Making Precision Medicine a Reality at Cleveland’s University Hospitals
Earlier this year, University Hospitals, an integrated health system in northern Ohio, took a big step into the world of precision medicine when it entered into an agreement with an Allscripts subsidiary with the goal to bring genomic data into the clinical workflow.
According to University Hospitals officials, the genomic data points were already part of the EHR (electronic health record) system, but with the 2bPrecise delivery program— an offering from 2bPrecise LLC, a wholly owned subsidiary of Allscripts—patient information will be more accessible to physicians allowing for the data to be part of the medical record and subsequently shape and tailor the best treatment or therapy options for patients.
University Hospitals (UH) serves the needs of patients through an integrated network of 18 hospitals, more than 50 outpatient health centers and 200 physician offices in 15 counties throughout northern Ohio. According to UH’s Jeffrey Sunshine, M.D., Ph.D., chief medical information officer (CMIO), the collaboration is another step in the journey to make healthcare as personalized as possible for all patients.
Indeed, Sunshine says that the collaboration “fits squarely in the larger strategy of providing patient-centered health, wellness and care. That’s been our strategy for quite some time, and precision medicine, which is becoming more commonly used, means something a little different every time it’s used for every different person,” he says. And the broader question, Sunshine adds, is “How do we provide the best tools we can for each patient? That [concept] is what’s driving this.”
The new system also will allow UH to use the gene data to better align tests and treatments for patients that have a history of cholesterol or psychiatric markers, as well as other conditions that genomic markers could provide the best treatment avenues, officials have noted.
Having an Effect on Patient Care
University Hospitals is no stranger to precision medicine initiatives with the most common uses cases currently taking place in oncology, Sunshine notes. In oncology settings, when suitable, “We will take advantage of markers of the patient or the tumor to make best recommendations of appropriate therapy, or preventive measures, based on who you are, our ability understand your genetic code, and/or what’s growing in ill form. And that is precise to the circumstances for the patient. Precision medicine not only means genetically modified care, but it’s most often used in that context right now,” he explains.
Sunshine specifically points to three areas he believes this initiative, and precision medicine more broadly, will have a positive impact on patient care. The first involves when there is a specific disease for which something in a patient’s genetic markers might let clinicians know that either the patient has that disease and has a genetic marker that says he or she should be treated differently because of that marker; or the patient is at high risk for something bad and a preventative measure could be taken, he explains.
What’s more, he notes, there is already evidence in oncology, and growing elsewhere, that “not everyone will respond the same to the drugs we might recommend for you, and we all understand that. But there is starting to be a growing experience that certain genetic markers can definitively predict for certain drugs that the drug won’t work or that it’s the wrong dose, so it could help us be very specific about the drug or dosage you should get,” Sunshine says. And that’s not limited to oncology; it crosses lots of domains. For example, he offers, there is growing evidence in the psychiatric domain that for certain gene markers, certain drugs won’t work, or that the dosage should be changed dramatically.
The third area that Sunshine points to is in preventive screening, where one might find through genetic markers that a certain patient is in a class of patients, who without that screening, clinicians wouldn’t have known are at a much higher risk for a disease. “So we should screen you more,” he attests. “And maybe that screening test has a certain cost that no one thinks we can afford for all U.S. citizens, but for 1,000 patients in the U.S. who need it, it’s a perfectly rational use of healthcare dollars,” he says.
To this end, speaking to the increasing pressure to lower healthcare costs, Sunshine believes that more personalized healthcare will be a big step in the right direction. “We've gone almost as far as we can on doing the same thing for everyone the same way, and now we have to figure out how to do it uniquely for the individual, because everyone doesn’t need everything, and we can’t afford to do everything for everyone." Therein lies the opportunity to be smart about it, Sunshine says, and figure out who needs what, at what highest priority, and what’s the best thing to do for that person or group of people. “And that opens a wide-open universe,” he says.
From an industry-wide perspective, Sunshine believes that CMIOs at integrated health systems like UH would say that they are doing “some form of precision medicine.” But it’s an ongoing development everywhere, he notes, adding that right now, precision medicine is probably not a top-three priority in in any organization’s broad outlook, but if narrowed down to a patient-centered care or patient engagement perspective, then it ranks high on that list. “With everything happening around EHRs, there is a lot of short-term attention on that, so some organizations are more or less along the strategy or momentum phase, but no one has a fully mature [precision medicine] model out there,” he says.
Going forward, Sunshine feels that to be successful in precision medicine endeavors, a continuous improvement culture will be needed—or as he explains it, “the culture that wants you to focus attention on having to do tomorrow different than today; a ‘get us to the future’ mentality.”
And perhaps even more important than that is making this data available and actionable for the front lines of care—a task that Sunshine puts squarely on himself and others in his position. “Primary care [physicians] would be excited to know if there were markers that could be obtained so they can alter their pharmaceutical approach to high cholesterol, hypertension or cardiac prevention for that patient,” he says. “If we, or anyone, who wants to do this can deliver that in a consumable and actionable form, the excitement and curiosity is waiting to be tapped.”
