LAUSR

As one of the founding fathers of medicine, Hippocrates was prescient in his discernment that patients show differences in the severity of disease symptoms and that some individuals can better cope with their disease compared with others. He believed that it was more important to know the person who has the disease than to tailor the treatment. Hippocrates was one of the earliest physicians to practice precision medicine, where medical decisions and therapies are tailored to the individual patient. In the modern era, precision medicine accounts for individual variability in genes, lifestyle, and environment that may cause patients to manifest disease differently and potentially respond to treatments differently. In the 1990s, scientific and technological advances brought about the genetics revolution, where studies of the human genome suggested that diseasemay have a genetic basis. Since then, advances in genomics and proteomics have provided great insight into the nature and evolution of disease. Simultaneous to the genetics revolution, shifts in health care reform led to the implementation of the 2009 Health Information Technology for Economic and Clinical Health Act, which incentivized the adoption of the electronic health record (EHR). The widespreaddeployment of EHRs led to the accrual ofmassive amounts of digitized clinical data, populated from biospecimens, health care visits, and administrative claims, amongst many others. From its inception as a field of acute caremedicine, anesthesiology directly practiced precision medicine, when the first anesthesiologists administered ether to their patients in unique amounts based on direct observation of clinical effects. Today, clinicians must interpret large amounts of clinical data for critical and timely decisions in the delivery of anesthetic and critical care. As afield, anesthesiology has a history of pioneering patient safety through the use of informatics. The data-rich acute care environment allows anesthesiology to shape the developing field of acute care informatics in a way that may provide advances in patient safety and quality and in reducing health care expenditures. Anesthesiology clinical and research enterprises will require new thinking, training, tools, and a vision for how to utilize and interpret acute care data. This chapter explores how anesthesiology can become the acute care arm of precision medicine by utilizing informatics to address the increasingly complex needs of patients, populations, and organizations.