How do electronic medical records (EMR) relate to disease management?
As EMRs get introduced, they can help DSM companies and health plans figure out who is going to benefit from highly aggressive
intervention—better than trying a shotgun approach with every disease category. Right now, EMR use is not widespread, but
the development of disease registries is happening quite fast as more DSM programs are developed. Obviously, it's the patients
who are candidates for DSM who appear in these registries. Health plans and providers are focusing first on trying to get
those patients' records as complete as possible because it's among those populations that incomplete records (like retinal
exams for diabetics, or out of range test results) can turn very expensive.
Why should pharma care about EMRs?
You may have heard of a pill called Vioxx. People have been quibbling about the results of the various trials for a few
years. But the first widespread confirmation really was the joint FDA-Kaiser analysis of Kaiser Permanente's records released
in August 2004, linking together the long-term impact of particular types of drug use with outcomes, based on continuous EMR
capturing of the data from large populations. I wish I'd figured out its importance in time to short Merck's stock! But in
hindsight it was a seminal event.
Does industry supports EMRs?
Pfizer has supported it through its investment with Microsoft and IBM in Amicore. But what's more interesting is the dichotomy
within Big Pharma about whether or not they actually want EMRs to go forward. If you talk to Kim Slocum at AstraZeneca, he
says yes, we need to record all the data we possibly can on the use of our products so we can show that they have a positive
impact on health and costs. But Kim says there are plenty of people within pharma who don't share his views. After all, EMRs
can answer some of the key questions that pharma has always turned away from, like: "Did this new pill improve health? Did
it save money? Did it cost extra money?"
What type of pressure does this technology exert on pharma?
Post COX-2s, Paxil (paroxetine) et al, the pharmaceutical industry will be forced to be far more open with the data it
collects during clinical trials. But it's electronic medical records that will eventually deliver information about the real
world use of prescription drugs. The spread of EMRs will happen on a timetable affected by payers, providers, and government,
and although pharma could conceivably nudge it ahead, it's not a high priority for the industry.
As with every new technology, the most important thing for pharma executives to examine is when do electronic medical records
go from being a curiosity to a mainstream method that researchers and governments use to assess the performance of medical
interventions? At that point, pharma needs to be ready to answer the questions I've just raised rather than say, "We're running
a clinical trial and will get back to you in two years, meanwhile keep taking the pills and trust in the FDA's approval from
six years ago." Merck essentially brushed off the Kaiser Permanente study on Vioxx that way, but that defense will become
less tenable as those data sets from years of EMR use build up.