The concept of precision medicine may have been new to the American public when President Barack Obama referenced it in his 2015 State of the Union address, but it is an area of medicine in which NorthShore University HealthSystem in Evanston, Ill., has been working for many years.
Roughly a decade ago, NorthShore saw the potential precision medicine — also known as individualized or personalized medicine — had to enhance patient care. The system began developing its Center for Medical Genetics by recruiting enthusiastic researchers and physicians with training in internal medicine as well as medical genetics.
NorthShore competitively recruited experts in medical genetics with its functional EMR system and robust data warehouse, which stores more than 10 years of patient data. Many clinical experts recognized the ability data would give them to apply their genomic and precision medicine research to direct patient care at NorthShore, an opportunity not available at many systems even today.
From there, the program and depth of expertise at NorthShore has grown to include roughly 200 physicians, including oncologists, pathologists and even a pharmacogeneticist.
Today, NorthShore University HealthSystem continues to unlock exciting opportunities in precision medicine as well as identify the challenges of the innovative model of care.
The challenges and opportunities of precision medicine
Precision medicine is still somewhat in its infancy, so investing in the innovative approach to care may initially intimidate to many health systems.
For NorthShore COO J.P. Gallagher, the potential for greater patient outcomes was and is still worth the investment.
"For me, weighing the worth of the investment comes down to asking 'what is our mission?' We are here trying to serve the patients in the community by preserving and improving human life," said Mr. Gallagher. "Precision medicine gives us some very powerful tools to do so by allowing us to diagnose patients better and faster, target therapies to be more accurate and relevant to each patient's condition and empower patients with more information."
NorthShore Research Institute Chief Scientific Officer Michael S. Caplan, MD, echoed Mr. Gallagher's sentiments and went on to say that precision medicine can improve the cost efficiency of care.
"Many medical screening and treatment strategies are developed based on cohorts of previously studied patients, yielding information not specific to any individual even though a person's individual makeup will respond to drugs and dosages differently," said Dr. Caplan. "With personalized medicine, we are able to tailor medicine that will allow us to treat patients better and more efficiently as well as decrease costs by not prescribing drugs that aren't going to work for specific individuals."
The initial investment isn't the only reason why precision medicine is still a relatively uncommon approach to medicine; additional challenges include the cost of DNA sequencing to patients and the limited amount of actionable information, according to Dr. Caplan.
"The cost of sequencing a patient's DNA is much less now than it was five years ago. When Steve Jobs had his DNA sequenced, it cost many millions of dollars and now it can be done for a few thousand dollars," said Dr. Caplan. "So gene sequencing is getting into the realm of being approachable for all people, but it's still very expensive."
Applying precision medicine to patient care
Currently, oncology is one of the biggest areas in which patients are seeing precision medicine most. That said, it's hardly the only area in which the innovative approach has potential.
Experts at NorthShore have begun exploring the possible ways precision medicine may apply to patients at risk for Alzheimer's disease and other neurodegenerative diseases, and antibiotic stewardship and better managing the use of narcotics and antidepressants are also growing fields.
Using genomics, physicians can not only find better treatments for patients, they can help patients realize the conditions for which they are at-risk and help them make modifications to their behaviors and lifestyles to postpone the condition or avoid it altogether.
Despite the potential good precision medicine can do, not every patient is quick to jump on board, according to Mr. Gallagher.
"A big part of practicing personalized medicine responsibly involves understanding how to connect with patients and put things in the appropriate context," said Mr. Gallagher. "Some people may not want to know or have any level of awareness about something that may never present itself, so there are very serious and legitimate questions that need to be taken into account when we work with patients."
To help patients work through their questions, NorthShore has genetic counselors and is rolling out broad-based physician education programs to help primary care physicians work with patients.
Although NorthShore provides services to patients who are interested in genetic testing, Mr. Gallagher emphasized the importance of never forcing genetic testing on patients.
The future of precision medicine
All in all, both Mr. Gallagher and Dr. Caplan expressed optimism regarding the future of precision medicine as an approach to care.
For instance, precision medicine has the potential to play an important and relevant role in population health as the industry transitions from a fee-for-service model to a value-based care system.
"As we become responsible for populations and taking care of much broader-based groups of individuals, precision medicine can be integrated into EMR systems," said Mr. Gallagher. "Doing so will allow physicians to extract information from larger cohorts of data and manage those populations more effectively, particularly when certain risk factors present themselves."
One goal NorthShore is committed to and excited about is the potential to use precision medicine and EMR systems to identify patients who might not have known they were at-risk for any number of conditions and engage them early, keeping them healthy and avoiding unnecessary interventions.
More studies, data and government-funded trials supporting the efficacy of using genomics to treat and care for individuals will result in less skepticism as time goes on, according to Dr. Caplan.
Dr. Caplan cited the President's introduction of the Precision Medicine Initiative and his request for funds to support the initiative in his 2016 budget as good signs.
"To hear President Obama's call to action in the State of the Union and his request for the actual allocation of dollars to accomplish a couple of key areas in precision medicine was very exciting and reassured me that NorthShore is on the right path to success."