Group practice tests precision medicine in prescribing drugs
Holston Medical Group, a large multi-specialty practice with 16 sites in Tennessee and Virginia, is working with precision medicine vendor 2bPrecise on bringing pharmacogenomics findings to the point of care.
Pharmacogenomics is the study of a patient’s genome to identify genetic factors that could predict how the patient will respond to a particular medication, such as an anti-depressant.
Holston is using the vendor’s platform to capture, store and analyze genomic data to enable physicians to test for genetic characteristics, particularly in the liver, to determine how quickly a patient breaks down chemicals and metabolizes the medicine.
If the patient has a fast metabolism, the medication may not be fully effective, says Steven Adkins, MD, a family physician and chief medical information officer at Holston Medical Group. Conversely, if the patient has a slow metabolism, a higher dose of medicine may be necessary.
Consequently, the practice is first focusing on behavioral health and chronic pain patients being prescribed an opioid because of the need to give the most precise and appropriate dose to avoid addiction.
The practice installed the 2bPrecise platform in September, in part because the vendor integrates easily with the Allscripts electronic health record system, and started testing patients in December. 2bPrecise also brought in decision support vendor Translational Software, which operates a database that continuously simplifies genetic information into evidence-based actionable recommendations.
Once physicians at Holston Medical Group started using the platform, they were surprised at the number of patients that they found with clinically impactful findings—there was an impressive depth and breadth of new knowledge about how life styles and genetic factors influenced how a prescribed medication was acting within a patient.
One patient, for example, had a genetically high risk of developing a blood disease and the decision support system recommended finding alternative medicines for consideration as she ages.
Seven physicians are testing the platform, each with 12 to 15 patients. To date physician acceptance has been high, Adkins says. “The doctors here actually think this is fun. It’s not a new machine or scope or hardware; it’s a new science.”
Patients also like a 16-page report that is automatically generated, he adds. “It’s all about them and they can discuss with the doctor if any changes need to be made.”
Use of the platform could be particularly helpful for provider organizations holding risk-bearing contracts with Medicare and other insurers, says Joel Diamond, MD, co-founder and chief medical officer at 2bPrecise and a family physician.
“These physicians must document patient needs and outcomes and sell the use of the technology to insurers to get reimbursed by showing that they are avoiding hospitalizations and related costs,” he adds.
The technologies of 2bPrecise and its vendor partners are going to become game-changers in the practice of genomics, Adkins asserts.
“Choosing medications without knowing the full patient genetic profile will become antiquated in a few years. When a person is on the right medicine to start with, it’s hard to measure what you avoided. This will impact medical decision making on countless patients.”
Still, Adkins notes that Holston Medical group is doing the pilot program and covering the costs, but he worries about who will pay for other similar initiatives and whether they will get a return on investment.
If an ROI is found, “I believe this will become a standard of care,” he adds. “However, genetics are probabilistic, but not an absolute. Clinical decision making is still critical.”