Cutting-edge providers are on the cusp of advancing IT and personalized medicine
In April, Palomar Pomerado Health in San Diego began offering a $399 genome testing kit at three of its outpatient centers, including two located inside grocery stores. Patients send in a saliva sample, then in six to eight days learn the extent of their propensity to develop Parkinson’s, prostate cancer, Type 2 diabetes, and 109 other conditions. They can access their Personal Genome Profile through a secure Web site run by biotechnology company 23 and Me, and compare it with those of family and friends.
The kit has the potential to bring genetic testing to the masses, but what does it mean for personalized medicine? Currently, there is no straightforward way to integrate the genetic data into a patient’s electronic medical record, says Orlando Portale, chief innovation officer for Palomar Pomerado. The first time a physician might see a report is in the examining room.
Palomar offers its physicians a two-hour seminar on interpreting the data. “What we think initially is that patients are probably going to be printing out paper copies of their profile, and when they visit physicians, come with this additional piece of information,” says Portale.
That leaves scant time to incorporate the data into treatment in any meaningful way, says Lyle Berkowitz, M.D., director of clinical information systems for Northwestern Memorial Hospital in Chicago.
“On the one hand, the more information, the better,” says Berkowitz, who also practices internal medicine. “The downside is when it crawls into that bucket of information overload. Do we really understand the context of this information or will it just create more concern and worry and busywork?”
According to Portale, Palomar hopes to have genetic data integrated into its EMR in about a year. That data, however, won’t be universally translatable because national standards for EMRs are still a pipe dream.
“We may have to develop our own [coding] initially in order to make this happen, then propose to some of the standard bodies to take a look at ours,” he says.
Grant Wood, senior IT strategist for Intermountain Healthcare Clinical Genetics Institute in Salt Lake City, says integration may not be far off. Intermountain is working on a pilot project with the Center for Personalized Genetic Medicine at Harvard Medical School to electronically transmit the results of a standard genetic test for hypertrophic cardiomyopathy directly into a patient’s EMR. The first transmission is scheduled for sometime this summer.
At Palomar, individual genetic reports will be updated as researchers find more genetic links to diseases. “In the next five to 10 years, those patient profiles are going to have 10 to 20 times more data than we currently have,” Portale says.