Earlier this month I attended the Precision Medicine Institute Symposium 2019 in New Orleans where I had the privilege of presenting Precision Medicine Informatics: What Hospitals, Physicians, and Payers Need to Know about Challenges, Approaches, and Best Practices. The one and a half day symposium organized by the Dark Intelligence Group provided an opportunity for trailblazers in the field of precision medicine to share their experience and best practices in establishing precision medicine programs within their organizations. During the symposium, several critical topics were presented including the implementation of next-generation sequencing and other technologies, drivers for implementing precision medicine programs, considerations for coverage and reimbursement, as well as leveraging information technologies for sharing data. Several common themes emerged that are worth noting.
Theme 1: Stakeholder Alignment Is Hard
First of all, and not surprisingly, there are numerous stakeholder groups within the health care system. Getting alignment of these groups including patients, physicians, laboratorians, health system administrators, payors, and even community leaders is challenging but essential for the successful implementation of any precision medicine program. One thing that all parties can agree on is that at the heart of success is a better patient experience and better patient outcomes at lower cost – the essence of value-based care. Data sharing and exchange is central to achieving this end goal. Integrated IDNs have a leg up on more decentralized systems, since they already have content sharing processes and common health informatics systems in place.
Theme 2: Genomics Programs Face Additional Challenges
Several presentations focused on the implementation of pediatric or adult genomics programs. Common challenges included the cost and expertise required to implement technologies such as whole exome and whole genome sequencing and the uncertainty in the interpretation of the results that such technologies generate. These are not trivial concerns and require careful thought as organizations decide to internalize the technology and build the infrastructure required for offering these types of services. Also of great concern is the burden of out-of-pocket costs transferred to patients and their families as payors struggle with the uncertainty of the value of this type of testing. Key to resolving uncertainty with payors is data. Integrated data sets can be used to demonstrate actionability, clinical utility, better patient outcomes, and the discovery of new disease insights. Moreover, well-structured integrated data sets can enable artificial intelligence, another common theme of the symposium.
Theme 3: Data Sharing Is Key to Improving Value and Health Outcomes
Our presentation focused on how an informatics approach is the best approach for managing the real-time exchange, storage, and analytics requirements for the enormous volume of high complexity data generated in today’s precision medicine programs. When an informatics approach is adopted, well-curated optimally structured data is readily accessible to healthcare providers to efficiently inform patient clinical decision making. It can also be used by health system administrators for making better-informed business decisions. Ultimately, advanced analytics including machine learning and artificial intelligence can be fully leveraged from data that has been optimally structured and archived. Data holds the power to improve value and health outcomes but not without multidisciplinary care team collaboration and the breaking down of data silos that currently exist in the non-interoperable healthcare IT environment.
Theme 4: Collaboration Is Critical
Throughout the presentations, collaboration among healthcare stakeholders emerged as the most common requirement for success. Precision medicine program implementation is still in its infancy with very few established best practices specific to precision medicine. However, the integration and sharing of data can provide significant value to a health system including improving the delivery and quality of care, better business decision making, advanced analytics capabilities, the use of artificial intelligence, and the curation and use of real-world data. These outcomes are all consistent with a learning health system and bring us closer to the goal of achieving a value-based health care system.
Overall, the Symposium underscored the significant challenges confronting us as we work toward the promise of precision medicine, but it also showed how far we've come in thinking through and tackling these issues.
To access all of the presentations from the Precision Medicine Institute Symposium click below.
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