How Organizations Can Integrate Precision Medicine with Clinical Care

While the promises of precision medicine in healthcare are seemingly boundless, the industry has had to overcome several challenges to integrating these approaches with everyday clinical care.

From seamlessly incorporating genomic and genetic data into EHRs and provider workflows, to training providers and educating patients on the benefits and concepts of precision medicine, healthcare leaders have a lot to consider before they can make individualized therapies a routine part of care delivery.

“The concept of using precision medicine in healthcare is still a new concept for a lot of people. People agree that precision medicine is great, but it’s getting from the theory of precision medicine to operationalizing it,” Maulik Purohit, MD, associate chief medical information officer at UH-Cleveland, told HealthITAnalytics.

To overcome some of the major barriers to integration, Purohit stated that organizations should start to look to advanced technologies, as well as find key use cases for personalized medicine in care.

“Automation of some lab processes will bring the cost down as well. So investing in this concept of precision medicine for getting the cost of lab tests down is critical. The second piece is the education aspect – how do you make this practical? And then third is having the right research and science behind this to know when and where precision medicine makes sense,” he said.

“For example, it might make sense to use precision medicine approaches when selecting antidepressant medication. But it may not make sense for other treatments and diagnoses. You have to know some of those things so that you can work around that and then incorporate it into the workflow of the provider.”

On a large-scale, industry-wide level, precision medicine integration will begin on the educational side, Purohit noted.

“One of the initial steps is incorporating precision medicine to our education program at medical schools. Second, we need to have the science and the funding for research studies that will show the value of precision medicine, or evaluate the context in which precision medicine could have value – whether that’s certain treatment plans or specific diseases,” he said.

“It may have greater value in some areas more than others, or providers may find that it doesn't matter. For example, in cardiovascular care maybe you find that whether you use a precision medicine treatment or a standard treatment, you get the same results. And that’s good to know, because then you can focus on using less expensive therapies.”

However, for other areas of care, providers may find that precision medicine therapies work better than standard approaches.

“If this is the case, then you can go straight to that medication instead of doing a trial and error, which is what we often end up having to do in medicine,” Purohit stated.

“There is also the challenge of understanding how to use precision medicine in the context of both physicians and patients – perhaps there's a higher upfront cost in terms of a copay, but there's a great return on that cost by having better care and better health for a longer period of time. We’d need to educate people on those things.”

On a smaller scale, provider organizations should be most concerned with how they’re going to execute precision medicine plans.

“On the level of an individual healthcare system, if you have the evidence and the reimbursement from an insurance standpoint, it then becomes a situation of operationalizing it. You can look into ways of farming out the lab tests so that you can integrate them back into your healthcare system through the EHR,” said Purohit.

“In our system, we're looking at a way that we can order a lab test on the inpatient side, so that the patient can have that lab test ready for their first primary care visit on the outpatient side. And that test can be incorporated into the treatment plan for the patient so that once they're out of the acute care hospital setting and in long-term care, they can have that test available.”

While this may sound simple, Purohit said that the process is easier said than done.

“You first have to understand whether it’s cost effective to do that for the patient and for the hospital system. Who's going to pay for it? Second, is getting the lab tests drawn, sent out to the right lab, and partnering with the right lab.”

“Then you have to have that test be in the workflow, and providers have to know how and when to use it. There has to be education for the patient as well. So, there are a lot of steps in that process, as simple and straightforward as it may seem. But it's doable.”

And for organizations that do carry out these steps, the payoff is evident.

“The potential for precision medicine and genomics is huge right now,” said Purohit.

“Pharmacogenomics is one example. Take the situation of anti-depressant therapy and a class medication called SSRIs, selective serotonin reuptake inhibitors. In that scenario, clinicians often prescribe one medication and then the patient tries it for six weeks to see what the effect is, and then you do a dose change. And then you switch to a different medication in the same class, and then keep going with that method for six to eight weeks.”

This standard method can start to add up – in terms of both cost and time, Purohit said.

“The difficulty is that it might take up to a year to get a patient on the right antidepressant medication,” he explained.

“Meanwhile, this trial and error methodology is costing a lot, and the patient is continuing to suffer with that disease during that time period. But with a pharmacogenetic method, providers could say, ‘The patient can benefit from medications A, B, and C, but not medications D, E, and F.’ You can move to the right medications at the right dose faster.”

With precision medicine treatments, providers can deliver the right treatments to the right patients in a shorter amount of time, resulting in care that is proactive instead of reactive, Purohit concluded.

“Precision medicine and the concept of genetics has the ability to provide real data on what's going on with a patient at the individual level. One of the limitations with research is that oftentimes you’ll do a study on a population level, let’s say 1000 people, and you draw some conclusion from the results. However, the reality is that not every individual in that study may react the same as everybody else in the study,” he said.

“That's always been a struggle for providers – taking a population-based study and converting it to the individual patient level. But now, you can have real data that applies to an individual patient, and you can discern that this patient would benefit from treatment A versus treatment B. Combining the population-level analysis with the individual analysis will lead to much better care.”