Implementation best practices: The best approaches to precision medicine


Precision medicine is just starting to gain ground in the healthcare industry. Most patients have yet to have medical care designed to enhance effectiveness or therapeutic value for select groups of patients, especially by utilizing genetic or molecular profiling.

But some forward-looking healthcare provider organizations have started using precision medicine in their day-to-day operations. And the number of technology vendors with precision medicine offerings is growing.

Precision medicine is indeed the future of medicine overall. And as a result, it is time for all healthcare provider organizations to start thinking about how they can incorporate the high-tech offering.

Here, executives from precision medicine groundbreaking provider organization NorthShore University HealthSystem and precision medicine technology vendors 2bPrecise, Orion Health and Translational Software offer healthcare CIOs and other leaders and IT workers key best practices and tips for implementing precision medicine technologies.

Future-proofing technology and strategy

Right from the start, healthcare provider organizations must future-proof their precision medicine strategy, said Assaf Halevy, founder and CEO of 2bPrecise.

“One of the riskiest aspects of the CIO’s job is investing in advanced technology to support organizational needs – needs that evolve and change over time,” he said. “This risk is particularly acute when selecting an informatics strategy to support a highly dynamic aspect of clinical care, such as precision medicine.”

Healthcare leaders are grappling with the challenge of how they can leverage insights from genomic science to improve the care they deliver to patients – now and into the future.

“CIOs must define a sound genomic data management strategy and activate an execution plan that engages users across the entire enterprise,” Halevy stated. “CIOs can help drive success by making sure they select a precision medicine platform that meets four specific criteria.”

“One of the riskiest aspects of the CIO’s job is investing in advanced technology to support organizational needs – needs that evolve and change over time.”

Assaf Halevy, 2bPrecise

First, the platform needs to integrate with multiple EHRs, he said. This is critical because most health systems today leverage more than one clinical information system – different software in the ambulatory versus acute setting, for instance, or specialty software for specific clinical disciplines, he explained.

“All areas can use genetic and genomic information, so it’s critical that it be made universally available,” he said. “Likewise, if the organization at some time replaces an EHR system, it wants to ensure the underlying precision medicine foundation continues to support enterprise needs.”

Data from a wide variety of labs

Second, a precision medicine platform needs to consume genetic and genomic test results from a wide variety of molecular labs, Halevy advised.

“As an organization begins its precision medicine journey, it often finds some departments are already doing molecular testing – and each might use a different lab,” he said. “Additionally, some labs offer specialized testing services addressing specific clinical needs – such as oncology or pharmacogenomics. To ensure value is extracted across the entire organization, the precision medicine solution must be able to ingest from a broad range of data sources.”

Third, a platform needs to provide in-workflow access to multiple knowledge databases, Halevy said. Although an individual’s genomic profile does not change over time, genomic science does – and at a dizzying pace.

“Clinicians must be comfortable that their precision medicine solution incorporates the latest research as they factor genomic information into their clinical decision making,” he said.

And fourth, a precision medicine platform needs to deliver flexibility to match clinical priorities, he said. Typically, an organization determines a “starting point” for its precision medicine strategy, such as oncology or behavioral health, and then scales and expands, he said. The precision medicine infrastructure must be agile in supporting these unique priorities, he stated.

Another future-proofing advocate

Dr. Chris Hobson, chief medical officer at Orion Health, agrees with Halevy, saying his first best practice is future-proofing.

“CIOs need to think very carefully about where they are headed with their current project portfolio and what they want precision medicine to do in the next three to five years for their organization,” he said. “Although in general, ‘more data from more sources is better,’ there are some specifics to consider. The field of precision medicine is already rapidly expanding beyond genomics to include evolving and entirely new concepts such as microbiomics, proteomics, metabolomics, phenotypes and endotypes.”

Machine learning is much more likely to be useful and the outputs to be valuable if the input data is sourced from a diverse population, with data elements drawn from across all the critical indicators, he explained. Ideally, these include clinical and the various “*omics” and non-traditional sources such as the social determinants of health, patient generated-data and behavioral data, he added.

“The other part of future-proofing is scalability,” Hobson said. ”The widely varied data drawn from a broad base of patients also represents potentially massive amounts of data that needs to be captured for each individual in a population. To ensure a high degree of accuracy and reliability, CIOs need to look for proven, enterprise-class systems that have also demonstrated the ability to handle massive data sets.”

From a technology perspective, therefore, CIOs should consider looking for technology architectures with the greatest flexibility to handle predictably large increases in both data volume and data types over the next three to five years, he added.

Work closely with strategic decision makers

Another precision medicine technology implementation best practice from Hobson: Work closely with both the provider organization’s domain experts and strategic decision makers.

“In order for precision medicine to work well, a high degree of fundamental knowledge, expertise and experience is needed to come up with breakthrough insights into an organization’s data,” he explained. “This is not something that can be done on a part-time basis by just anyone and potential pitfalls can lie in unexpected places. Technology professionals are very used to the ‘gotchas’ that crop up in any technology implementation. In the case of precision medicine, those unexpected highly complex issues can arise at any point.”

“Many generously funded and well-executed programs have resulted in disappointing utilization because their communities were not ready to adapt clinical practices in order to adopt precision medicine.”

Don Rule, Translational Software

Having established the point around a high degree of domain expertise, Hobson strongly recommends as a best practice that CIOs take careful account of the organization’s strategic goals.

“This is important to be sure that the precision medicine work is clearly focused to align with the organization’s overarching strategic direction,” he said. “There are virtually limitless interesting research questions to be tackled with these exciting new technologies. Accordingly, a lack of strategic focus to the work runs the risk that it may result in interesting results that do not advance the organization’s needs as a whole.”

Playing nice with workflow

Halevy of 2bPrecise advised that genomic test results must be made “workflow-friendly.”

“The results from genetic and genomic tests can have a tremendous impact on clinical decision making,” he cautioned. “They can help providers arrive at a highly accurate diagnosis sooner, choose the right medication as the first line of therapy instead of using a trial-and-error approach, and identify targeted therapies for heritable conditions in specialties such as cardiology, neurology and neonatology.”

But to deliver on this value, healthcare organizations must bring genetic and genomic test results directly into the clinical workflow so they are readily available and actionable, he stated.

“Currently, these test results are often returned as paper or scanned documents and saved in the HER,” he explained. “Unfortunately, to be able to use them, clinicians must know that the test was done and results are available somewhere in the clinical information system, leave their normal workflow and hunt for the molecular lab report, figure out what the results mean in context of the patient’s current condition, and interpret and apply the information as they consider other factors in the broader patient record.”

This time-intensive, manual approach is a barrier to clinicians’ ability to leverage valuable genomic data, Halevy said.

“Forward-thinking CIOs are in a position to accelerate adoption of precision medicine – and greatly improve the quality of care their organization delivers – by seeking precision medicine solutions that ingest genomic results as discrete data, integrate them with clinical information, and deliver this combined record to the clinician within the patient context and at the point of care,” he said.

Grounding precision medicine in primary care

NorthShore University HealthSystem, is an early adopter and national leader in personalized medicine. NorthShore has integrated genomic and personalized medicine across its health system, including at the primary care setting. The advanced tools and technologies available across NorthShore present a clear opportunity to strengthen the patient relationship, aid the clinician decision process, improve care and provide value in a variety of ways, said Dr. Peter Hulick,…

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