Precision Medicine

Creating a Strategy for Personalized Medicine

NorthShore University HealthSystem (NorthShore) recently co-hosted the inaugural precision medicine summit, buildpm19, with KLAS. Providers, vendors, payers, and others spent the day collaborating on the best ways to create an effective precision medicine strategy.

I can’t replicate the amazing conversations that took place. However, I thought I would share a few highlights, as well as insights into what NorthShore has learned in our work with genomics and personalized medicine over the last several years.

The Role of Your EMR Vendor

Surprisingly, most healthcare providers interviewed for KLAS’ latest precision medicine report responded that they did not believe that their EMR would play a primary role in the future of precision medicine. In fact, many felt their EMR is not positioned, or isn’t positioning itself to advance their strategy.

In my opinion, keeping your EMR vendor an arm’s length away from precision medicine may feel easier at first. Ultimately, though, bringing precision medicine data back into the EMR in a systematic manner without the help of your EMR may be more trouble than it’s worth.

Why? At NorthShore, if we want to incorporate new tools or care pathways for the providers, we know that those must be seamlessly integrated into the provider workflow, not in addition to it. Personalized medicine has proved to be no different. For that reason, we have ensured that our EMR is considered in all decision making.  

Recognizing that Epic continues to evolve their product in this space, we have also developed our own bioinformatics and interfacing engine, codename “FLYPE”. It helps us bring precision medicine data from both our laboratory and outside products back into our EMR. That connection has allowed us to accelerate our work in precision medicine because, as mentioned before, it has been seamlessly integrated into providers’ existing workflows.  

Potential Roadblocks

Rolling out a robust personalized medicine program requires working with a myriad of vendors and tools, and plenty of problems are bound to arise. I’d like to share three roadblocks we have had to navigate around and that other providers may want to keep an eye out for.

The first hurdle is seeing through the hype. It can be difficult to distinguish whether a product is really what the vendor says it is or simply smoke and mirrors. I find it easiest to trust people who freely admit that they don’t know everything. We choose vendors who have good concepts in mind and are looking for a partner to help them build their tools. Two examples for us have been ActX (pharmacogenomics) and PierianDx (molecular oncology).

The second problem I want to mention is that of integration and interfacing. Different people have different definitions of what “interfacing” means. At NorthShore, it means that data is completely integrated into our workflows. We had to develop our API and all of the other infrastructure to allow for that true integration.

The third roadblock has to do with data security management, particularly in terms of genetic information. In this rapidly evolving field, it is essential to work with companies who are startups. Unfortunately, many of these companies have been forced to learn the hard way that data security in their mind is not the same as the health system’s (or government’s) minds. As a result, concepts that take weeks to build and develop outside of healthcare can take months (or gulp… years), depending on the scale and interaction with the data

Pushing Toward the Ideal

We believe that personalized medicine is a critical piece of the healthcare puzzle. It can proactively identify patients who have a high risk of disease and don’t even know it. Then providers can change care plans to better streamline and tailor prevention and treatment methods to those patients.

Our work in precision medicine should also help us have the right drugs and treatments available at the right times. A shotgun approach of trial and error isn’t good enough. Our patients deserve to have proactive treatment provided to them in a precise and systematic way.

NorthShore wants to create a differentiated experience and expectation of care for all of our stakeholders: our patients, providers, payers and community. We hope our model and approach will give them the confidence and comfort necessary to take their first steps into genomics.

Personalized medicine is taking off in many directions, so our providers need our program to be a safety net. That net currently includes electronic tools, such as those for decision support, as well as facilities, including our 10 subspecialty genomics clinics that providers can refer patients to.

We are also thinking about the economic side of things. Running with our precision medicine program is the right thing for us to do, but the reimbursement environment is not keeping pace with the development of the technology. We need a model that is innovative, nimble and sustainable. We are fortunate at NorthShore to have received seed funding from our ‘Transformation through Innovation’ fund, but we still need to keep a focus on the economics and value proposition for all involved.

A Worthy Goal

Today, a precision medicine program is a differentiator, but I hope it won’t be for very long. At NorthShore, we believe advanced primary care that includes genomics as part of the patient experience should be a goal of every health system.

I’m grateful for opportunities, such as the inaugural buildpm19 conference, that allowed stakeholders from across the country to work together on creating realistic solutions for today’s (and tomorrow’s) problems. I believe the wisdom shared by the attendees provided outstanding insights for those who are venturing into the exciting world of precision medicine.

I look forward to seeing the buildPM19 white paper that will be published in the coming month.

     Photo Cred: Shutterstock, LeoWolfert