitions in this field but, paradoxically, invests less than other countries. So it’s amazing that, despite allocating fewer resources, France sometimes achieves very high productivity. We see this phenomenon in the field of medical imaging. The number of installed scanners is very low in France, but the number of images taken is very high. In IT services we see the same trend. On average you need one IT person for around 100 other hospital staff. France only deploys on average 0.42 IT people per hundred, but even so some hospitals still manage to provide a rather advanced level of service. It may be that they’re taking some risks – only time will tell. But the shortage of staff is nevertheless worrying. Most European countries have speeded up their transition to digital and have decided to provide sufficient resources, especially human resources. But France’s policy seems to be “the logistics will catch up” and the country is recruiting too few people or at least not allocating sufficient resources, while at the same time the regulators are encouraging healthcare establishments to speed up deployment of increasingly sophisticated solutions. A contrasting example is the United States, where they have injected substantial funds and so generated a lot of new employment. In actual fact half of all new jobs created in the USA are in the healthcare & social services sector. So there is a need to drive forward development of the available resources plus the skills needed going forward. In fact Europe is now starting to see a substantial e-health divide between countries.

By Quentin Capelle