A patient comes into your office, and after an examination, tests, and the like, you decide the patient needs to take a specific pharmaceutical for a specific condition. Happens all the time, right?

Some of your patients, however, do not respond to this therapy or do not respond as well as they should. Too often, it takes time to discover the reasons and to alter dosage or treatment.

What if you could get the information that a patient, for example, might have difficulty with metabolizing certain compounds, which would make some treatments less effective? What if you knew that certain pharmaceuticals might not work as well for patients with certain genetic conditions? What would make it even better is if there was a web site that would allow you to find that data quickly, efficiently, and accurately.

Speaking at the Personalized Medicine World Conference in Mountain View on Monday, Russ B. Altman, PhD, Professor of Bioengineering, Genetics, and Medicine and Chair of the Bioengineering Department at Stanford University said such a tool is already available for physicians.

In his presentation, Altman used the example of such a patient as described above. For now, this patient may be atypical, as he has had his genome sequenced, but when the physician needed specific information, the physician used the website www.pharmGKB.org to search for the drug name and information from studies on the drug. The results are broken down into categories, such as genes, variants, drugs, diseases, pathways, and publications.

The physician discovered the patient had difficulty metabolizing certain enzymes, and using the information on the website about the pharmaceutical, was able to adjust the dosage, leading to a successful outcome.

The goal of the website, Altman said in his presentation, is to maximize efficacy while minimizing toxicity.

But Altman was quick to add that you don’t have to have a patient who has had their genome sequenced to find useful information on the website. Type in ‘type II diabetes,’ for example, into their search engine, and you can find information about studies, genes, diabetic neuropathy, diabetic retinopathy, and more.

The 11-year old web site’s goal is to curate and store the world’s pharmacogenomic knowledge. The information is publicly available at no charge.

California again ranked in the bottom half of states in health system performance, but improved to 31st from its previous ranking of 40th in 2007, according to the Commonwealth Fund “State Health Care Scorecard.”

Focused on identifying opportunities to improve, the Scorecard assesses states’ performance on health care relative to achievable benchmarks for 38 indicators of access, quality, costs and health outcomes. The number one ranked state was Vermont, while Mississippi ranked last. California’s ranking was immediately behind New Jersey and immediately in front of Oregon.

According to the Scorecard, if California improved to the level of the best-performing state, more than half a billion dollars could be saved in health care spending. Specifically, the following improvements would have to occur for California to reach Vermont’s current level of health care:

• Insured Adults: 3.9 million more adults ages 18-64 — or 15 percent of California’s adult population — would be covered by health insurance (public or private), and therefore more likely to receive health care when needed.
• Insured Children: 698,671 more children (ages 0-17) would be covered by health insurance (public or private), and therefore more likely to receive health care when needed.
• Adult Preventive Care: 1.4 million more adults (ages 50 and older) would receive recommended preventive care, such as colon cancer screenings, mammograms, pap smears and flu shots at appropriate ages.
• Diabetes Care: 399,875 more adults (ages 18 and older) with diabetes would receive three recommended services (eye exam, foot exam and hemoglobin A1c test) to help prevent or delay disease complications.
• Childhood Vaccinations: 111,706 more children (ages 19-35 months) would be up-to-date on all recommended doses of five key vaccines.
• Adults with a Usual Source of Care: 4.5 million more adults (ages 18 and older) would have a usual source of care to help ensure that care is coordinated and accessible when needed.
• Children with a Medical Home: 1.8 million more children (ages 0-17) would have a medical home (or Patient-Centered Medical Home, an approach to providing comprehensive primary care) to help ensure that care is coordinated and accessible when needed.
• Preventable Hospital Admissions: 31,877 fewer preventable hospitalizations for ambulatory care sensitive conditions would occur among Medicare beneficiaries (age 65 and older) and $286 million would be saved from the reduction in hospitalizations.
• Hospital Readmissions: 10,195 fewer hospital readmissions would occur among Medicare beneficiaries (age 65 and older) and $181 million dollars would be saved from the reduction in readmissions.
• Hospitalization of Nursing Home Residents: 7,115 fewer long-stay nursing home residents would be hospitalized and $87 million would be saved from the reduction in hospitalizations.
• Mortality Amenable to Health Care: 4,874 fewer premature deaths (before age 75) might occur from causes that are potentially treatable or preventable with timely and appropriate health care.

The Commonwealth Fund is a privately funded foundation that promotes access, quality and efficiency in American health care, with particular attention to uninsured, low-income, minority, young and elderly Americans. The Commonwealth Fund carries out its mission by supporting research and providing grants in health care practice and policy.