Nuclear medicine was the first medical specialty to incorporate computers into the everyday practice of medicine. Today we live in the age of information technology and telecommunications. Has the time come for the Society of Nuclear Medicine to again play a leading role in helping establish an International Health Manifestations Database? During the past half-century, we have witnessed revolutionary advances in chemistry, physics, biology, and medicine, yet the manner of delivering health care to the individual patient has changed little. We have not taken full advantage of moving the individual patient into the forefront of health care. As we create more and more molecular information about a person, we need to have ready access to this ever-increasing molecular information. We need to promote the patient’s personal involvement and responsibility in his or her care. Better, readily available knowledge of the patient’s personal health will result in better, more effective, and more efficient health care.
Today, information and communication technology makes it possible to begin to develop a vast international network of electronic health records. Those who are less than 40 y of age will eventually have a periodically updated personal computer chip containing lifetime manifestations of their state of health, including but not limited to nuclear medicine images. It would be possible to periodically enter the data from the personal chip into an International Health Manifestations Database (and by manifestations, I mean symptoms, physical signs, lab tests, imaging—all the aspects of life related to health or disease). Patients would be alerted if abnormal manifestations were identified or predicted. The health chip would periodically search a database that helps answer the following questions in easily understood language: Is anything wrong? What is going to happen? What can be done about it? Is the treatment helping? Rather than simply giving a name to a person’s disease, the health chip would reveal all aspects of that person’s health and illness. The health manifestations on the computer chip would search the database to characterize the disease, predict what is likely to happen, and suggest possible treatments.
Molecular imaging can play an important role in helping bring about this revolution in health care. Using statistical averaging, a series of PET images can be integrated to yield computer images of healthy individuals and patients with different diseases. A step in the right direction was taken by Okada et al. in a joint effort by Hamamatsu Phototonics, the University of Washington, and the University of Michigan to study an existing brain population–based cohort made up of 551 healthy individuals and 31 patients with Alzheimer’s disease. The investigators derived a composite, statistically analyzed distribution of 18F-FDG in the brains of patients with Alzheimer’s disease. If a person begins to experience loss of memory, his or her 18F-FDG study can be compared with the images in the database.
To create the International Health Manifestations Database, we need to continue to create such well-defined subsets of images of disease manifestations. This process would be analogous to the open-source approach to computer programming, in which programming advances become available to all. Eventually, we would be able to compare the patient’s anatomic, functional, and biochemical imaging studies with images in the database through coregistration or precise overlay of the database image.
Is it beyond our wildest dreams to create such a database? The International Health Manifestations Database is achievable. What we need to do is persuade Microsoft, Google, Yahoo, or another information technology company to collaborate with the SNM, seize this business opportunity, and provide financial support. Until now, the practice of medicine has been managed primarily by physicians, hospital administrators, and insurance companies. The database would give patients a greater role in the operation of the health care system. They would have greater access to information that permits them to make informed choices. Patients would continue to look to their doctors for advice about maintenance of health and guidance through the complexities of an illness, but the patients would be partners rather than clients. Please let me know what you think about these ideas: hwagner{at}jhsph.edu.
