Top 5 videos from HIMSS17

Top 5 videos from HIMSS17

Physician-executive shares tips on building an IT infrastructure for personalized care

Precision medicine is promising, but integrating genomics with EHRs and workflow poses challenges. The technology for testing is the easy part. Putting the results into a usable format for clinicians can be more problematic, says Inova's John Deeken, MD.
By Mike Miliard
01:57 PM
IT infrastructure personalized care

Many larger health systems are embracing the vast new promise of precision medicine, and many of them are learning from each other as they go. At HIMSS17, John Deeken, MD, of Fairfax, Virginia-based Inova Health System will offer some lessons learned for providers looking to put technology to work for genomics-based care.

Deeken, chief operating officer of Inova's Translational Medicine Institute, said his organization has made some very encouraging strides in recent years with pharmacogenomics and personalized medicine.

But in his HIMSS17 talk, "Building an Integrated Precision Medicine Infrastructure," which he'll present alongside Inova's technology partner, Translational Software, he'll also offer tips for clearing some of the hurdles along this new clinical path – namely, how best to integrate genetic and genomic data into workflows, ensuring its in the optimal format to help clinicians make informed decisions at the point of care.

"It's a challenge across the board for health systems to do this, and for their EMRs to do this," said Deeken. "From a technology standpoint, it's one of the key challenges moving forward."

The promise of genomic testing is no secret. But the reality of using IT to capture, interpret and put that data to use is another matter. Thankfully, Inova has been able to best some of the tricky technical and infrastructure pitfalls on the way toward a substantial genomic testing program that's enabling tailored treatment protocols.

[Also: EHRs and health IT infrastructure not ready for precision medicine]

"As a health system, we've committed to precision medicine and personalized care as one of our main strategic goals," said Deeken. "One of our main initiatives is that, through our Translational Medicine Institute, we've developed a CLIA-certified genomic testing laboratory. In that lab we've set up standard-of-care genomic tests but also, more broadly, useful tests in different clinical settings."

For example, he explained, "if people are going into surgery, if pediatric patients are going into cancer therapy, if people are in need of help with psychiatric medications, we've developed genomic testing platforms – and, in partnership with Translational Software, have developed the reporting capability – to make it as user friendly to the physicians and the patients as possible."

That's no small feat, said Deeken: "A big challenge in the precision medicine field is physician education and physician utilization: What we needed to do is make the report and the results as useful and understandable to the reporting physicians as possible."

One of Inova's big recent initiatives on the precision medicine front gets started on the ground floor, so to speak.

"If one believes that using genomics to help personalize care starts at any age, what better time to do that than when people are born?" said Deeken.

"Our main hospital here is Inova Fairfax, where we have about 10,000 babies born each year," he explained. "We started pharmacogenetic testing for every newborn as part of our free service to that new family. Parents are offered to have this test done, and the results are sent back to the physician and to the parents of the newborn – a profile of the testing: seven different genes that are involved and at least 21 different medications. Most of those medications won't be relevant to the child until later in life, but what better time to start this approach of personalized care?"

Getting there, however, has not been without its impediments.

On the technology side, at least, the gene extraction and genetic testing, "is pretty straightforward and getting easier and cheaper by the year," said Deeken. "The challenge is mainly on the data extraction and interpretation."

A core question to answer there, he added, is "to really have this at its highest use, how do we get this information into electronic medical records? How can treating physicians or pharmacists have warnings or notices go up when they're taking care of a patient that might be impacted? A lot of the work we've been doing is around both how to incorporate this into the laboratory software and – even more of a challenge – into electronic medical records."

All big health systems that have tried to deploy personalized medicine into their clinical workflows have had similar challenges, he said, and are all works in progress at this point.

At Inova, "we have a number of health settings and patient populations we've looked at, and we've developed this capability and the infrastructure, under a CLIA umbrella, of high-throughput testing capability," said Deeken. "Translational Software has developed the ability to take data and turn it into highly-useful, highly interpretable results for physicians and patients. So that's what we'll be talking about at HIMSS – how we've partnered to do that."

Another help in figuring best how to integrate genomic results has been to learn from other heath systems facing similar challenges but perhaps trying different approaches, such as Intermountain, University of Maryland and Vanderbilt," he said.

He's hopeful too that, in the not-too-distant future, what they learn will help ensure that prediction medicine won't just mainly be the domain of large health systems and academic medical centers.

"I certainly hope it's something we have across the board and that there's a democratization of this effort," said Deeken.

"It's certainly true that the technology is outpacing the utilization," he added. "I would say the biggest challenge – and I say this as a doctor who's been in this field 15 years – is not technology or even health system willingness (to embrace personalized care), but education and physicians' ability to change the way they practice from how things were when they were back at medical school – to get on board with this new approach." 

Deeken's session, "Building an Integrated Precision Medicine Infrastructure," is scheduled for Monday, Feb. 20, 2017 at 3:00-4:00 PM EST in Room 331A. HIMSS17 runs from Feb. 19-23, 2017 at the Orange County Convention Center.

Twitter: @MikeMiliardHITN
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This article is part of our ongoing coverage of HIMSS17. Visit Destination HIMSS17 for previews, reporting live from the show floor and after the conference.

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