At Acumen we spend a lot of time thinking about healthcare technology in terms of electronic health records and data management, and our blog often focuses on the adoption of healthcare technology with regard to the EHR and Meaningful Use. For example, last week’s post was about ICD-9 and ICD-10. It provided food for thought about how to use technology to document patient care to support claims and payor data. The adoption of EHRs and this type of healthcare technology is revolutionizing the way we collect data and analyze integrated data sets to improve patient care and population health.
But, what if technology actually becomes healthcare?
In his blog post on November 25, Dr. Ketchersid mentioned the ASN keynote address by Dr. Anthony Atala, “Regenerative Medicine: New Approaches to Healthcare.” In his address, Dr. Atala presented an overview of his 25 years of research that has led to the creation of flat and hollow organs using human cells on biomatrices or through the use of 3D bioprinters. The research has led to the use of bioengineered tissues to repair or replace ureters and bladders for patients.
A broad view of healthcare technology
While the U.S. government has been fostering the development of traditional health IT, it has also, through the Department of Defense, been supporting other healthcare technology like the “Body on a Chip” project. Research labs including Dr. Atala’s lab at Wake Forest and labs at MIT, Brigham and Women’s, University of Michigan, and Johns Hopkins have been working on various aspects of this project to create organ functionality on a 2-inch chip.
Kidney on a Chip
Dr. Jonathan Himmelfarb leads the Kidney Research Institute at the University of Washington where his group has developed the Kidney on a Chip. Technology is central to this biological effort. Advances in microfabrication, microelectronics, microfluidity, and nanotechnology have made it possible to create systems that organize human cells into physiologically functional “organoids”. In these microenvironments, human cells such as capillary cells, podocytes, and proximal tubule cells are supported by the circulation of a blood-replacement fluid. The chip-based nephron cells receive circulation that results in filtration at the level of the glomerulus, followed by exposure to the intrinsic transport properties of the proximal tubule and Loop of Henle.
While it would be magnificent if the Kidney on a Chip were a stepping stone to a wearable or transportable kidney, that is not the purpose of the technology today. These organs on a microchip are being used to study cellular and organ response to toxins and other injury agents along with the response to treatments. Such research systems preclude the use of laboratory animals, which may or may not respond like humans, to study tissue injury along with drug toxicity or efficacy.
BTW more than EHR, HIE, ESCO….
Bioprinting, microfluidic platforms, and nanotechnology may not be the stuff of our current daily encounter with healthcare technology, but the abundance of related acronyms is a common thread. The U.S. Department of Defense (DOD) through the Defense Threat Reduction Agency (DTRA) has provided the $24 million research grant to the Wake Forest Institute for Regenerative Medicine to create “Body on a Chip” systems. The plan is to study and develop Medical Countermeasures (MCMs) to nuclear, chemical, and biological threats. The biological platforms that are developed are part of the eX Vivo Capabilities for Evaluation and Licensure (X.C.E.L.) program. The Massachusetts Institute of Technology (MIT) is working in partnership with the National Institute of Health (NIH) and the Defense Advanced Research Projects Agency (DARPA) to create “microphysiological organ system modules” that bring multiple physiologic systems together on one platform to create whole organ systems to study the effects of new pharmaceuticals as part of the “Barrier-Immune-Organ: MIcrophysiology, Microenvironment Engineered Tissue Construct Systems” (BIO-MIMETICS).
While this technology is exciting, I feel a bit overwhelmed. How can nanoparticles on a microchip encompass so much complexity? I still don’t completely understand Meaningful Use and ICD-10 looks a little daunting, but at least they use technology I can see.