Re-engineered EHR aims to better integrate genomic information

Meditech is attempting to ease access to more data to support better decisions by physicians. Other EHR vendors are working with partners to achieve similar goals.

Large healthcare organizations have been blending in precision medicine approaches when treating patients for years, but use of these capabilities has been limited by a lack of integration of the necessary data into electronic health records systems.

Such integration is complex because of a variety of challenges.

Genomic test results don’t mesh with the technical structure of most EHR systems. The formats of data from commercial labs that do genomic sequencing typically are proprietary, making it difficult to receive data and automatically integrate it. And without genomic information within EHRs, physicians often can’t easily access it when care decisions are being made.

Meditech says its “Expanse Genomics” enhanced EHR system, which it unveiled earlier this year, is designed to help address that problem. The company says the system provides a new way to collect genetic information, pairing it with tools and resources that enable clinicians to make more informed clinical decisions for patients.

Golden Valley Memorial Healthcare (GVMH) is the first organization to deploy Meditech's Expanse Genomics

Meanwhile, some other EHR providers, including Epic and Cerner, are working with partners to enable easier access to genomic-based guidance for clinicians within records systems.

A re-engineered EHR

The re-engineered Meditech records system is designed to help give provider organizations of all sizes the ability to access patients’ genomic information, the company says. Some of the earliest adopters of the system, according to the company, are community hospitals, which otherwise would probably be priced out of a genomics program.

Meditech had been attempting for years to overcome barriers to integrating pharmacogenetics into systems used at the point of care, says Jennifer Ford, the company’s product manager for genomics and laboratory information systems. Early on, it realized that its EHR needed to be re-architected to store the complex data associated with genomic tests, she explains.

“Patients benefit from personalized treatment when their physicians are armed with genetic data about their ability to metabolize medications, their predisposition to disease or characteristics of a tumor.”

In another critical step, Meditech persuaded reference labs to use standards-based approaches to communicate genomic test results. Its Expanse Genomics product leans on Health Level 7’s version 2 as well as its Fast Healthcare Interoperability Resources, or FHIR, standard.

The new Meditech system presents genomic data to clinicians as they are making treatment decisions and augments the raw data with other tools and information that can help enable more informed treatment strategies, Ford says.

For example, physicians receive pharmacogenetic alerts through embedded integration of drug data from First Databank, a provider of drug and medical device databases. The EHR also enables physicians to order genetic tests from within the system. The EHR isolates genetic-related factors that can affect treatment decisions and communicates easily understandable information to clinicians rather than scattering it in multiple electronic systems, Ford adds.

The goal of the approach is to “integrate the process of collecting, storing and centralizing the display of patient genetic information in the EHR, and providing guidance and clinical decision support,” says Hoda Sayed-Friel, Meditech’s senior vice president.

Other approaches

Other records systems companies are pursuing partnership approaches to achieving similar goals.

For example, Foundation Medicine in 2021 announced a partnership to integrate its comprehensive genomic profiling and other testing services with Epic Systems Corp.’s EHR system. Epic also plans to partner with Chicago-based Tempus to add large-panel genomic sequencing across the EHR company's network.

Meanwhile, ActX, a Seattle-based company, offers a genomic decision support platform that can support EHRs from Cerner, Epic and others.

Making the right clinical decisions

Genetics can play a crucial role in making treatment decisions, Ford says. For example, therapeutic decisions can be customized based on a patient’s specific information, helping clinicians to understand how patients metabolize medications and whether they are predisposed to particular diseases.

Genetic information is particularly critical for clinicians working in certain specialties, such as pediatrics, oncology and behavioral health. “Patients benefit from personalized treatment when their physicians are armed with genetic data about their ability to metabolize medications, their predisposition to disease or characteristics of a tumor,” Sayed-Friel says.

Organizations that expect to be early users of the Meditech system say they anticipate that the genomics-enhanced EHR will help clinicians – both within acute care and ambulatory care settings – improve treatment.

“This solution is going to expand our possibilities for delivering precision medicine at our organization and enhance our connectivity with commercial labs,” says Wiliam Dailey, M.D., CMIO at Golden Valley Memorial Hospital, Clinton, Mo. “It’s also going to elevate our ability to analyze and parse results into discrete, actionable data displayed directly into patients’ charts.”

Another early adopter, Frederick (Md.) Health, expects the new Meditech system will help to automate the process of bringing information into a harmonized medical record, says Jackie Rice, vice president for information technology and CIO. Until now, physicians who wanted to delve into a patient’s genetic information had to go to several sources – including PDFs – before synthesizing it to inform their course of action.

Frederick Health precision medicine & genetics

Rice anticipates that having access via the EHR to continually updated information from First Databank to support clinical decisions will prove beneficial. “Many of our clinicians may have taken genetics courses or training, but they can’t keep up to date” on an ongoing basis, because of the vast amount of research being generated, she notes.

Frederick Health, which gets genetic information from five labs, has worked with them to map the patient genomic information it receives into the EHR. All the combined data helps to focus not only therapeutics but other aspects of personalized care, Rice says.

Taking advantage of genetic data within the EHR “will be a culture change for many of our doctors, and it’s up to us to provide training that is pertinent to them,” Rice says. “If we do that, we’ll have a lot more buy-in. Right now, they are very enthusiastic about the possibilities – they are all in. They want guidance so they don’t order a med that won’t work for a patient.”

This content is is part of a series of articles and related material highlighting the people, processes, and technologies currently advancing Genomics and Precision Medicine. See related content

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