Patients will soon know much more about their genome—and they expect their hospitals and physicians will have precision medicine programs that know what to do with it
There’s an interesting challenge coming to the CEOs and senior administrators at the nation’s health networks and hospitals. Consumers increasingly are more knowledgeable about how their personal genetics shape their health than their physicians and caregivers. It is a trend that requires every institution to have a strategy in place to serve the needs of these informed patients.
The stakes are high because precision medicine promises to deliver personalized treatments tailored to each patient. As hospitals and healthcare systems move toward the use of genomic profiling in everyday delivery of care, embedding such data into patient electronic health records (EHRs) should only be a preliminary goal; it must be integrated into all facets of care delivery. Executives should also be keenly attuned to how patients will understand what their genetic information contains, and what services they may demand.
Some large providers have already recognized the need for routine genomic profiling. Geisinger Health System announced in May that it would fold 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 2018 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. 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. 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.
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, Feinberg 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. (Photo copyright: Geisinger Health)
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 will quickly have to adapt next generation technologies—such as software with artificial intelligence (AI) capabilities—to absorb and appropriately analyze the coming flood of genomic data and provide effective treatment plans for patients.
Joel Diamond, MD, Chief Medical Officer for 2bPrecise Health, which creates clinical models for genomic information, noted that there will soon be patient data from proteomics, metabolomics, microbiomes such as the gut, 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 also will need to be worked into a patient’s EHR in a way that it can be easily reconciled with treatment decisions. Interfaces also may have to be created to easily integrate the data into ancillary applications such picture archive and communication systems (PACS) or medication systems, according to Don Rule, CEO of Translational Software, a Seattle area firm that provides analytical options for providers with genomic data.
Moreover, according to Diamond, the rise of consumerism in healthcare—where patients can shop around for services and are motivated by ever-rising out-of-pocket costs—means they will insist more be done with their genomic profiles. He observed that “consumer demand will be like nothing we have seen previously” and providers are “ill-prepared for that now.”
While Geisinger Health is currently on the cutting edge of using genomics in patient care, what constitutes it will change swiftly. Hospitals and health networks systems will have to plan strategically and invest heavily in precision medicine services to keep up.
Already, first-mover health systems have such services in place for oncology, pharmacogenetics, sepsis and anti-microbial stewardship, and non-invasive pre-natal genetic screening.