By Assaf Halevy
2018 has been a year of acceleration for organizations seeking to leverage precision medicine. Momentum is clearly building as healthcare leaders explore how genomics could impact real-time clinical decision-making.
This puts the industry on the brink of what Malcolm Gladwell famously characterized as a tipping point: that moment when an idea or innovation “crosses a threshold…and spreads like wildfire.”
While preparing for a genomics “wildfire” might be overly optimistic, there is little doubt that 2019 will fuel significant progress in converting the promise of precision medicine into daily clinical practice.
Advanced state of readiness
But like any other great movement, this transformation is more complicated than simply flipping a switch. Three critical forces have converged and matured, and are now poised to push precision medicine into the clinical workflow in 2019.
Public Awareness. It has been years since a medical advance has piqued consumer interest the way precision medicine has (the advent of antibiotics? polio vaccines? outpatient surgery?). Coverage of genomics long ago migrated from scientific and clinical journals into the general media. The FDA has approved direct-to-consumer tests for both breast cancer and medication metabolism. Often, patients challenge their physicians with questions about how genomic testing could impact their care – from prevention to diagnosis to treatment. In fact, consumers may be the force driving providers to educate themselves and explore how they can bring genomics in their clinical decision-making process.
Payment Policies. Payers have begun to acknowledge that precision medicine will absolutely and dimensionally change how clinicians treat patients and keep them healthy. Consider these scenarios:
- A genomics test could uncover genetic variants which, combined with the patient’s pedigree, indicate a patient is at a higher-than-average risk for colon cancer. The physician can recommend lifestyle changes, and initiate appropriate screening and prevention protocols. With this level of vigilance, cancer might be avoided – or caught at an early stage for less costly and more effective treatment.
- Pharmacogenomics testing can reveal that a patient scheduled for surgery metabolizes blood thinners like Plavix ineffectively, putting them at risk for clotting. Applicable genomics insights can help a physician chose the right medication at the right dose – thereby avoiding complications that consume resources (and could be deadly).
It is not a far leap, then, to recognize genomics will have an impact on both value and quality. Going forward, the industry can expect to see payers align incentives to encourage providers to pursue precision medicine as a new standard of care.
Progressive Technology. To date, the buzz around precision medicine has occurred on the opposing ends of a spectrum: with the science and sequencing of genomics at one extreme and the patient or consumer at the other. The missing “middle ground” has been the provider.
In 2019, we must focus on bringing these two ends into the middle – by implementing clinical support and data management technologies that enable clinicians to leverage genomics insights within their workflows to help patients achieve the best possible outcomes.
Up to this point, results from genomic tests have been largely inaccessible to providers. Typically, reports from molecular labs are returned via paper or scanned in formats that cannot be integrated with the medical record. In addition, these reports have not been translated into clinical vocabularies that are meaningful and useful to providers. The net-net is that volumes of clinically relevant and highly valuable information has been excluded from day-to-day clinical decision-making.
Informatics solutions are now available that overcome these obstacles, harmonizing genomics data and presenting it in an actionable format within the patient context so providers can achieve therapeutic benefit faster.
With the convergence of these three forces, healthcare leaders preparing for 2019 and beyond have already begun setting their precision medicine strategy. Those at the forefront are adopting an enterprise-wide approach that enables them to leverage genomics in a department or clinical specialty aligned with their strategic priorities (e.g., pharmacogenomics, behavioral health, oncology, etc.) and then scale across all practice areas. In addition, they select informatics tools that allow them to futureproof against the new scientific findings and clinical applications that are sure to come.
Assaf Halevy is founder and CEO of 2bPrecise, LLC., leading an international team dedicated to bridging the final mile between the science of genomics and making that data useful at the point of care.