We love to talk about genomics and precision medicine, but I often wonder how much of it is really making it into hospitals and health systems. The good news is that the Center for Connected Medicine recently put together a report called “Genomic data management is vital to precision medicine efforts at health systems” to answer this very question. To understand some of the report findings, we interviewed Philip Empey, Associate Professor of Pharmacy & Therapeutics in the School of Pharmacy at the University of Pittsburgh and Associate Director for Pharmacogenomics for our Institute for Precision Medicine.
When Empey was asked if there was a dominant vendor in the genomics and precision medicine space he said “There isn’t just one dominant genomic vendor. Often times the focus is on one therapeutic area or one aspect of the system like in-lab reporting pipelines, electronic health record alerting, patient or provider education, or population management.”
While it makes sense that many precision medicine platforms are focused on one therapeutic area, it does beg the question of if the market is just too early for one vendor to consolidate the space and that as the market matures we’ll see a company or possibly private equity consolidate multiple therapeutic areas into one enterprise platform for health systems.
Coming from the report mentioned above, they found that 67% of health systems are approaching genomic data management from an enterprise-wide level and 33% are approaching it from a department level. It’s interesting to see so many health systems approaching this at the enterprise level.
Empey added that it was surprising to him that “33% of respondents said their organization already has a strategy in place.” Although, he added the large caveat that this might represent a “high variability in these strategies.” Reminds me of those who talk about patient engagement. Not all patient engagement is created equal. The same seems to be true when it comes to how comprehensive a genomic strategy you have in place.
Empey suggests a number of things that he see enterprise platforms including:
- Re-interpretation of Genomic Data
- Clinician Notification
- Access to Test Results from a Variety of Molecular Labs
- In-workflow EHR Integration
The last piece is no doubt of particular interest to myself and the Healthcare IT Today community since the EHR is the center of much of what we do. When it comes to EHR integration, it seems that one key to genomic EHR integration is storing genomic and pharmacogenomic data discretely and applying standardization to the process. Empey suggests that organizations such as Clinical Pharmacogenetics Implementation Consortium (CPIC) are leading the efforts for some of these standards. This reminds me of the lessons we’ve learned about discrete data and standardization in other areas of the EHR.
While it’s great to talk about precision medicine platforms and genomic data models, the best part of precision medicine and pharmacogenomics is the stories of patients. We asked Empey to share an experience he’s had with genomics that impacted the life of a patient. Here’s the story he shared:
There was a particular elderly patient at our institution that had received a cardiac stent procedures four times previously and each time she was discharged on clopidogrel to prevent blood clots. When she had each recurrent event, it was blamed on worsening disease or poor medication adherence. Interestingly, while clopidogrel is the most commonly-used antiplatelet medication after a stent procedure, there are ~ 30% of patients who have difficulty metabolizing this medication. And because clopidogrel is a prodrug, it must be metabolized, or activated, to work as expected.
On the fifth visit, this patient presented to UPMC and was found to be an CYP2C19 intermediate metabolizer and predicted to have a reduced function of the enzyme needed to activate clopidogrel. This pharmacogenetic finding gave clinicians and the patient the data they needed to understand what may have been the underlying reason for therapeutic failure. The new pharmacogenetic data justified prescribing of the more expensive alternative therapy.
I love this story because it’s easy to see how much this helped the patient. However, I also love it because it illustrates how hard genomics and pharmacogenomics is to make sure it’s effective. Of course, any new innovation needs to start somewhere and it looks like health systems are starting to create more of a strategy around genomics and precision medicine.
This article is part of the #HealthIT100in100