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many advances in such a short period of time, however, that many physicians remain bound by approaches rapidly becoming outdated.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.
Nursing is increasingly becoming as “high tech” as it is a “high touch” profession. Today’s nurses have more technology at their disposal than any nurses ever before, and as one might expect, it’s considerably improving patient care.
One area where nurses are putting technology to use is in informatics. Officially known as the study of information, in the world of health care, health informatics is the management of health information. Using electronic medical records, devices that collect health information electronically, and other electronic information standards, health informatics nurses are responsible for managing, interpreting, and communicating the data that comes in and out of health care facilities, all with one primary purpose: Improving the quality of patient care.
But how does that happen, specifically? How are nurses using informatics as a way to improve the care they — and their colleagues — provide to patients? As it turns out, there are several key ways that informatics is part of that effort.
Documentation has long been considered an important part of the nursing profession, but it’s more vital than ever to the delivery of quality care. While the theory and practice of nursing, the standards of nursing practice, legal and ethical considerations, and other points that are taught in advanced nursing programs all influence the practice of nursing, it’s information, and specifically, electronic documentation, that is having the greatest influence on modern nursing.
Modern nursing care is driven by individual patient needs and history — information that is collected and organized in electronic patient records. By documenting a patient’s condition, and sharing that information electronically, nurses are able to more effectively manage care, and by extension, improve the quality of that care.
A great deal of documentation takes place automatically thanks to connected devices, which collect specific information in real time and transmit it to patient records. By looking at the documentation of a patient’s condition over time, nurses can make better decisions about how to provide care and when changes or adjustments need to be made.
Reduced Medical Errors
Patient safety is a primary concern of any health care provider, and nurses are often on the front lines of ensuring that their patients are kept safe and preventing medication errors, misdiagnoses, falls, and other problems. Health informatics provides important data that can prevent these errors; for example, an electronic record can provide information about a possible dangerous medication interaction or allergy that might not otherwise be immediately apparent. Armed with data, nurses can make quick decisions that keep their patients safe.
In fact, in a study by the Agency for Healthcare Research and Quality (AHRQ), a majority of nurses reported that when they have access to EHRs, they have fewer problems with getting patients ready for discharge, fewer medication errors, and better quality of care. And when it comes to transfers between departments, nearly 15 percent of the nurses surveyed reported that information was more likely to be shared and less likely to “fall between the cracks” when electronic systems are used.
At the HIMSS Annual Conference and Exhibition in Chicago, HIMSS released the results of the 2015 Impact of the Informatics Nurse Survey – a survey of nearly 600 participants including C-suite executives, clinical analysts and informatics nurses. The survey examined the growing technology-driven healthcare ecosystem and the role nursing informatics – a specialty that integrates knowledge, data and wisdom – is playing in this evolving environment. The results indicated that the role of informatics nurses has expanded greatly and is having immense impact on patient safety and overall care, as well as notable workflow and productivity improvements.
This year’s survey, supported by the HIMSS Nursing Informatics Community, found that 60 percent of respondents believe that informatics nurses have a high degree of impact on the quality of care provided to patients. The survey also showcased that the majority of respondents claim that their organization had hired an informatics professional in a leadership capacity. Moreover, 20 percent of respondents reported employing a Chief Nursing Information Officer (CNIO) at the leadership helm.
“The 2015 Impact of the Informatics Nurse Survey showcases the positive influence informatics nurses are having on improved quality and efficiency of patient care,” said Joyce Sensmeier, vice president of informatics for HIMSS. “We are going to continue to see the role and use of technology expand in healthcare and the demand for nurses with informatics training will grow in parallel. As clinicians further focus on transforming information into knowledge, technology will be a fundamental enabler of future care delivery models and nursing informatics leaders will be essential to this transformation.”
As healthcare provider organizations look to build upon their electronic health record (EHR) solution in order to leverage data analytics and population health management tools to transition to a true learning health system, nurses will continue to play an important role in the process. Key findings from the survey reinforce that participants believe that informatics nurses bring value to the implementation phase (85 percent) and optimization phase (83 percent) of clinical systems processes. These numbers are a clear indicator that the informatics specialty is a critical part of evolving healthcare organizations.