2017: Precision medicine moved closer to mainstream
The past year highlighted the many aspects of precision medicine, showed that there are more emerging, and recognized oft-mentioned obstacles, such as high costs as well as clinical, financial, technological and cultural concerns.
Major health systems like Geisinger and the Cleveland Clinic broadened their precision medicine work -- and that bodes well for what might be underway for 2018.
Here’s a look back at some of the most promising developments in precision medicine in 2017.
Progress in genomic sequencing has led to some exciting breakthroughs in clinical therapies. And now information about those therapies is becoming available for use within the EHR. “Context-sensitive links embedded in EHR systems,” Marc Williams, director of the Genomic Medicine Institute at Geisinger, said in a HIMSS Learning Center webinar, “can be used to provide links to online clinical resources to help anticipate clinicians' information needs.” He said the capability is available for addition to any Meaningful Use compliant system.
Geisinger CEO David Feinberg, MD, noted the national exposure will make it possible for Geisinger to “double-down on our bet on this game-changing approach to anticipatory medicine – preventing early-onset cancer, cardiovascular events, and other diseases, and keeping people out of hospitals.” Geisinger’s MyCode Community Health Initiative and electronic health data integration will play integral roles in this new national effort.
“Do I really believe that the next precision medicine breakthrough is coming within an EHR? No,” said John Halamka, MD, CIO of Beth Israel Deaconess Medical Center. “It will come from third-parties … twenty-six-year-olds working in their garage to link innovations to EHRs using FHIR APIs.” John Quackenbush, a professor of Biostatistics and Computational Biology at the Dana Farber Cancer Institute and Harvard School of Public Health, added that “EHRs are not designed for treating patients, not designed for biomedical research, they’re designed for getting paid.”
Intermountain Precision Genomics Core Laboratory launched RxMatch, a new service that makes it possible for physicians to personalize prescription medications for their patients. The practice is called pharmacogenomics, or PGx, the analysis of how genes affect a patient’s response to medication. RxMatch Anti-Depressant Panel, for example, is powered by CNSDose, a company that delivers decision support based on cutting-edge knowledge of liver and blood-brain-barrier metabolism of antidepressant medications. The test allows physicians to use patients’ genomics to find the right antidepressant faster than using existing trial-and-error methods.
The National Institutes of Health initiative is meant to generate innovative approaches and best practices in healthcare by focusing on diverse and underserved populations beyond academic medical centers. Researchers will develop methods to integrate genome sequencing into the practice of medicine, improve the discovery and interpretation of genomic variants, and explore how genome sequencing affects healthcare outcomes.
The new Dementia with Lewy Bodies Consortium will also build a national, coordinated registry for clinical data. Principal investigator James Leverenz, MD, of Cleveland Clinic will lead the multi-center study, which is funded by a $6 million grant from the National Institutes of Health. The five-year program aims to identify biomarkers that can help with diagnosis, detect disease progression and measure response to treatment.
Just like online streaming giant Netflix uses behavior data to recommend movies and shows to customers, medicine is on the cusp of becoming that personalized in its approach. “We are not applying that same kind of data understanding in healthcare today and we really should be and will be in the future,” said India Hook-Barnard, director of research strategy and associate director of precision medicine at the University of California in San Francisco. “It will really be disruptive in the same way that we have seen with marketing, the way we’ve changed how we shop – the way we use data to do a better job is something we’ve done in many other realms of our lives, even down to what kind of movie Netflix suggests.”
The Office of the National Coordinator declared this year that American healthcare is on the verge of a new age. “The Precision Medicine Initiative (PMI) will usher in an era of individualized healthcare,” ONC chief scientist Teresa Zayas Caban and ONC health scientist administrator Kevin Chaney said. That convergence of federal funding under the 21st Century Cures Act, which allocates money for the National Institutes of Health to expand PMI, and work that ONC is undertaking with NIH, FDA, HHS Office for Civil Rights and Veterans Affairs, will drive safe and secure health information exchange to advance precision medicine initiatives, Caban and Chaney explained.
As the industry moves more toward value-based care, precision medicine and its evidence-based principles can help ease that transition. "It's a big step to go from trial-and-error medicine to evidence-based medicine," said Jim Adams, executive director of research at The Advisory Board. "Even for evidence-based care and precision medicine, genomics data is really important. But it's not one-to-one. "You can get to precision medicine without genomics data. There's a lot of work that can be done without the genomic data to achieve precision medicine while we wait for the technology and industry to catch up."
IBM will integrate its cognitive computing platform Watson for Genomics into San Francisco-based biotech company Illumina's tumor sequencing technology.
The alliance, announced in January, will expand access to genome data interpretation, the better and quicker to close the expensive and time-consuming gap of interpreting genomic data – and make precision medicine to treat cancer a reality. Illumina, which has been called the Google of genetic testing, is reputed to generate 90 percent of all DNA sequence data.