Few healthcare leaders doubt that insights made available
through precision medicine and genomics have the potential to vastly improve
care and outcomes.
Assaf Halevy
But the industry struggles to overcome numerous barriers
that, at first glance, seem to obstruct providers’ ability to fully leverage precision
medicine. There is no question that obstacles exist, but a well-considered
strategy can help providers move quickly down a forward path.
Let us consider the six primary obstacles to leveraging precision
medicine to its fullest:
Provider education and expertise. Precision medicine, as an
influencer at the point of care, is a nascent discipline. Few physicians
practicing today were thoroughly educated in genomics (the depth of training is
increasing, however, according to a 2017 article in the Association
of American Medical Colleges News).
Physicians find themselves in a position of educating themselves quickly,
especially as the FDA approves more targeted immunotherapies and treatments. In
addition, because of the rise of direct-to-consumer tests, patients themselves
are demanding doctors factor this information into their clinical decision
making.
Slow-to-change standards of care. Without a doubt, delivery of
healthcare must be evidence-based. Genomic science has introduced so many
advances in such a short period of time, however, that many physicians remain
bound by approaches rapidly becoming outdated. The industry must find ways to
deliver new findings into the clinical workflow reliably and quickly, so
providers can utilize the best approach in each patient encounter.
Limited time to process new data. Physicians are already
presented with more data than they can effectively manage. Genomics represents
an entirely new and voluminous data set. To deliver any value, this information
must be rendered useful and readily available within the EHR. Access must be
smooth and seamless so physicians are not forced to leave their workflow to hunt
for relevant insights.
Foreign nomenclature. Currently, genomic results are returned
in PDFs (not as discrete data), rendered in vocabulary common to genomic
researchers and scientists. It must be “translated” into meaningful clinical
nomenclature and then integrated into the current workflow to be fully useable.
Regulatory and liability concerns. Genomic results do not
represent a snapshot in time the way phenotypical information might. A
patient’s genetic variant could impact care decisions well into the future as
the individual’s condition changes and genomic science advances. How does a
provider store and manage genomic data, making sure that its very existence
does not create liability issues in the years ahead?
Lack of or sluggish reimbursement. Payer policies and
guidelines lag behind discoveries related to precision medicine. What
reimbursement exists varies greatly from payer to payer and is founded on
disparate understandings of medical necessity. While payment is becoming more
common, physicians nevertheless must consider the financial impact of ordering
a genomic test – and what they will do if the results indicate that an
expensive or uncommon treatment is the best choice for a particular patient.
Innovation and Strategy
Key to Success
While these issues are complex, they are not insurmountable.
Savvy healthcare leaders are establishing precision medicine strategies today
in recognition that the landscape will become only more complicated.
Visionaries and early adopters are implementing scalable
informatics infrastructure as the backbone of their precision medicine
initiatives. Many of the obstacles above can be addressed by an
enterprise-spanning platform that:
Synthesizes genomic data with clinical
information into an ontology that creates a comprehensive view of the patient.
This compendium can then be delivered through the EHR, presented in a
meaningful vocabulary, where it can be actively used in real-time clinical
decision making. In addition, providers are able to reference evidence for
their decisions, which could help support medical necessity appeals and
short-circuit prior authorization processes.
Delivers fingertip access to multiple curated
knowledge bases. Physicians can re-interrogate a patient’s genomic data against
the latest scientific findings to ensure current standards are followed – now
and far into the future. This also gives physicians access to resources so they
can keep abreast of this rapidly changing field and helps shield them from
future liability.
Enables broad usage of precision medicine tools.
The value of genomic insights is curtailed when data is siloed in a specialty-
or department-specific system. Making functionality available across clinical
areas gives all providers access to data that might impact care and outcomes.
The future of healthcare has been made more exciting because
of precision medicine and genomics. With a well-considered strategy, healthcare
leaders can begin to leverage value today and prepare themselves to be
successful for years to come.
Few healthcare leaders doubt that insights made available through precision medicine and genomics have the potential to vastly improve care and outcomes.
But the industry struggles to overcome numerous barriers that, at first glance, seem to obstruct providers’ ability to fully leverage precision medicine. There is no question that obstacles exist, but a well-considered strategy can help providers move quickly down a forward path.
Let us consider the six primary obstacles to leveraging precision medicine to its fullest:
Provider education and expertise. Precision medicine, as an influencer at the point of care, is a nascent discipline. Few physicians practicing today were thoroughly educated in genomics (the depth of training is increasing, however, according to a 2017 article in the Association of American Medical Colleges News). Physicians find themselves in a position of educating themselves quickly, especially as the FDA approves more targeted immunotherapies and treatments. In addition, because of the rise of direct-to-consumer tests, patients themselves are demanding doctors factor this information into their clinical decision making.
