Toolkit helps nurses at smaller hospitals start practicing precision medicine
Genomics and precision medicine are still seen primarily as the province of large academic medical centers with lots of resources, given that they require highly specialized knowledge and robust IT infrastructure.
But a new online toolkit from the National Human Genome Research Institute hopes to help nurses and clinicians working in smaller care settings start taking advantage of the promise of this new paradigm in treatment.
The Method for Introducing a New Competency Genomics website launched by NHGRI, a division of the National Institutes of Health, offers more than 100 resources for nursing leaders "at all levels of genomics competency," according to the group.
Whether offering tips on basic genomic facts or exploring the practical implications of precision techniques for hospitals and health system, the MINC toolkit is meant as a "starting point for healthcare providers who want to promote genomic integration into practice to benefit their patients,” said Laura Lyman Rodriguez, director of the division of policy, communication and education at NHGRI.
It can help nursing leaders care for patients who are undergoing genomic testing and treatment and better prepare their workforce for fast-emerging clinical applications, she said.
Structured in a Q&A format, the toolkit lets users tailor their interventions according to what will work best for them in their particular clinical setting. Among the lessons it offers: assessing where to begin; how to design a genomics action plan; how to select interventions; how to overcome bottlenecks and challenges; how to assess whether new techniques are working and how to make them last.
The website also offers video testimonials from various healthcare professionals, offering lessons about how they overcame hurdles as they developed genomic competencies at their own organizations.
The emergence and maturity of precision medicine in recent years makes it the right time for a toolkit such as this, said Rodriguez.
"We are in the midst of an inflection 'wave,'" she said. "Genomic medicine is already in broad use in fields such as oncology, while other areas of care are just beginning to implement genomic applications. Now is, therefore, an ideal moment for providers across the spectrum to think about how these advances might apply to their own patients, and begin to plan for how they will prepare to implement those applications."
Even if providers aren't yet quite sure how to put precision medicine into practice, she said, "there is the opportunity to learn by building upon the successes of others who have already begun the process. We hope that this kind of resource will help providers (and institutions) to jump-start their own activities and enhance their ability to efficiently move toward genomic medicine as a means to meet the needs of their patients."
While world-class, resource-rich healthcare institutions – Mass General, Penn Medicine, Johns Hopkins, Mayo Clinic, UCLA, USSF – are still clearly at the forefront of genomics and translational medicine, Rodriguez said NHGRI is "working to help facilitate the dissemination of knowledge from large academic medical centers to smaller care settings, and settings in different environments, such as rural health care practices."
In fact, of its flagship research programs, the Implementing Genomics in Practice consortium, or IGNITE, is focused on just that, she said. "It includes partnerships between academic medical centers and diverse clinical care settings so methods for dissemination and sustainability of genomic medicine in clinical care can be studied and made available for others to utilize."
Still, "the timeframe for broad uptake in smaller care settings is a bit unpredictable, and I anticipate that it will occur at different rates for different types of care – just as is happening in academic medicine."
What are some basic best practices – do's and don'ts – for integrating genomics techniques into patient care?
While emphasizing that it's still an emerging discipline, and that strategies will "likely vary based on the type of setting and the type of care," Rodriguez noted that "we have seen to date that it is definitely useful to engage healthcare administrators, because they are critical in releasing time for practitioners to update their knowledge in genomics, and to provide openings in the Grand Rounds schedule or even dedicate time for a series on genomics within such local continuing education programs."
Those leaders are "also in important positions for incentivizing learning and application of new technologies by providers or across care systems."
And what about IT? Where should hospitals be investing their resources to capitalize on the coming precision medicine wave?
"Rather than a focus on specific technologies for any group of providers, NHGRI has focused on developing and maintaining resources and tools in partnership with health professional organizations," said Rodriguez.
"NHGRI resources include tools such as the Genomics and Genetics Competency Center, or G2C2, which provides practice-based competencies mapped to a set of curated educational resources for five different provider disciplines, and the Global Genetics and Genomics Community, or G3C, a learning resource that provides a series of 15 interactive case-studies involving genomics," she said.
"We also convene the Inter-Society Coordinating Committee for Provider Education in Genomics, or ISCC, which brings together over 70 professional organizations and others working in clinical care to discuss needs and opportunities for professional education in genomics and ways to integrate this knowledge across teams and disciplines," said Rodriguez.
Irrespective of a hospital's organizational or technological maturity, it's critical to manage expectations as these fundamental changes in patient care gain traction, she said.
"One thing to avoid doing is to expect non-genetics healthcare practitioners to become geneticists," said Rodriguez. "Rather, we have learned from the community that providing the tools to make the usage of genomics clear and relevant to an individual's practice is the ideal way to encourage uptake of the information."