At the recent HIMSS 2021 conference in Las Vegas, I had a chance to sit down with Dr. Joel Diamond, Chief Medical Officer at 2bPrecise and Dr. Maulik Purohit, Chief Innovation Lead and Associate Chief Medical Information Officer at UH Cleveland. In the discussion Dr. Diamond complimented Dr. Purohit and his team for having one of the most comprehensive and true Enterprise level visions for precision medicine at their healthcare organization.
After hearing such a compliment, I had to explore what a true Enterprise vision for precision medicine included. Dr. Purohit then rolled off the entire spectrum of efforts to be able to do precision medicine effectively at a healthcare organization. Here’s my cliff notes version of what he described along with a few of my own experiences:
DNA Tests – Precision medicine starts with patients having access to the DNA tests. Obviously, if the tests aren’t happening, you can’t do the rest of the process. The costs of tests are coming down where these tests are going to become more and more common and may eventually be part of every patient’s care.
Results Stored in the EHR – It’s great to do the DNA tests for precision medicine, but if the results don’t make their way back to the EHR, then it’s going to be much harder for them to be made actionable. A separate repository is great for research, but you have to bridge to the point of care if you want to make those DNA tests actionable. Needless to say, EHR vendors still have a fair bit of work to do in this regard. We previously featured MEDITECH’s genomics integrations, but we hear that many of the other EHRs are storing it in existing fields rather than building out a full area for genomic data. Not hard to imagine how this will eventually catch up to them and render the genomic data less than useful.
Test Findings Easily Available to Clinician – Related to getting the genomics data into the EHR is making that data available to the clinician in an easy to access and easy to understand fashion. Obviously, there’s a lot of work to still be done in this regard. It’s one thing to have the genomic markers in the EHR. Another to help a clinician know what to do with them.
Clinician Education on Precision Medicine – Carrying the above concept one step further, there’s still a lot of education that needs to happen for clinicians when it comes to precision medicine. Many haven’t used precision medicine in their care and so there’s a learning curve and trust that has to be created for them to reliably use it. Plus, the research in genomics is moving so quickly that it’s hard for a clinician to keep up with all of these changes. An enterprise effort around precision medicine will take this into account and incorporate clinician education on the latest precision medicine findings as part of the platform.
Treatment – Connecting genomic data to actual treatments is another important step. If we collect the data, make the data accessible in the EHR, and have trained clinicians, but don’t connect them to the treatments that are designed for that precise patient, then what’s the point? Ok, there are some cases where a doctor could still have a conversation about genetic risks with a patient and health behaviors, but precision medicine is moving so quickly that there are now clear treatments that are effective for patients based on their genetic markers. Plus, there are some treatments that genetics says won’t be effective for certain patients. Understanding these nuances and connecting the data to the treatment plan is a key final step to make precision medicine impact care.
Unfortunately, when you talk to someone about precision medicine they often only talk about one or two components of those listed above. While this is good because it’s building out the infrastructure and research that’s going to be needed to make precision medicine a reality in healthcare, you can see where those efforts can fall short on results when it comes to impacting patient care.
What do you think of this vision of what’s really required for precision medicine to impact patient care? Is there something missing? How quickly can we get this vision implemented across the majority of healthcare organizations? I’d love to hear your thoughts and experiences with it in the comments and on social media with @hcittoday.
Great job!