BIG DATA AND THE ROLE OF DERMATOPATHOLOGY IN PERSONALIZED MEDICINE
In the United States, medicine has largely been practiced on a fee-for-service basis, focusing on the treatment of ill patients with a long chain of reversible and irreversible pathological events (“sick care”) rather than the promotion of health care initiatives that prevent disease (“health care”). The World Health Organization defines health as “a state of complete physical, mental, and social well-being and not merely the absence of disease of infirmity.”1 The Institute for Healthcare Improvement has proposed a triple aim for future health care models: 1) improving the health of populations, 2) improving the patient experience of care, and 3) reducing the cost per capita for health care.2 In 2012, the Agency for Healthcare Research and Quality found that the top 1% of chronically ill patients of the U.S. population accounted for 28% of the total health care expenditures and that the top 5% accounted for more than half.1 The Center for Disease Control defines “population health” as an “interdisciplinary, customizable approach that allows health departments to connect practice to policy for change to happen locally. This approach utilizes non-traditional partnerships among different sectors of the community—public health, industry, academia, health care, local government entities, etc.— to achieve positive health outcomes.”3 Fundamentally, population health is centered on value-based care. Whether funded by bundled payments, capitation, or other risk-sharing arrangements, these new models of care will enable physicians to provide the health care services that meet the “triple aims.” This shift away from fee-for-service “sick care” will dramatically place increased responsibility on providers to demonstrate cost effectiveness in their practice of medicine. According to the NIH, “precision medicine” is defined as “an emerging approach for disease treatment and prevention that considers individual variability in genes, environment, and lifestyle for each person.”4
To generate well-informed health care decisions, we need information. Pathologists have always been the stewards of patient tissue and fluids and now must become the stewards of the new types of data extracted from these patient specimens.
It is widely established that pathology and laboratory information have a substantial effect on clinical decision-making.5 Becich et al. published that 50-70% of all clinical decisions regarding patient care were attributed, in part, to clinical and anatomic pathology data.6 The Mayo Electronic Result Enquiry System has shown that the majority of relative patient data in their system is derived from pathology services (94%), with radiology (3%), patient data (1%), electrocardiography (1%), and surgery (1%) representing only minor components of the patient’s individual medical record.7 Therefore, the foundation of precision medicine is really precision pathology. Through the study of interrelated variables that influence the origins and behavior of disease, precision pathology can ultimately promote disease prevention, early detection, treatment selection, triage of care, and the prolongation of life across populations. The data used in these analyses is both large and small.8...