Rapidly falling costs and the increasing clinical value of human genome sequencing and genetic testing is reaching the point where innovative hospitals and health networks are ready to offer these services to patients in family practice settings
Several prominent first-mover health networks and hospitals are taking steps to incorporate genetic tests and gene sequencing into primary care settings. This raises the stakes for hospital CEOs who have yet to establish a precision medicine strategy for their institutions.
Probably the most-publicized initiative to bring genetic testing to primary care is happening at Geisinger Health System. The healthcare organization announced in May it would incorporate genomic profiling into its routine care. It will treat a patient’s genomic profile as something akin to a mammogram or cholesterol screening.
“Understanding the genome warning signals of every patient will be an essential part of wellness planning and health management,” said Geisinger Chief Executive Officer David Feinberg, MD, when he announced the new initiative at the HLTH Conference in Las Vegas. “Geisinger patients will be able to work with their family physician to modify their lifestyle and minimize risks that may be revealed,” he explained. “This forecasting will allow us to provide truly anticipatory healthcare instead of the responsive sick care that has long been the industry default across the nation.”
Geisinger had previously launched the MyCode Community Health Initiative, which has enrolled some 190,000 participants to move precision medicine forward. Patients have their DNA partially or fully sequenced and are notified of any genetic issues that may put them at greater risk for health issues. About 500 patients so far have been told they have an increased risk for certain cancers or heart disease.
Another health network that is introducing genetic tests in primary care settings this year is Sanford Health in Sioux Falls, SD. It has high expectations that offering genetic tests will be welcomed by patients.
“Nobody else in the world is doing this,” declared Nate White, Executive Vice President of Sanford Health Fargo. “What we’re after is the primary care setting.”
Geisinger Health CEO David Feinberg, MD (above) was one of the first hospital leaders in the nation to announce that genomic profiling would become a routine part of care delivery within his system. In a recent article he co-authored in the Harvard Business Review, he observed that “millions of Geisinger family members … no longer have to rely on the law of averages to forecast their health and make plans about their life and how they live it.” However, nimble integration of genomic data into all facets of patient care is likely years away. (Copyright: Geisinger Health.)
Markers for Diseases, Drugs
Sanford officials said that the genetic test they will offer to primary care patients includes markers for such conditions as:
- Aortic aneurysm;
- Thyroid cancer;
- Lynch syndrome (a hereditary form of colorectal cancer);
- Hereditary breast and ovarian cancer;
- Retinoblastoma (a form of eye cancer usually occurring in children);
- Wilms’ tumor (a type of cancer that starts in the kidneys); and,
- Wilson disease (which causes copper to accumulate in the liver, brain, and eyes).
The choice of genetic markers for the 60 diseases and 30 prescription drugs, including the test panel, is based on one important fact—each is clinically-actionable. The result should be measurable improvement for patients, say the Sanford administrators.
Precision Medicine Goes Beyond Gene Sequencing
But simply analyzing a patient’s genomic profile and warning them of potential health risks down the line won’t be an effective long-term strategy for most providers. Pharmacogenomic testing is already on the rise. Meanwhile, hospitals and health networks will need to quickly adapt next-generation technologies—specifically software with artificial intelligence (AI) capabilities—to store and appropriately analyze the coming flood of genomic data. This analysis will be used by physicians to provide effective treatment plans for patients.
Joel Diamond, MD, is chief medical officer for 2bPrecise Health, which creates clinical models for genomic information. He noted that there will soon be patient data from proteomics, metabolomics, microbiomes such as gut bacteria, and other genomic sources. Diamond told Healthcare IT News that “there will be an increasing need for the merging of this data with clinical information.”
Genomic data will also need to be incorporated into a patient’s electronic health record (EHR) in ways that allow it to be used to make diagnoses and select the most appropriate treatments for individual patients. Interfaces may also have to be created to easily integrate the data into ancillary applications, such picture archiving and communication systems (PACS) or medication systems, according to Don Rule, Chief Executive Officer of Translational Software, a Seattle area firm that provides analytical options for health networks, hospitals, and clinical laboratories generating and using genomic data.
Precision Medicine and the Rise of Consumerism
Moreover, the rise of consumerism in healthcare—where patients shop around for services and are motivated to do so by ever-increasing out-of-pocket costs—means they will insist more be done with their genomic profiles, according to Diamond. He observed that “consumer demand will be like nothing we have seen previously,” and that providers are “ill-prepared for that now.”
Among the precision medicine treatments expected to become commonplace due to genomic profiling is gene therapy using technology such as CRISPR/Cas, which could be used for patients to better fight diseases.
While Geisinger and Sanford may be on the cutting edge of using genomics in primary care settings today, experts believe that swift advances in knowledge about the role the human genome plays in different diseases and health conditions will create more opportunities to use genetic tests as part of routine care. Hospitals and health network CEOs will want to stay informed about these developments, so they can position their institutions to offer useful genetic tests in primary care clinics.