It is important is to focus on the expectations, questions and concerns that are common across the precision medicine field today. One of these is the general consensus across the industry that provider organizations won’t be able to lean on one vendor to meet all of their precision medicine needs.
Precision medicine is a multidisciplinary priority for a health system. In other words, doing work in precision medicine and operationalizing a precision medicine program takes multidisciplinary collaboration across several key areas of expertise within a health system.
Precision medicine services and solutions need to be geared to accommodate several important workflows, including:
- Pharmacy (particularly for specialty pharmacists with pharmacogenomics expertise)
- Research (especially for translating research into clinical insights and drug development)
- Clinical trials
- Oncology (where genomics are most often applied in a clinical setting)
In working with providers over the last couple years, I often hear that the intricacy of precision medicine and a lack of vendor consolidation means that providers can’t expect a single vendor to meet all of their needs. That, of course, breaks the tradition of some of the more established health IT market segments for which “consolidation is king.” More often than not, vendors try to portray their tool as a “one-stop shop.” They want to work toward market domination by providing tools for the entire workflow of a given care environment.
This is not the case in precision medicine. Here, at least for now, coordination is king. For most pioneering organizations with which I am familiar, the inherent complexity in applying genomic data to care requires extensive partnership and at least some outsourcing.
This means that providers must have a solid strategy for integrating workflows. Provider leaders should start by asking, “What kind of precision medicine lifecycle do we want to build?” Establishing the proper perspective will help providers choose vendors that support collaboration across those crucial workflows mentioned above.
Lurking in the subtext of this discussion on precision medicine workflows is the specter that haunts most of healthcare IT—data exchange. In fact, many providers with whom I have spoken look at precision medicine as another painful facet of the larger interoperability problem the industry is trying to solve. In the current applied genomics market, there aren’t many vendors working hand-in-hand to pass data along. Yes, there are a couple of high-mindshare vendors–like Synapse, Philips and Tempus Labs, for example—that are seeking to create a network for genomic data sharing and integration. But providers find that there are few opportunities to collaborate in a “vendor-agnostic” way that translates genomics to clinical action.
Several key dichotomies perplex providers as they begin the precision medicine journey. Providers must consider how to adjust their programs’ objectives based on the type of testing they will offer. KLAS plans to identify leaders in this space based on common expectations of the industry, which are beginning to take shape. Expectations such as how data insights will drive clinical action and intervention. From companies that offer diagnostic services, providers want quick turnaround times without sacrificing accuracy.
The discussions at the upcoming BuildPM19 precision medicine summit March 4 and 5—hosted by KLAS Research, NorthShore University HealthSystem and others, will focus on the practical clinical utility of certain use cases (for example, pharmacogenomics). Specifically, the attendees will discuss how to rally the industry around best practices and standard approaches.
Providers will need to align program objectives with the breadth of their genetic testing services. For instance, there is short-term utility in targeted gene panels in comparison to the enormous infrastructure required to host whole-genome sequencing.
For the healthcare IT savvy but precision medicine naïve, passing off precision medicine to the EMR giants feels like a no-brainer. “We’ve done it with the ED and cardiology,” some providers say. “Even population health is slowly being gobbled up by EMR vendors.”
However, I’ve often heard from the organizations pioneering precision medicine programs that that precision medicine is too complex for EMRs to tackle just yet.
As the main data repository and data-delivery tool in most care scenarios, the EMR may ultimately be how precision medicine data is delivered at the point of care. Still, providers that have been interviewed say the EMR isn’t an ideal platform for analyzing, integrating and incorporating genomic data. That’s because diving headlong into precision medicine means accommodating multiple petabytes—each one a million gigabytes—of data. That is the level of data storage and processing truly necessary for an organization that commits to doing homogenic sequencing at scale for thousands of patients. For now, that requires working with specialized vendors unencumbered by the task of supporting an enterprise system.
The EMR should instead play a supportive role in the delivery of precision medicine. I don’t think anyone expects EMR vendors to lead the charge in pioneering precision medicine. In fact, if providers are calling for anything from EMR vendors, it is to solve interoperability problem. Providers want EMRs that will enable more open data sharing and API integrations to third-party or specialty tools, such as those for bioinformatics or diagnostic reporting.
The reality, for the time being, is that providers must forge their own coalition of vendors across the precision medicine pipeline. We look forward to working with providers, vendors, consultants and other interested parties to build out an implementer’s guide to aid health systems as they seek to embark on this new area of patient care.