THOUGHT LEADERS Precision Medicine Requires

IT Beyond Traditional EMRs Insightful and innovative leaders will focus on their precision medicine strategy and ensure clinicians have the tools they need to leverage the important data generated through genetic and genomic testing By Maulik P. Purohit, M.D.


esearch initiatives measuring pro- jected growth of the global next- generation sequencing (NGS) market vary somewhat, depending on the specifi c study. Yet, all agree growth is inevitable and accelerating. Early in 2020, for exam- ple, Fortune Business Insights valued the NGS market at $6.3 billion in 2018, and anticipates it reaching $31.4 billion by 2026, a compounded annual growth rate (CAGR) of 22.2 percent. With more patients being tested—and

more providers ordering these tests—it’s critical for health system leaders to evalu- ate the workfl ows and solutions available to govern ordering practices and manage resulting genetic/genomic information. Those who anticipate that their electronic medical record (EMR) will provide the fl ex- ibility necessary to accommodate the infl ux of genetic and genomic information will fi nd themselves poorly prepared. Challenges will arise in three areas: 1. Core EMR functionality. These IT systems were designed to store and display “point-in-time” data, including clinical summaries, operative notes, lab tests and imaging studies. Typically, exams, work- ups and tests need to be repeated to refl ect the patient’s current phenotypical status. Conversely, patient genetic profi les are static and can be leveraged over an individual’s lifetime. This requires IT solutions that store, manage and serve up insights derived from genetic testing across multiple providers, diverse clinical specialties and varied care settings along an extended timeline. In addition, these solutions must also be able to integrate scientifi c discovery. Research around genetics and genomics is advancing at an unprecedented pace. Updates about new knowledge need to be incorporated at the point of care and within the clinical workfl ow so providers can combine this dynamic information with the static genetic profi le To fully optimize the power of precision medicine, healthcare leaders must explore platforms delivering informatics functional- ity beyond scope of current EMR software.

2. Organization-wide IT infrastructure. Healthcare has never adequately solved its interoperability problem, and the infl ux of precision medicine data will only exacerbate the issue. Because genetic information rep- resents a patient’s lifetime signature, access and utilization across the enterprise (and beyond) will be critical. The industry is currently dominated by two

primary EMR vendors. The remainder of the healthcare market – half or more of provider organizations – use one of any number of smaller systems. Within many organizations, like UH (University Hospitals) Cleveland, different EMRs are used in disparate and specialty care settings (e.g., oncology, ED, LIS, etc.). Yet none of these solutions exchanges information in a satisfactory manner. Under this scenario, a provider orders a genetic or genomic test, sending it to one of several labs that offer processing and analysis for the specifi c markers in question. Results are returned as non-discrete data (limiting utility of the information) as a PDF or text fi le, or locked behind the lab’s proprietary portal. Beyond signifi cantly constraining the clini-

cal value the organization can derive from genetic and genomic test results, the lack of an adequate infrastructure impedes leadership’s ability to manage lab relationships and con- tracts, govern ordering processes, streamline precision medicine workfl ows, and prevent costly duplicative testing 3. Lagging data literacy. For the most part, clinicians received only limited education about genetics and genomics during medical or nursing training. Those with keen interest subsequently might decide, independently, to read journal articles so they can remain abreast. Unfortunately, these unstructured approaches produce great variability in terms of how well precision medicine is being leveraged. If clinicians are aware that an addi- tional layer of data is available when they make therapeutic decisions, their patients’ response, outcomes and patient satisfaction will likely improve. To accomplish this, however, organizations are best served by software solutions that grant frictionless


Maulik P. Purohit, M.D.

access to up-to-date knowledge bases and clinical guidelines to inform the course of treatment providers might pursue, regard- less of their familiarity with the intricacies of genomic science.

Overcoming precision medicine barriers Leadership at UH Cleveland has embarked on a strategy to overcome these barriers. Central to its approach is utilization of a precision medicine platform that inte- grates with multiple genetic/genomic labs and sits on top of the EMRs used across the enterprise. This infrastructure provides the data man- agement functionality necessary to render the information meaningful and useful. Because it transcends individual EMRs, the platform enables providers across the entire University Hospitals system—e.g., oncol- ogy, maternal-fetal medicine, rare disease, behavioral health—to leverage insights that can transform care. “We believe precision medicine represents

the emerging standard across multiple spe- cialties,” says Jeffrey Sunshine, M.D., Ph.D., chief medical information offi cer (CMIO) at UH Cleveland. “It’s critical that provid- ers across our organization have access to meaningful and actionable information within their clinical workfl ow. This requires enterprise-spanning software that offers functionality beyond traditional EHRs.” The aggressive advancement of precision

medicine no doubt presents a challenge to organizations both large and small. Insightful and innovative leaders will focus on their precision medicine strategy and ensure clinicians have the tools they need to leverage the important data generated through genetic and genomic testing. Maulik Purohit, M.D., is a physician executive, author, and innovator in health IT, artifi cial intelligence, stress, and brain injury. Dr. Purohit currently serves as the Clinical Innovation Lead and Associate Chief Medical Information Offi cer and staff physi- cian for brain injury and neurorehabilitation at University Hospitals Cleveland.

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