Although precision medicine carries promise when it comes to care delivery, actually implementing a meaningful genomic data-driven strategy can be more challenging.
At the Tennessee-based Murfreesboro Medical Clinic and SurgiCenter, the team has successfully made pharmacogenomic information readily available at the point of care – to the satisfaction of providers and patients.
“Our physicians – like those at many other organizations – recognize the value in identifying potential drug-gene interactions when prescribing medications,” said Dr. Nicolas Cote, chief medical information officer and president at MMC, in an interview with Healthcare IT News.
“They represent a significant patient safety issue and have tremendous implications about how effective treatment is and how quickly patients begin to benefit from the medications we prescribe,” he continued.
Cote, who will be presenting at HIMSS21 this August, outlined the pharmacogenomic (often shortened to PGx) information program at the health system and talked through the steps MMC took to make it happen.
PGx testing is a logical way to identify and avoid drug-gene interactions, Cote explained, but providers need to be able to order tests and see the results within their workflows as they make clinical decisions.
“As we began our program, we uncovered three specific barriers to this: provider understanding about what PGx is and how it can be used in patient care; perceived cost of PGx tests and whether or not insurance would cover them; and difficulty in accessing test results during the course of clinical decision-making,” Cote said.
MMC identified a pilot group of providers to work with the PGx program. At the same time, it worked with a PGx lab partner on a patient financial assistance program to offset testing costs that might not be covered.
“Finally, we invested in a software tool from 2bPrecise that helped automate the workflows surrounding the process of ordering the tests and delivering results into the workflow,” Cote said.
When it comes to key technology considerations, Cote said, the team wanted to ensure PGx information was integrated with typical workflow. The tool they adopted sits as an app atop the electronic health record desktop, within the patient context.
“Providers simply click on it to review PGx information,” he explained. “They are able to see if the patient is on medications that carry a possible risk of drug-gene interactions, so they can easily make a decision about whether they should order the test.
“Likewise, they can see a dashboard with the results after the test report is back. The dashboard allows the provider to open the full lab result and link to knowledge bases for additional insights if he or she wants,” he continued.
Cote flagged that once a PGx test is done, the results rarely change for the rest of a patient’s lifetime.
“The software MMC uses allows us to manage this data so providers other than the ordering provider can access it – both in the present and far into the future,” he said.
So, given the advantages of such a program, what are some barriers to adopting it?
“It does little good for one physician to order the test and then have the results confined to a document file known only to him or her,” Cote said. “We want to make sure that any and all providers are able to incorporate these insights into their decisions about medications.
“It’s critical that organizations implement the appropriate informatics structure so that data from any lab can be ingested, that any provider seeing the patient is aware the information is available to them, and that they can then easily access it within their workflow,” he added.
Cote also pointed out that PGx is a single component of the broader precision medicine universe: Organizations can expect volumes to grow as more providers identify patients at elevated risk from heritable diseases and use the resulting data to deliver targeted therapies.
“Organizations should be considering what sort of informatics infrastructure they need to accommodate this new and voluminous data set,” he said.
MMC has enjoyed “enthusiastic feedback” across the board, said Cote, with both patients and providers reporting satisfaction with the program.
Cote says he believes genetic and genomic testing represent the next paradigm shift in healthcare – and he hopes HIMSS attendees learn what an impact precision medicine can have.
“It’s critical that organizations begin planning how they will accommodate the new workflows that will be required, as well as the data management challenges they will need to address,” he said.
Cote will go into more detail in his HIMSS21 session, “Before and After: HIT Galvanizes Precision Medicine Success.” It’s scheduled for Wednesday, August 11, from 11:30 a.m. to 12:30 p.m., in Venetian Marco Polo 701.