The early successes that SF Otolaryngology has had and the relative ease with which they integrated pharmacogenomic testing into their daily workflow indicates that adopting precision medicine into clinical workflows is not only possible, but practical
As the field of precision medicine matures to a point where it can be implemented into everyday clinical practice, hospital and health system leaders may soon be pressed to offer treatments that are individualized. While there are benefits to being an early adopter in the precision medicine space, there are also going to be challenges.
A San Francisco-based otolaryngology practice recently implemented genetic-based treatment offerings. Lessons learned here could be used to guide other practice or hospital leaders that are planning to integrate a precision medicine strategy.
The goal was to reverse the effects of early cognition impairment by using pharmacogenomic testing. The initiative targeted certain chronic conditions and sensory system changes.
“With these insights, we needed a way to better manage patients on multiple medications, as well as tools to ensure all the drugs our patients took were safe and therapeutically effective,” Jacob Johnson, MD, the president of San Francisco Otolaryngology Medical Group said in a recent interview for HIMSS and Healthcare IT News. “This, of course, leads us to pharmacogenomics.”
Pharmacogenomics (PGx) is essentially the study of how someone’s genetics impacts their response to medications. Pharmacogenomics is one of the key components of precision medicine and basically involves a genetic test that can be used to make medication decisions that are tailored to specific individuals.
From the perspective of the physician, pharmacogenomic testing has at least four benefits for patients.
- PGx saves patients money on ineffective medications.
- Testing prevents patients from having avoidable unpleasant or possibly fatal side effects related to some medications.
- Precision prescribing improves the efficacy of the physician’s comprehensive treatment plans, which leads to improved quality of life.
- Testing also has the potential to reduce visits to the doctor’s office and alleviate shortages in healthcare personnel and facilities.
“It is clear the industry is on the cusp of embracing pharmacogenomics and genetic/genomic testing in general,” continued Johnson. “The first hurdle is to realize the value of precision medicine to close care disparities and improve quality.”
Challenges Encountered When Adding Pharmacogenomics Testing
Although the value of PGx testing is clear, it does present a number of challenges to physicians, clinical diagnostic laboratories, and healthcare institutions. A primary challenge is the difficulty of analyzing the complex amount of information involved in PGx testing and comparing it to the medications the patient is being prescribed—and then turning that information into actionable intelligence that a busy physician can use to drive good medical care, in a cost-effective, efficient and reliable manner.
Johnson added that pharmacogenomic test results are a life-long signature and need to be available over many visits in a persistent way. Pharmacogenomics also requires that providers have in-workflow access to current knowledge-bases and clinical guidelines.
Overcoming these implementation obstacles required obtaining a new software. “As San Francisco Otolaryngology began its pharmacogenomic journey to improve care, we recognized that our current software was not designed to support these activities,” Johnson reflected. “This meant that, unless we were willing to manage testing and resulting workflows manually, which is unsustainable in a growing practice, we needed to find an informatics solution designed specifically to help us leverage the opportunity pharmacogenomics offered.”
SF Otolaryngology identified 2bPrecise for the software and integrations needed in order to succeed with the precision medicine effort. 2bPrecise describes itself as an EHR-agnostic, cloud-based precision medicine platform that supports point-of-care decision making.
“Their platform consumes genetic/genomic data from molecular labs and clinical information from the EHR, synthesizing them into a clinical-genomic ontology,” explained Johnson. “The results are accessible to providers within their workflow. Plus, the solution is built to interact with evolving knowledge sources and care guidelines.”
SF Otolaryngology has only recently implemented this change, but it has already seen some positive results. “We’ve received positive anecdotal feedback from clinical staff and patients alike,” Johnson said. “In one instance, a senior patient had suffered a minor cardiac event. Because she was on multiple drugs, we ordered a pharmacogenomic test for her and found that neither her blood pressure nor cholesterol medications were well suited for her based on her genetic profile.”
Pharmacogenomics implementation in clinical practice is steadily increasing as one possible path to proactive medication management and reducing the risks of polypharmacy. Since adverse drug events often result in hospital admissions and prolonged hospital stays, pharmacogenomic testing will continue to be evaluated as a potentially meaningful measure.