Many believe that precision medicine is the next frontier in healthcare, but the landscape is complicated. With thousands of genetic tests offered in the market today, physicians are frequently unsure what to order and how to interpret the results.
On August 31, panelists discussed precision medicine, the role of diagnostics like pharmacogenomic testing and the intersection of precision health and population health during the first day of the Precision Health Virtual Summit hosted by hc1 and Becker's Hospital Review. This event was sponsored by Quest Diagnostics, Snowflake, and AWS.
Presenters were:
- Brad Bostic, chairman and CEO, hc1
- Mitch Daniels, president, Purdue University in West Lafayette, Ind.
- David B. Nash, MD, founding dean emeritus, Jefferson College of Population Health in Philadelphia
- Robert Michel, editor-in-chief, DARK Daily and The Dark Report
- Kristine Ashcraft, medical director for pharmacogenomics, Invitae
- Yuri Fesko, MD, executive medical director of medical affairs, Quest Diagnostics
- Jordan Olson, MD, division chief, clinical pathology informatics and quality, Geisinger in Danville, Pa.
- Matthew Katz, principal and founder, MCK Healthcare Strategies, LLC
- Rehan Waheed, MD, senior medical director and CMIO healthcare analytics solutions, Quest Diagnostics
- Brian Patty, MD, chief medical informatics officer, Medix Technology
- Albert Villarin, MD, vice President and CMIO, Nuvance Health in Danbury, Conn.
- Stephanie Lahr, MD, CHCIO, CIO and CMIO, Monument Health in Rapid City, S.D.
- Peter Embi, MD, president and CEO, Regenstrief Institute in Indianapolis
- Umberto Tachinardi, MD, CIO, Regenstrief Institute
Five insights from the first day of the summit:
- A lack of interoperability and connectivity makes it challenging for physicians to access and interpret test results. Oncology, for example, depends on precision medicine markers to identify the appropriate therapy for patients. Batteries of tests are needed, and the results must be integrated in ways oncologists can understand. Another significant problem is test results often come back in PDF format and get lost in the ordering provider's files. "When that happens, the test frequently gets reordered, or the results aren't incorporated into the patient's care. We need to store results discretely so we can trigger the right clinical decision support for the right person at the right time," Ms. Ashcraft explained. Yet, integration between systems is often easier said than done. "Every time we stand up an interface, it's a de novo effort. That's not sustainable," Dr. Olson said.
- Contrary to what many believe, precision medicine and population health aren't on a collision course. In reality, population health and precision medicine are highly complementary. "Precision medicine will reduce waste by getting patients to the right drug at the right dose for the right indication," Dr. Nash said. "And it will do so quickly. If that can happen for many people, you can improve population health."
- Precision medicine must be viewed through the lens of population health. Precision medicine has the potential to save lives, improve outcomes and reduce waste. "We know that Black men, for example, have a disproportionate share of prostate cancer and it's more aggressive than in white men," Dr. Nash said. "When we treat these individuals, however, we may have to overcome fears of clinical trials and decades of institutional racism. Social overlays affect how we communicate with patients and treat them. Precision medicine has to be understood through the lens of population health."
- Diagnostics are essential for precision health but scaling these programs is difficult. Many clinicians and patients want widespread access to pharmacogenomic testing to understand a patient’s genetics may influence their response to specific treatments. In many cases, however, the science is far ahead of the operations. "We can do these tests very well on a very small scale, but screening 100,000 people for a pharmacogenomics marker requires a level of infrastructure that we're still struggling to understand," Dr. Olson said.
- Genetic counselors are key members of precision health teams. Genetic counselors are skilled at providing emotional support to patients, once test results are available. They are also valuable resources for physicians. "Prior to COVID, we worked with independent physicians affiliated with an ACO to educate them online and in person about standards related to diagnostics," Mr. Katz said. "Engaging with each other and with genetic counselors reduced their fear of ordering the wrong tests." Despite the value of genetic counselors, some insurers unfortunately don't cover the cost of their services.
To view the full sessions from Day 1 of the Precision Health Virtual Summit on-demand, click here. To learn more about hc1, click here.