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Lynn M. Etheredge Medicare’s Future: Cancer Care Health Affairs, January/February 2009; 28(1): 148-159. [Abstract] [Full Text] [PDF] [Erratum] [Reprints & Permissions]

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Prototyping A Twenty-First-Century Biomed System Through Cancer

Kenneth H. Buetow, John Niederhuber, Director, National Cancer Institute, NIH, DHHS   ( 19 January 2009 )

Prototyping A Twenty-First-Century Biomed System Through Cancer 19 January 2009
Kenneth H. Buetow, Associate Director, Bioinformatics and Information Technology National Cancer Institute, NIH, DHHS, John Niederhuber, Director, National Cancer Institute, NIH, DHHS Send comment to journal: Re: Prototyping A Twenty-First-Century Biomed System Through Cancer buetowk{at}nih.gov Kenneth H. Buetow, et al.	In his proposal for a “new cancer care policy . . .in a data rich future,” Lynn Etheredge correctly notes that the National Cancer Institute (NCI) has built the requisite infrastructure for a learning health care system (“caBIG solves the major technical problems needed to exchange data within the cancer community, from molecules to patients’ clinical data.”) Currently, caBIG is connecting in a national network not only sixty-plus NCI-designated Cancer Centers, but also NCI community cancer centers, where 85% of cancer patients are treated. Moreover, caBIG enables the seamless continuum that is at the heart of a learning health care system in which knowledge of aggregated clinical outcomes drives next-generation research discoveries, which in turn are validated at the bedside for improved clinical outcomes, in a seamless “virtuous cycle.” In addition, caBIG and the Food and Drug Administration have collaborated for electronic coordination of clinical research information. caBIG has also demonstrated its capacity to exchange information with the emerging Nationwide Health Information Network. While these efforts have been cancer-focused to date, NCI is in effect prototyping a twenty-first-century knowledge-based biomedical system. The “BIG” (Biomedical Informatics Grid) in caBIG serves as a nationwide, interoperable, interconnected information technology platform that enables information sharing. A health care ecosystem then forms –- for the first time ever -- that electronically links academic centers, care delivery organizations, insurers, diagnostic and pharmaceutical product innovators, government research and care institutions, and all other players in the biomedical enterprise. As data are shared among those previously siloed entities, reunification occurs between the currently divided worlds of clinical care and research. Specifically, the availability of clinical encounter and molecular characterization information permits prequalification of participants and rapid assembly of study populations; research can be conducted without reestablishing duplicative tools and infrastructure; redundancy of research activities is eliminated; real-time monitoring of safety occurs; and the development of new therapeutic inventions can be conducted faster and less expensively with near-term benefit to patients. This prototype is already under way. We invite all sectors to participate (www.bighealthconsortium.org) to carry Etheredge's bold concept even farther and more broadly.