Checklist: These 9 steps will future-proof your hospital's precision medicine program
While precision medicine is still an emerging practice and technology, experts point to a few clear steps to get prepared for the future.
1. Precision medicine is not hype, not a fad.
"I believe that the promise of precision medicine is real," said John Halamka, MD, chief information officer of Boston's Beth Israel Deaconess Medical Center. He predicts we'll be there "not in five years, but in one."
"I think that we are near critical mass in terms of awareness of precision medicine and recognition that it will be a part of the standard of care," said Don Rule, CEO of Translational Software.
2. Have a sound data management strategy in place.
"On the IT side, having a well thought out ontology to gather patient information is critical to being able to gain insight over time," said Don Rule, CEO of Translational Software.
"Whether it's community hospitals or academic medical centers, all of them just have a basic data problem right now," added Joel Diamond, MD, chief medical officer of 2bPrecise. "Start figuring out where the data sources are. Look for the multiple labs where oncologists are ordering their genetic tests, biopsies, somatic results from. Now that liquid biopsies are becoming more prominent there are multiple labs doing that, too.”
3. Consider how easily data is available.
"If it's stored in one system and not available somewhere else, shame on us," said Diamond. "We can't live in a world anymore where there's data that just exists in paper form and you can't do anything with it."
4. Prepare for new investments in IT infrastructure.
"Health systems need to understand the cost and complexity of the infrastructure necessary to support large clinical trials and registries," said Shaun Opie, chief science officer of Vantari Genetics.
5. Keep physicians and clinicians educated.
"If a drug has a 30 percent chance of being hyper-metabolized and not being well-used by a given patient we should just know that and think about that as we prescribe drugs. That's an easy one, it's not hard, and we should be building it into continuing medical education," said Diamond.
"I look at my own journal, American Family Physician, and the CME I get from those articles, and it's very rare to see articles about genomics and precision medicine," he said. "We could start there. We can educate people about the American College of Medical Genetics and Genomics.”
6. Arm patients with the right information – and tools.
The rise of consumer-focused genetic tests such as 23andMe is changing the ways patients communicate with their physicians. “The tests could indicate genetic disposition for an array of conditions, and raise a bunch of potential medical questions – and not all of those are potentially actionable," said Diamond. Physicians will be asked for help interpreting these results for individuals as more people go with direct-to-consumer testing, said Jessica Langbaum, principal scientist at Banner Alzheimer's Institute. "They might not really understand what the report is telling them, or what it means for their biological relatives."
7. It's not just genomics: Social determinants play a role.
"Precision medicine is about more than the genetics and the drugs," said Vik Bakhru, MD, chief operating officer at ConsejoSano, a Spanish-language patient engagement platform.\As much as 70 percent of a person's health is determined by socioeconomic or environmental factors, he said. But despite near-ubiquity of EHRs, that crucial information is still not often being logged to help guide care and treatment plans.
8. Understand participants have well-justified worries
"The way the landscape is right now, 80 percent of studies fail to meet their recruitment goal and stated timeline because it's so hard to find eligible participants," said Langbaum. "There are big concerns out there that at the national level we need to address. We often hear that people would like to participate in a study but are fearful to do it because they can't risk losing their health insurance."
9. Potential rewards are immense, but there's lots of hard work to do.
"Most patients are eager for more effective means of care and the technology issues are readily solvable when the problem set is well defined," said Rule. "The primary issue today is a catch 22 between providers looking for evidence of success and the evidence of success is scanty because of low utilization."
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