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A growing number of organizations are adopting tools to bring the advances of genomic science into the physicians’ workflow, and early evidence shows its helping.
I have been contemplating the concept of “empowerment” recently-a term bandied about as an antidote to physician burnout. I’ve found that, much like the timeless adage about weather, lots of people are talking about it…but no one is actually doing anything about it.
With one major exception: A growing number of organizations are adopting tools to bring the advances of genomic science into the physicians’ workflow. Providers fortunate enough to have access to this information tell me it makes practicing medicine fun again and helps them feel more “doctor-y.”
That sounds like a compelling cure for burnout to me.
How are genetics and genomics empowering? Briefly put, insights from molecular testing:
· give providers a focused view of individual patients’ heritable risk factors,
· facilitate highly accurate diagnoses,
· reveal how well the patient may or may not metabolize specific medications, and
· identify targeted therapies to deliver the safest, most effective results.
Knowledge is power
Precision medicine is a game changer for physicians-in large part because it gives them much more information to leverage when making critical care decisions. That’s key because, as we’ve all been told, knowledge is power”).
Here are several examples:
Consider 30-year-old Sara, who reports a significant familial history of breast, ovarian and colon cancer. Sara’s physician can order a molecular lab test to determine whether she exhibits genetic variations elevating her risk for one, any, or all of these diseases. If so, the physician and a genetics counselor can begin appropriate and aggressive screening and prevention. If not, Sara’s physician can alleviate her anxiety-and avoid putting her through early and frequent diagnostic studies (which also increase the lifetime cost of keeping her healthy).
Dr. Green, a psychiatrist, has treated Kevin for 14 months for depression. Green has tried several therapies, escalating dosages of each when Kevin didn’t respond. Finally, Green orders a pharmacogenomics panel to gain insight into which medications Kevin metabolizes well and which might cause undesirable side effects. With test results in hand, Green quickly can understand why previous drugs were ineffective and prescribe therapy that has a nearly immediate positive impact. Imagine how many months of frustration, office visits and trips to the pharmacy have been wasted when pharmacogenomics testing could have enabled Green to arrive at the best drug and dosage as the first line of therapy?
Likewise, consider 4-year-old Carlos who develops a seizure disorder. A genomics test helps the specialist precisely diagnose the cause and immediately begin the appropriate therapy. This information prevents or greatly reduces ongoing seizure activity, developmental complications and undesirable side effects from trial-and-error treatments. It also reduces the likelihood of costly hospitalizations and readmissions. These tests, if integrated within the clinical record, represent valuable information all of Carlos’s clinicians will need to consider as they make future diagnostic and therapeutic decisions.
Remove barriers to point-of-care genomics
It’s clear why this knowledge represents power in the physician’s hands. And therein lies the challenge: making sure it lands in their hands. It’s critical to ensure this vital information is readily and conveniently available to clinicians within their workflow.
Genetic and genomic testing is already being done in many healthcare organizations; some even have established their own molecular labs. Unfortunately, results are not saved as discrete data, nor are they integrated with the wider clinical record. To factor these insights into their clinical decision making, providers must:
· be aware that molecular tests have been ordered, received and saved (typically as a PDF) somewhere in the organization’s IT ecosystem
· understand how and where to find the results
· exit their workflow and open a lengthy scanned document (often dozens of pages)
· sort through the full lab report (typically not “translated” into familiar clinical terminology)
· synch what they are reading in the report with other information contained in the medical record
· decide how relevant the information is and add it to other considerations
For precision medicine to be truly empowering, healthcare organizations must overcome barriers to making the data useful and meaningful to providers as they go about the day-to-day practice of medicine.
When embarking upon their precision medicine strategy, organizations need to consider the following:
· Who within their organization is already ordering genomic tests and from which labs?
· How are test results being received and stored within the organization’s IT system?
· Is the data easily available to all other clinicians across the enterprise? (Pharmacogenomic tests ordered by a psychiatrist, for example, are also valuable to a PCP, cardiologist, oncologist and others. Likewise, germline information about heritable disease risk and targeted therapies spans specialties.)
· Will providers-some of whom have had minimal training in genetics and genomics-be able to understand and make use of test results? How can they achieve a specified level of proficiency?
· As the volume of genetic and genomic data grows-as it surely will-how will the organization manage it?
· How will individual providers be able to keep up with the rapidly advancing field of genomic science and bring new discoveries to bear with previously diagnosed patients and as new conditions manifest?
Precision medicine is rapidly becoming recognized as the new standard of care. The potential for improving quality and safety of care-as well as patient loyalty-is tremendous. And because it empowers providers with new information and robust clinical decision support, it promises to enhance their satisfaction as well.
Recognized as a thought leader in the field of precision medicine, Dr. Joel Diamond is an adjunct associate professor of biomedical informatics at the University of Pittsburgh. He is a diplomat of the American Board of Family Practice and a fellow in the American Academy of Family Physicians. He serves as chief medical officer for 2bPrecise, and cares for patients at Handelsman Family Practice in Pittsburgh.