Personalized & Precision Medicine: November 2019

IT Will Be Key to Precision Medicine’s Success in 2020

Joel Diamond

Unless IT concerns related to precision medicine are addressed, healthcare will simply reenact a mistake made years ago with EHRS: valuable data that can directly impact care will be locked in a silo, unavailable during clinical decision-making.

Nov. 18, 2019 (MedCity News) – Progress in genomic science has been astronomical over the past few years. In fact, the tipping point that validated the clinical significance of genetic/genomic testing is barely visible in the rearview mirror. As a result, stakeholders ranging from clinicians to regulatory agencies, to professional associations, to payers have begun championing the value that precision medicine delivers in terms of better diagnoses and more effective therapeutic interventions.

For example, in educational materials explaining incidence of dilated cardiomyopathy (DCM), the American Heart Association notes that a full third of DCM patients inherit the condition from their parents or other family members. Germline testing can identify patients with this genetic variant, leading clinicians to a faster diagnosis and earlier treatment. The Food and Drug Administration (FDA) has stated its commitment to approving targeted therapies based on genetic mutations as appropriate. Payers are beginning to issue reimbursement policies to cover the cost of genetic/genomic testing. United Healthcare, for instance, began covering pharmacogenomic panels for patients with anxiety and depression this October.

This leads us to the next great transformation necessitated by precision medicine: implementing the technology infrastructure to govern the ordering and resulting processes inherent to genomics, as well as finding ways to manage the great volumes of data generated by testing.

Precision medicine is already being pursued sporadically across many, if not most, healthcare organizations. Oncologists are likely to be ordering somatic tests to better profile patient tumors so targeted therapies can be delivered. Family practice, behavioral medicine and psychiatric departments are using pharmacogenomics to understand how well (or poorly) patients metabolize specific medications and which might trigger side effects or safety concerns. These insights allow them to prescribe the right treatment at the right dose the first time around – instead of spending months on a trial-and-error approach.

Cardiovascular and neurology specialists (among others) order germline tests to help them diagnose, treat and gain new insights into many common conditions such as congestive heart failure, arrhythmias, aneurysms, epilepsy, nerve pain and dementia. Some health systems even order germline tests on all newborns so a full genetic profile is available – which can be used throughout the individual’s lifetime.

The value of the data being generated through these clinical “pockets” cannot be understated. It carries information that can be used across a multitude of care settings far into the future – to help providers and specialists arrive at more accurate diagnoses faster, and identify the most effective treatment sooner. This, in turn, can help healthcare leaders move the needle to improve quality efforts and optimize revenue while reducing the risk associated with poor outcomes.

To realize full value, however, healthcare organizations must ensure genetic/genomic test results are readily available to clinicians at the point of care and in a vocabulary that makes them meaningful. Unfortunately, few health systems have invested in the IT resources that can make this possible. Currently, test results are ordered in a vacuum and results are often returned in a PDF that will be hard to access. In addition, the information is relayed in a nomenclature unfamiliar to clinicians, so they struggle to understand how to apply the results to specific patient circumstances.

Unless these concerns are addressed, healthcare will simply reenact a mistake made years ago with the advent of electronic health records: valuable data that can immediately and directly impact care will be locked in a silo, unavailable during clinical decision-making.

As the industry heads into 2020, it must make plans and take action to get ahead of this looming problem. Healthcare IT professionals must be brought to the table to help organizations strategize about their precision medicine initiatives. The key to success with this new standard of care is recognition that data generated by genetic/genomic tests can be used endlessly across the enterprise and over the long term as patient conditions change. Organizations must seek out platforms that will consume genomic test results as discrete data and integrate it with patient-specific clinical information. Likewise, the platforms must be made available within existing workflows, so clinicians can leverage it during decision making – and can interrogate the data as patient conditions change and genomic science delivers new insights.

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