It’s probably not surprising to learn that City of Hope, one of the top cancer and research centers in the United States, has invested a great deal in precision medicine. What’s a bit more interesting is that, unlike in past years, precision medicine — a care model that provided targeted treatments based on genetic or molecular profiling — is no longer limited to certain types of organizations. Now, integrated networks like Mass General Brigham and even community hospitals like Frederick Health have entered the fray, and are realizing the myriad benefits of precision medicine.
“We believe it’s here,” said Jackie Rice, CIO at Frederick Health. “We believe it’s going to make a difference in the community.”
Alistair Erskine, MD, Chief Digital Health Officer at Mass General Brigham, agreed, noting that precision medicine is “becoming more and more compelling,” he said. “It’s not going to be able to help solve every problem in medicine, but it can definitely contribute to the ability to tailor medicine.”
During a recent discussion, panelists Rice, Erskine and Beth Lindsay-Wood, CIO at City of Hope, shared their experiences with precision medicine, including what it takes to provide the right infrastructure, and how they’re working to overcome the biggest obstacles.
Although precision medicine isn’t exactly a novel concept, there are still misconceptions about what it actually means. In its simplest form, precision medicine is “using information about genes, the environment, and lifestyle to address disease prevention, diagnosis, and treatment,” noted Erskine. The ultimate goal is to leverage knowledge to enable providers to act more proactively in “predicting the susceptibility of disease and prescribing drugs more accurately.”
It is not, however, about a specific patient, but rather, utilizing genomics for disease prevention, treatment, and management across populations, said Lindsay-Wood. As a National Cancer Institute-Designated care center, City of Hope has had a precision medicine program in place for several years; recently, though, both precision medicine — and the IT components needed to support it — has become a major initiative.
Lindsay-Wood’s team created a technology suite that leverages genetic profiling and DNA sequencing to provide the right data at the right time. The oncology learning platform, as she called it, provides real-world evidence and outcomes based on research to guide decision-making.
Enabling that, of course, is no easy task, particularly when dealing with large, complex data sets. This type of “high-performance computing” requires sophisticated hardware, which City of Hope approaches using a combination of on-premise machines and cloud computing.
In addition, the organization’s data lake, called Poseidon, serves as a repository for information coming in through different sources. It can be used both by physicians and researchers, she noted. Although being able to house data is “a core competency” for the organization, it doesn’t come cheap — or easy, for that matter. “It requires care and feeding as we continue to evolve the platform and look at new types of data that need to be factored in,” she said. “We have to have usable information.”
Four core systems
It starts by establishing a solid infrastructure, according to Erskine, which must include four core pillars:
- Engagement, which encompasses website analytics, CRM tools, portals, and digital health apps for specific disease conditions. “You need to think about how you engage the patient, because that engagement is going to be critical, especially as you look at collecting data points for precision medicine.”
- Patient records, which means “making sure we have a good understanding of the problems, medications, notes, studies, and the disease registries that exist to be able to pre-cohort patients.”
- Populations, which refers to data brokers such as Amazon, Meta, and Google that can provide “more precise data,” Erskine said.
- Analysis and prediction, which includes data lakes, enterprise data warehouses, and the engines to create AI or deep learning from the data points that are available, “especially on the unstructured side.”
Perhaps just as critical, he noted, are the supporting systems: interoperability, to ensure data flow across the continuum, and security, which is particularly important with such valuable information. “You want to make sure it’s bullet proof.”
And while it may not be possible to execute any initiative flawlessly, especially one as complex as precision medicine, there are steps leaders can take to improve their chances. Below are some best practices provided by the panelists.
- No siloes. Despite being a community hospital, Frederick Health has started down the path of precision medicine, thanks to the support of the board and CEO. But because funds are limited, Rice’s team is under increased pressure to deliver results. And so, after piloting the program in oncology, they pushed for a system-wide approach with a steering committee representing different areas. “We didn’t want it to be siloed,” she said.
- Integrated genetic testing. Last summer, Frederick Health began integrating genetic testing with its Meditech EHR, which enables them to bring in discreet results from different labs. Doing so, however, wasn’t a simple task. “We worked with our vendors to make sure the data were standardized,” she noted. “If you’re going to bring in all of this information from different places, it has to land in the right spots within the EHR. “That’s a challenge when you have all of these entities, but we worked through it.” The other piece was enabling physicians to order genetic tests directly, rather than reaching out to individual labs to place orders, which has saved “a lot of time,” Rice added. “We feel like we’ve made a big step forward.”
- Working it in. “If you want providers to be able to use this information, you have to put it in their workflow,” said Rice, especially primary care providers who only have about 15 minutes with each patient. By incorporating precision medicine into their flow, “we’re able to let them know upfront if a patient had genetic testing done.”
- Engines ready. To reduce some of the technical debt that seems to be inevitable, Erskine advised making sure to have both an interface engine and API engine in place. “Doing point to point interfaces can become very complex and very expensive very quickly,” he said.
- Partner up. Although precision medicine initiatives are driven by physicians, IT must be a critical partner, according to Lindsay-Wood. To her, that means having “a good foothold in terms of how we solution, how we help drive, what are the next things that we need to work on, and what technologies we need to be exploring. We have to get out ahead of it.” Structured reporting, for example, can be challenging, and so IT leaders and staff need to be aware of what’s happening and be ready to apply solutions. “We partner well with the precision medicine team, as well as clinical leaders. It takes a village.”
The cost equation
It also, however, takes a significant investment, which has proven to be a stumbling block. With costs for some therapies as high as $10,000 per month, according to Erskine, payers are looking for direct correlations between treatment and avoidance of illness.
And in many cases, establishing ROI can be extremely difficult, noted Rice, especially for community organizations. “It’s hard to quantify, but we believe it’s going to make a difference.” This is where successful patient stories can play a big role. “We all need to be out there working to get that reimbursement done. We have to prove to the payers, ‘If you let us do this, we can do disease prevention and you’re going to be better off.’”
And once the funds have been obtained, it’s the leader’s duty to “protect the work that needs to be done for precision medicine,” said Lindsay-Wood, particularly with so much competition for resources and prioritization. “There are so many other things that could distract us from doing this important work. And so it’s my responsibility to make sure that we carve out what we need to advance this, because our patients are counting on us.”
To view the archive of this webinar — How IT Leaders Can Support Their Health Systems’ Precision Medicine Journey — please click here.