Electronic Health Reporter

By Assaf Halevy, founder and CEO, 2bPrecise, LLC.

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many advances in such a short period of time, however, that many physicians remain bound by approaches rapidly becoming outdated.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.

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.