Readers Write: A Global Perspective on Advancing Precision Medicine with Genomic EHR Integration

Readers Write: A Global Perspective on Advancing Precision Medicine with Genomic EHR Integration
By Jennifer Ford

Jennifer Ford, MBA is manager of clinical product management and genomics at Meditech.

The promise of precision medicine is simple, using genetic data to identify the best treatment for each patient as quickly as possible.

During my travels to South Africa and Namibia, healthcare leaders in both urban and remote areas shared enthusiasm for the role of EHRs in incorporating genomic data to guide treatment decisions. However, it also made wonder that if the passion for advanced technologies like genomics is so universally embraced, then what barriers are holding us back from widespread adoption?

The Challenges of Adopting a Precision Medicine Program

Despite its promise, adoption of genomics and precision medicine has been slow. Several challenges, both real and perceived, are hindering its adoption:

• Costly testing. While the costs of personal genetic testing have declined significantly in recent years, many patients still face difficulties accessing genetic testing due to high out-of-pocket costs and limited or no coverage.
• Limited availability of testing. Not every health system offers this type of testing, either due to a lack of local testing facilities, insufficient funding, or the absence of a service line.
• Lack of understanding testing value. Many healthcare providers are unfamiliar with the use of genomics in diagnosis and treatment, particularly those working in environments where genomic data is not a prevalent part of the EHR.
• Lack of EHR Integration. Providers often don’t have access to this data within their EHR workflows, and if they do, it is as a static document that is attached to the patient’s record and is too cumbersome to sift through.
• Result data is not actionable. The lack of standardized clinical alerts or decision-support systems that incorporate genomic data means providers may lack the tools or training to make genomically informed decisions.
• Testing is reserved for academia. Precision medicine remains more prevalent in academic and research centers than in community-based health systems, where most care occurs.

These challenges and misconceptions often stem from experiences that predate the integration of genetic data into the EHR, but the paradigm can change.

Overcoming the Challenges of Adopting a Precision Medicine Program

I’ve worked with healthcare leaders who are integrating genomics into the EHR. The result has been that when genetic data is ingested discretely into the EHR, clinical alerts become available for each patient based on their genetic information, enabling personalized patient care.

Genetics is not just for academic centers. I’ve seen the value that community hospitals gain when patients receive genetically-led services locally rather than traveling to larger academic medical centers. By equipping community clinics with a user-friendly, plug-and-play solution, they can focus on translational research that will lower costs, improve accessibility, and achieve better patient outcomes.

The Benefits of Adopting a Precision Medicine Program

The benefits of genomics in healthcare are becoming increasingly clear. The use of genomic data extends beyond cancer treatment, as health systems are using it to improve behavioral health treatment, newborn and pediatric care, and health and weight management. Having effective technology that can analyze genomic data to provide clinical support empowers clinicians to deliver more targeted patient treatment and support population health objectives. Adopting a genomics program can also support service line growth.

Global Precision Medicine Initiatives

Various initiatives worldwide are bringing genetic testing to the forefront of healthcare. Each area of the world faces distinct challenges related to geography, patient demographics, and scaling testing opportunities.

In South Africa and Namibia, healthcare leaders shared their desire to improve access to genetic testing in African nations. To reduce costs and maximize the benefits of genomic data, they are experimenting with leveraging social determinants of health to identify and prioritize patient cohorts to whom they will deploy testing. Where technological infrastructure may be limited, national labs are looking for ways to more equitably transport and perform testing from remote villages using drones, satellite internet services, and other technologies.

In England, the National Health Service (NHS) announced a £650m investment to provide every baby in England with DNA screening to identify potentially fatal diseases and to offer personalized healthcare as part of the government’s 10-year plan. The NHS recognizes that when patients receive personalized healthcare to prevent ill health before symptoms begin, it will reduce the pressure on NHS services and help people live longer, healthier lives. In the US, a similar approach has been announced in Florida’s Sunshine Genetics Act, which funds newborn genome sequencing pilots. These efforts are helping shift the paradigm toward proactive, personalized healthcare.

In Maryland, Frederick Health operates a dedicated precision medicine and genetics clinic that uses genomic data for precision medicine in behavioral health and beyond. In a Scottsdale Institute presentation, they shared how they addressed cost concerns by negotiating testing costs with laboratories and started a rapidly growing clinical trials program. They use genomic data to identify patients for clinical trials, increasing enrollment and improving care. They have found that moving clinical trials into the community hospital space increased revenue.

Ontario Shores Center for Mental Health Services in Canada announced that it would offer free pharmacogenetic testing of eligible patients to improve outcomes. The testing is initially focused on improving the treatment of patients who are admitted with schizophrenia or schizoaffective disorder, with plans for future expansion to use pharmacogenomics in behavioral health management.

Final Thoughts: Adopting Precision Medicine in Clinical Care is Essential

The more that genetic data is integrated into the EHR, the faster widespread deployment will occur. As clinicians find meaningful utility in genetic data, the importance of a strong precision medicine program shifts from a nice-to-have to a must- have. The key factor is how the EHR can leverage genetic data to improve patient outcomes.

As applications for genetic data evolve, an established genetic program becomes essential to improving physician satisfaction by empowering them with the advanced tools that they need to provide the best possible patient care.