Health systems must consider physician workflow for precision medicine programs

Health systems must consider physician workflow for precision medicine programs unknown

CHICAGO — Implementing precision medicine programs could allow health systems to diagnose disease more quickly or predict a patient's response to a specific mediation, said panelists at the 2023 HIMSS Global Health Conference & Exhibition.

But there are challenges to putting together an effective genomics program, said Jackie Rice, vice president for information technology and chief information officer at Frederick Health.

"Outside of a few specialties — mother-baby, oncology — most of our providers don't have advanced training in genomics," she said. "Yeah, they might have a class of two, but they don't have that advanced training for how they're going to treat their patients."

The health system also wanted to make sure genetic testing could happen seamlessly in the physician's workflow. That meant ordering tests within the EHR where results could be quickly accessed. Physicians also needed information on how to interpret those results, as genomics is a rapidly evolving field, Rice said.

"The physicians may have limited knowledge because it's changing weekly or every two weeks," she said. "[...] So we also worked with a third-party vendor to put some clinical decision support in there."

Pharmacogenomics, or using genetic testing to determine how a patient will respond to different medications, was a key focus for the program, said Dr. Kristin Conley, chief medical information officer at Frederick Health.

"You can see, based on some of those genes, how you would typically respond to a medication. Do you metabolize it quicker than the average person? Or maybe you're a slow metabolizer, and we need to have a lower dose to get that effect," she said.

It can be difficult to justify the cost of a precision medicine budget when health system budgets are tight, Rice said. But she argues many patients could benefit from pharmacogenomics. Plenty of people know a friend or family member who cycled through several antidepressants before they found one that worked.

Looking ahead, health equity will also be important to study. Where do patients who've received genetic testing live? Are patients from racial and ethnic minorities accessing the tests? Since some cost is out-of-pocket, Rice said it's key to look for grants and encourage payers to cover these services.

"We really believe that 10 years from now, people are going to say, 'You actually took care of people and you didn't do their genetic testing?' " she said. "We're going to do lab testing, imaging and your genetic testing. We're going to treat you for what you really need to be treated for, and find the right medication quicker and the right diagnosis quicker so that you can get that treatment quicker."