Slow-to-change standards of care. Without a doubt, delivery of healthcare must be evidence-based. Genomic science has introduced so many advances in such a short period of time, however, that many physicians remain bound by approaches rapidly becoming outdated. The industry must find ways to deliver new findings into the clinical workflow reliably and quickly, so providers can utilize the best approach in each patient encounter.
Limited time to process new data. Physicians are already presented with more data than they can effectively manage. Genomics represents an entirely new and voluminous data set. To deliver any value, this information must be rendered useful and readily available within the EHR. Access must be smooth and seamless so physicians are not forced to leave their workflow to hunt for relevant insights.
Foreign nomenclature. Currently, genomic results are returned in PDFs (not as discrete data), rendered in vocabulary common to genomic researchers and scientists. It must be “translated” into meaningful clinical nomenclature and then integrated into the current workflow to be fully useable.
Regulatory and liability concerns. Genomic results do not represent a snapshot in time the way phenotypical information might. A patient’s genetic variant could impact care decisions well into the future as the individual’s condition changes and genomic science advances. How does a provider store and manage genomic data, making sure that its very existence does not create liability issues in the years ahead?
Lack of or sluggish reimbursement. Payer policies and guidelines lag behind discoveries related to precision medicine. What reimbursement exists varies greatly from payer to payer and is founded on disparate understandings of medical necessity. While payment is becoming more common, physicians nevertheless must consider the financial impact of ordering a genomic test – and what they will do if the results indicate that an expensive or uncommon treatment is the best choice for a particular patient.
Healthcare technology continues to proliferate the sector, the developments almost too many to track. The sector abounds with innovation and push forward in the name of better – even the minutest – advancements of care and better care outcomes. The coming year will be no different. As we enter the final year of the 21st century’s second decade, we’ve witnessed a tremendous amount of evolution in just 19 years. What role will our healthcare technology play in the healthcare industry in the next year?
A lot. And not just for a few, but members of many, many areas, even those peripherally involved with the boundaries of care. We must understand where current innovation is, but also the challenges these migrations attempt to solve. Being aware of the trends ahead can give us all a better grasp of how care delivery is changing and we can better understand how new areas can resolve real industry problems.
To help us navigate the year ahead for healthcare and its technology, the following are some of the trends that it leaders, observers, insiders, consultants and investors think are important or need to be taken notice of in 2019.
By Joel Diamond, MD, FAAFP, chief medical officer, 2bPrecise.
Joel Diamond, MD
Patients are becoming more engaged in (and financially responsible for) their own care. As such, they are increasingly interested in information about their health risks and which courses of treatment have the best potential for success. In my practice, I have seen a sharp rise in the number of patients asking about genetic and genomic tests.
Healthcare consumers are drawn to the idea that this information can unlock answers to persistent health problems, or reveal risk for future issues. They want genetic information to lay out a clear path forward for prevention and treatment, perhaps indicating which medications will be most effective for their profile. It’s one of the reasons why direct-to-consumer genetic testing, such as 23andMe, has become so popular.
The precision medicine learning curve
Soon we will move from individual gene tests and panels to exome and full genome testing, some of which is happening today. As the concept of applying genomics and precision medicine gains momentum, physicians are enthusiastic about the potential of personalized care plans to improve patient outcomes.
But are physicians equipped with the right tools to put precision medicine into practice? For example, can we identify which patients might benefit from genetic testing? Do we know what test to order? How do we interpret results? How do we incorporate this information into the patient record? And of course, cost is always an issue: Who pays for these tests?
These are some of the many questions physicians are wrestling with today. If they have a clinical-genomic solution within the electronic health record (EHR) workflow, they can get some of the support they need to meet rising demand for personalized medicine and care plans.
3 trends to watch as consumers drive precision medicine into the mainstream
Consumer interest shows no signs of slowing, which will continue to bring new challenges and opportunities into the physician’s office. Trends include:
Search for genetic destiny.I’m seeing more patients who believe precision medicine will resolve every health issue, especially when diagnosis or treatment is difficult. There is ample reason to hope, but it is up to the physician to educate consumers and set realistic expectations. There are multiple factors that have a bigger impact on health than genetics. Patients are concerned about familial inheritance for diseases, when environment and lifestyle often have a greater influence.
Prescriptive patients. We’re going to see more consumers demand specific courses of treatment, based on the genetic or genomic information they have. For example, someone who finds out she is at risk for cardiovascular disease may request a stress test. Physicians will need new kinds of educational support to assess and stratify risk. They will need to be well informed about which tests will bring the most benefit, so they can educate their patients, too.
Data outpacing science. Genomic knowledge is growing at an exponential rate, at times generating more questions than answers for researchers and physicians. We recognize many variants in DNA codes, but don’t yet know what they all mean. We still have much to learn about the data we are generating. Cloud-based repositories of genomic data, with continual updates and notifications for providers and patients, will be essential.
