Laboratory News

Finally, Payers Use Data Mining to Identify Problem Prescription Drugs

In recent weeks, the nation's largest health insurance company has announced that it will launch a real-time data mining program to identify problems with individual prescription drugs or combinations of drugs. WellPoint, Inc  will collaborate with the Food and Drug Administration on this innovative data mining project.

Starting in early 2009, the medical information of as many as 20 million of WellPoint's 36 million beneficiaries will be evaluated in real time to identify patterns or spikes in specific medical problems where the likelihood of problems with specific therapeutic drugs or combinations of drugs might be at fault. If this works-and there are plenty of reasons to believe that it will-this data mining effort may trigger radical changes to the existing system of monitoring for drug safety problems. That's because the existing drug safety monitoring system is believed to capture less than 10% of adverse reactions to therapeutic drugs, according to the U.S. Government Accountability Office.

What is significant for the laboratory profession is that WellPoint intends to use laboratory test results in its patient records as one flag for problems related to prescription drugs. As an example, certain lab test results for enzyme levels could be an early indicator of organ damage from an adverse reaction to a prescription drug that, if unaddressed and untreated, could lead to a chronic disease.

Advances in software technology and the ability to detect patterns across large quantities of data are a key reason why WellPoint believes it will be successful with this data mining effort. Although WellPoint will be first to do such data mining across such a large pool of patients, other insurers have had early successes in more limited settings. For example, Kaiser Permanente used its patient data base to identify problems with Vioxx. In response, it curtailed use of Vioxx on its beneficiaries about one year before the drug was pulled from the market, and, after further consultation with FDA on its findings, pulled Vioxx from its formulary a month before the drug was recalled by its manufacturer.

It is widely-recognized that healthcare has significantly lagged the insurance and the banking industries in its effective use of information technology. That is why WellPoint's announcement is significant. It demonstrates that certain large healthcare corporations are making tangible advances in how they use information technology to study clinical and administrative health data to produce information that can be used to improve health outcomes and reduce medical errors.

Further, this new WellPoint business initiative should remind laboratory directors and pathologists to review their current strategy for laboratory informatics. It won't take long for other payers to follow WellPoint's lead and establish their own data mining efforts. Because laboratory test data remains a cornerstone of every patient's health record, this development positions laboratories to be key contributors in efforts to mine data, identify useful patterns, then use this knowledge to establish new care algorithms and treatment pathways. Savvy lab directors and pathologists will grasp how this opens the door for their laboratory to provide additional value to health insurers.

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