#BioIT18: Mark Boguski On Precision Diagnostics And The Launch Of A Population Health Project In Thailand

By Allison Proffitt

May 22, 2018 | A few minutes before he took the stage as the opening plenary speaker at the 17^th Annual Bio-IT World Conference & Expo, Mark Boguski promised international population genomics news.

It was a provocative start, and Ken Kuckein, director of marketing for DDN Storage, set him up perfectly. Healthcare isn’t just a technology problem or just a data problem, Kuckein said. Our challenges are multi-faceted; they include political issues, public perception issues, and data security issues.

Kuckein is right, of course, which made the challenge Boguski laid out that much more interesting: What would a clean-slate healthcare system look like? What if there was no old guard to retrain, no old technology to update, no existing operating procedures to overhaul? What if there were no legacy systems?

“Come with me 11 time zones into the future: to Thailand,” Boguski said, dramatically.

Liberty BioSecurity, where Boguski serves as Chief Medical Officer, plans to work with Thailand-based Charoen Pokphand Group (CP Group) on a population health project created from scratch, he explained. CP Group, based in Bangkok, is Thailand’s largest private company with wide-ranging business interests in retail, telecom, property development, finance, and agriculture. CP Group’s newly-formed CP Medical Center (CPMC) division has committed to the development and implementation of a next-generation health data platform and system for the benefit of the population of Thailand.

In a press release posted in conjunction with Boguski’s address, Liberty Bio outlined the partnership’s three arms; precision population health for under-studied populations across Asia; the implementation of a Diagnostic Management Team to improve diagnosis accuracy and efficiency; and the development of an AI-ready Digital Health Data System capable of providing early warning of disease and drive innovative preventive medicine.

Population health starts with genomics, Boguski told the audience at Bio-IT World, but there’s been a persistent bias in data collected by genome projects. Asian genomes, in general, are not well-represented, and “We know virtually nothing about the Thai genome,” he said.

The CP Medical Center vision is to gather medical and health data from about 350,000 Thai employees and dependents of CP Group. Data will include genomic data, microbiome data, family history, electronic medical records, and wearable health monitors.

The plan prompted ethical and privacy questions from the audience, of course, especially with a giant company funding and driving the initiative. Boguski assured the audience that all research would take place with extensive informed consent.

After the presentation, I asked Dr. Rujapong Sukhabote, Chief Medical Officer of CP Medical Center, how he expected the Thai people to react to the plan. Culturally, the Thai people value prevention, he told me. Medical care in Thailand is expensive, sometimes prohibitively so, and Sukhabote expects the Thai people to welcome preventative insights that could help keep them and their loved ones well.

The Foundation of Precision Medicine

All of these data will help move Thailand toward precision diagnostics, Boguski said, what he calls the foundation of precision medicine. Data volumes from pathology far surpass those from radiology, and 70% of critical medical decisions are based on lab tests, he said. Diagnostic data live in the laboratory information management system (LIMS), not the electronic health record, Boguski argued.

But our current diagnostic workhorses—microscopes, dyes used to stain samples, x-ray machines—haven’t changed much since the 19^th century. “They aren’t even FDA-approved!” Boguski said.

To further the problem, he argued, doctors aren’t trained to properly order and use lab tests. There are redundant tests, inappropriate tests, or results that are misunderstood and misused. The result is real patient harm.

Boguski advocated for a Diagnostic Management Team, a concept he said was pioneered at Massachusetts General Hospital, but “never caught on because treating physicians don’t want lab doctors telling them what to do.” It’s part of the plan for the CP Medical Center.

Lest we get completely discouraged, Boguski assured the Boston audience that there are efforts toward the future here as well. He cited work at The James Comprehensive Cancer Center at Ohio State University. The James is going all digital, Boguski said, phasing out all of their microscopes. So far, the Cancer Center has digitized 1.2 PB of data. If all of the NCI Comprehensive Cancer Centers followed suit, we’d generate an Exabyte of data a year, he said.

But this sort of digitizing is going to catch on slowly in the US, Boguski said. Here clinical labs are cost centers instead of profit centers.

That brings him back to Thailand. With little legacy infrastructure to overcome, Boguski believes that CP Medical Center and Liberty Bio can create an “integrated precision diagnostic platform of the future” combining radiology, genomics, and pathology.

The efforts align with a nationwide push to launch “Thailand 4.0”, a government initiative to move the kingdom into a value-based economy, transitioning from traditional services and unskilled labor to high-value services and knowledge work. CP Medical Center is breaking ground on a physical hospital with the support of the Thai government, Boguski said, and will host a Thailand 4.0 pilot project, getting started before the hospital itself is completed, and launch an Integrated Precision Diagnostic Center of Excellence.

Just before the session broke for Bio-IT World’s opening reception, Boguski fielded one final question. “When do you think machines will routinely be making diagnoses,” an audience member asked. “Sooner than you think!” Boguski promised.