Precision Medicine

Major EMR Vendors Debate Their Role in Precision Medicine

Earlier this year in March, I had the opportunity to direct KLAS’ Build Precision Medicine summit. The event served as a workshop to push the industry forward with open discussion and innovative ideas. We put together a great panel comprising Dr. Ethan Gershon, InterSystems’ Clinical Safety Officer; Peter DeVault, Epic’s Vice President of Interoperability and Genomics; Ryan Owings, Cerner’s Senior Director of Acute Care Strategy; and Dr. Salman Naqvi, Allscripts’ Chief Medical Information Officer. To our knowledge, this is the first formal EMR-focused precision medicine panel featuring several major players in the industry.

The EMR and Precision Medicine

The panel members shared their perspectives regarding the EMR’s role in the evolving space of precision medicine, and I would like to give you an inside look at the panel’s discussion.

Most people in developed countries have medical records, and these countries have undergone a lot of investment and implementation over the last decade to digitize healthcare. With the advancements that have taken place, providers and vendors are now wondering what additional roles the EMR can play in the future as well as what roles the EMR will not be capable of filling.

Ethan Gershon felt that asking expert vendors for advice is a necessary course of action. “I don’t think the EMR can replicate the expertise of those expert systems.”

Peter DeVault said that the US really needs to focus on the “interoperability of knowledge” and the transferring of patient information into algorithms. The strategy, in his opinion, needs to be gathering data “from national sources, from your favorite vendors, and from the department down the hall—and maybe the pharmacogenomics department at your own institution.” Each of those groups has complementary knowledge that needs to be integrated.

Dr. Salman Navqi felt strongly that EMR vendors do not need to commit to delivering precision medicine and shouldn’t be promising data storage for files. “I don’t think the EMR needs to get into deploying all of the tools available through artificial intelligence and machine learning. Let the precision medicine knowledge sources do more of that discovery. Use the EMR as an actioning tool when it’s appropriate.”

However, DeVault thought otherwise: “We’re doing a lot of work in machine learning and getting into the space.” Peter believed there is a lot of promise with using structured phenotypic data in EMRs to interpret genomic data. “We might be well situated to interpret genomic and other -omic data,” he said. “We are moving beyond the traditional confines of what EHR conjures up in the imagination.”

The EMR as Holistic Collector of Data

With so much potential information to be had in the future, providers are hopeful that their EMRs can be designed to collect the data so that they can target the data and make specific clinical decisions.

“From a health IT point of view,” Gershon said, “somebody else is going to have the true innovative breakthrough that makes the difference at the bedside.”

Ryan Owings sees a lot of Cerner’s focus not necessarily being on the traditional EMR platform but rather on “another platform that’s really looking at the longitudinal record of the patient and loading in all that broader information.”

The EMR and Patient Care

Many providers are still concerned about the bottom line: how do we take care of patients? We have paid our EMR vendor hundreds of millions of dollars, so how are they going to help us?

DeVault challenged the idea that genomics and the kinds of data being discussed in precision medicine are easily interoperable. “Most laboratories have not even tried to send the discrete data that we’re talking about,” he said. “They all want to solve the problem; so do we. We want the data so that our customers can have it to treat patients.”

“I don’t think EHRs are transactional anymore,” said Dr. Navqi. “Our job is to enable that kind of innovation.”

A genomic strategist brought up a concern about making precision medicine approachable to both primary care physicians and specialists studying genetic variants and specific social determinants of health.

To that, Dr. Navqi responded, “A lot of us forget that healthcare is very diverse. We also have to solve for people who don’t even have an IT shop.” The EMR, he said, is just not at a point where it can tell providers everything they need to know.

The EMR and Cybersecurity

Cybersecurity is already a hot topic across various healthcare spaces. Providers are looking ahead to a time when precision medicine and genomic data are predominant in healthcare, and they are understandably concerned about protecting the increasingly sensitive information. They want to know what they are doing right and what they are doing wrong.

Gorshen brought up the EU’s General Data Protection Regulation, which regulates processing of personal data of individuals in the EU. “The EU regulation is going to drive a lot of new granular functionality.”

Ryan Owings admitted that “the hacker community is so advanced and so good,” but cybersecurity is also at the forefront of his mind. Cybersecurity just has to “keep getting better.”

“Cybersecurity is not an easy spot for any of us to be in right now,” DeVault added. “While we are trying to patch up the holes that we already know are there, we’re opening up more vectors, and that’s just the world that we live in for good and bad.”

More Work Needed

I wish I could share every comment that was made during the summit, but I hope that this peek can spark more conversations elsewhere. For a full account of the EMR panel and our summit roundtables addressing programmatic development and technology strategies, you may be interested to read our complimentary summit implementer’s guide. If so, feel free to contact me.

I have had many conversations over the last two years about precision medicine, and the consensus is that more can be done. As we talk and learn more about precision medicine, we can more quickly solve the problems discussed during the summit, such as applying precision medicine to patient care and, of more pressing importance, defining what precision medicine is.  I am excited to see what more we have yet to discover.


Photo Cred: Tonhom1009