How to Bring Precision Medicine into Routine Clinical Care
Jessica Kent
July 30, 2018 (HealthITAnalytics) – Precision medicine has taken the healthcare industry by storm in recent years, offering the promise of more individualized treatments, improved patient outcomes, and a deeper understanding of genetic conditions and rare diseases.
Initiatives like NIH’s All of Us Research Program and investigative efforts from large health systems have aimed to advance precision medicine research and make personalized therapies a reality in standard care delivery.
More healthcare organizations are also adopting precision medicine strategies, using big data analytics and emerging technologies like machine learning to match optimal treatments to individual patients.
However, many organizations still face challenges when it comes to implementing these strategies.
Integrating precision medicine and everyday care will require strong data management, a solid technological infrastructure, and joint efforts from leaders across the care continuum.
What strategies can healthcare stakeholders adopt to overcome challenges and accelerate the integration of precision medicine and routine clinical care?
Using genomic data for disease insights
Genomic data has emerged as a key component of precision medicine, offering a way for providers to determine the most effective therapies for patients based on the unique makeup of their DNA.
Genetic testing has become more affordable in recent years, and some large entities like Geisinger Health System have taken the opportunity to apply genomic sequencing to routine healthcare and advance precision medicine.
“Understanding the genome warning signals of every patient will be an essential part of wellness planning and health management,” says Geisinger CEO and President Dr. David Feinberg.
“Geisinger patients will be able to work with their family physician to modify their lifestyle and minimize risks that may be revealed. This forecasting will allow us to provide truly anticipatory health care instead of the responsive sick care that has long been the industry default across the nation.”
However, despite the growing availability and affordability of genetic tests, many organizations have been slow to consider patients’ genomic data along with their clinical information.
A 2017 survey indicated that although the vast majority of patients are interested in genetic testing, providers may not feel prepared to explain hereditary conditions or to deliver informed genetic counseling.
Several national initiatives have aimed to enhance providers’ understanding and use of genomic data, including the National Human Genome Research Institute’s (NHGRI) Implementing GeNomics In pracTicE (IGNITE) Network.
In a recent study published in Nature’s Genetics in Medicine, IGNITE members identified provider education as a key driver of genomic data use in clinical settings.
“Broader dissemination can be achieved by incorporating training in genomics in medical school curricula and encouraging continuing medical education (CME) programs to cover this topic,” the group stated.
“Educational programs addressing research advances, treatment guidelines, and related liability laws are ideal topics for physicians, nurses, and pharmacists already in practice.”
The IGNITE Network’s SPARK Toolbox also offers numerous educational resources and best practices to help clinicians and researchers implement genomics within healthcare organizations.
Organizations must pair education with access to genetic testing. Many providers are not able to offer these tests to their patients, limiting their ability to engage in precision care.
A survey from Cardinal Health revealed that 58 percent of oncologists do not have access to genetic testing at their organization. For providers that do offer tests, 36 percent must wait two weeks or longer to receive the results.
Collaborations between healthcare entities and genetic testing companies may help to increase the availability of timely genome sequencing for patients, which can accelerate the integration of precision medicine and clinical care.
For example, a recent partnership between supermarket chain Albertsons Companies and genetic testing company Genomind will allow select pharmacies to give patients clinical-grade genetic tests and help providers optimize treatment decisions for their patients.
Implement cutting-edge health IT for data storage and sharing
Providers must evaluate an overwhelming amount of data when applying precision medicine strategies to patient care.
The clinical, genomic, and socioeconomic information needed to develop personalized treatment plans will require organizations to have advanced methods of data storage in place.
Data infrastructure will also need to enable seamless data sharing to facilitate the spread of best practices across the care continuum and allow researchers to access or share valuable datasets.
However, many healthcare organizations lack the technical infrastructure needed to carry out these tasks.
In a recent survey sponsored by Oracle and conducted by GenomeWeb, data management and storage were ranked among the top obstacles for organizations trying to achieve their precision medicine goals.
To ensure that more organizations have access to clean, up-to-date, actionable information, larger institutions could share data-driven best practices with smaller entities.
For example, Dana-Farber Cancer Institute is working to provide clinical decision support to oncologists who want to deliver personalized treatments to their patients.
The Clinical Pathways tool, developed by experts at Dana-Farber and now distributed by Royal Philips, provides clinicians with a data-driven roadmap of the best treatment options available for cancer patients.
“A big part of Pathways is providing decision support with these extremely complex genomics. We want to help clinicians distinguish between what’s important and what isn’t, and then help them decide what they want to do about it,” David M. Jackman, MD, Medical Director of Clinical Pathways at Dana-Farber told HealthITAnalytics.com.
“The idea is to try to bring all this information together – genomics, radiographic data, and past treatment methods. Then, based on all of that information, Dana-Farber experts will recommend the best pathway to treat individual patients. Anybody in any hospital system can now gain access to Clinical Pathways if they wanted to participate in this.”
The Fast Healthcare Interoperability Interoperability Resource (FHIR) also offers opportunities for organizations seeking to store actionable, genomic data. The widely-adopted data standard can help to overcome data siloes and enable the seamless transfer of information across disparate systems.
A 2016 study demonstrated the potential of FHIR to enhance precision medicine. Researchers developed a FHIR-based precision medicine application that integrates with electronic health records (EHRs), designed to help oncologists diagnose and treat complex cancer patients.
After collecting user feedback, the team found that reactions to the application were generally positive, demonstrating the potential for the technology to navigate the complicated nature of cancer care.
Demonstrate the value of precision medicine to payers
As more organizations start to pursue the benefits of personalized treatments, more healthcare payers should consider covering these tests and treatments.
However, many payers have been hesitant to reimburse therapies without hard data proving their value, which can hinder precision medicine’s progress.
“There remain many challenges to determining ‘if and when’ precision medicine provides sufficient value relative to its costs, and whether payers should reimburse for precision medicine testing,” Geoffrey S. Ginsburg, MD, PhD wrote in a recent article published in Health Affairs.
“Our recent analyses of private payer coverage policies for genetic tests measuring multiple genes (such as panel or whole exome sequencing tests) indicate that there is limited and variable coverage of such tests.”
To demonstrate the validity of precision medicine, stakeholders can monitor and reward success of these innovative therapies across large populations.
Researchers have conducted investigations to prove the economic benefits of broader genetic testing, which could accelerate reimbursement.
A recent study published in the Journal of the National Cancer Institute sought to discover the benefits of screening the general population for breast and ovarian cancer gene mutations instead of only screening high-risk patients.
Researchers found that screening the general population was more cost-effective than screening only high-risk patients, and that broader genetic testing can prevent 1.91 cases of breast cancer and 4.88 cases of ovarian cancer each year.
Conducting more studies like these can further demonstrate the value of precision medicine in clinical care.
Some payers have already taken steps to include precision medicine treatments in their plans, including Harvard Pilgrim Healthcare. The payer recently began signing a series of contracts to bring more components of precision medicine into value-based care reimbursement.
Through a partnership with Illumina, a genetic testing company, Harvard Pilgrim will cover the costs of prenatal genetic testing for women with average-risk pregnancies.
Ensuring that precision medicine is reimbursable will likely play a major role in accelerating its adoption across the care continuum.
As the healthcare industry moves toward more personalized care, organizations seeking to adopt precision medicine must ensure they have the capabilities in place to carry out these initiatives.
Having access to actionable, clean, up-to-date data will facilitate innovative, personalized therapies and allow precision medicine to become a reality in clinical care.