In this first installment of a monthly column called “It Things in Healthcare IT,” Luis Castillo talks genomics and the potential impact on the patient transition process.
At its core, genomics, or precision medicine, deals with sequencing each patient’s individual genome and using that information to supplement or even guide the care plan.
Say a patient’s genome suggests that they would not respond well to a certain medication; the physician can deduce that information and go in another direction immediately so that the individual receives the care they need.
Genomics certainly isn’t a new concept, but what is new is the number of providers who are finally talking seriously about creating genomics-based initiatives at their facilities. We’re seeing clients and assorted other hospitals build out programs that will use genomics to influence care decisions in a way that simply hasn’t happened before, ensuring that patients receive the right care plan and that no time or resources are wasted on remedies that don’t work.
Holding clues to what the future may look like are initiatives like the Veterans Administration’s Million Veterans Program, which has thus far built a massive database from the genomes of hundreds of thousands of veterans. This will enable researchers to compare and contrast information in order to achieve breakthroughs related to a variety of diseases and conditions.
Hospitals can realize important enhancements to their care transition processes by harnessing genomics-based practices in their strategy. While such formulations are currently in their infancy at most organizations, here’s what has us excited about these possibilities for the transition process.
Plenty of research still has to be done before we can fully harness the possibilities of precision medicine but, as a concept, it’s relatively straightforward to see the difference it can make.
Imagine a given treatment option and its impact on two distinct patient populations. For the first type of patient, their genome suggests it would take two to three days for the individual to respond well enough to be transferred to the rehabilitation facility. For the second type of population, it might take a week.
Because genomics has allowed you to easily identify these two types of patients, you can better gauge the time you need to keep each person in your inpatient setting prior to transfer, which will thus reduce those nasty readmissions that could trigger costly financial penalties.
There are multiple ways in which genomics can segment your patient population into multiple audiences through which to center different types of care. And length of stay is just one possible difference.
You could actually begin to evaluate your post-acute care (PAC) providers based off of how they meet certain genomics-based care metrics. Facility A may have otherwise stellar quality scores, but you discover that patients whose genomes have experienced a common mutation keep getting sent back to the hospital or respond poorly to treatment and thus take longer to convalesce. For that sliver of the patient population, Facility A would not be the top choice to present to those individuals when preparing discharge. Instead, you might bring Facility B to the top. Facility B’s overall scores might be lower than the other facility’s, but their groundbreaking treatment for that particular patient population could make it the perfect fit.
Identifying Risks…And Opportunities
This is really what genomics is all about: mitigating potential risks while capitalizing on otherwise-missed opportunities.
The patient discharge and transition processes are critical steps in the patient’s care journey. A lot needs to go right at these times in order to ensure the individual’s recovery, and precision medicine can identify areas of interest.
Surprises aren’t something that physicians want to deal with. Care that’s “on the fly” is necessarily not going to rise to the level of care that’s pre-planned with the patient’s best interest in mind. It’s the difference between drawing up the perfect play in a football game versus just having your quarterback lob the ball to the end zone. Sure, either one might work, but the first option takes into account the odds and maximizes the potential for success.
Genomics presents a heretofore unrealized level of strategy for planning the patient’s transition to wellness. By categorizing patients based off of scales that didn’t exist just a few years ago, scales that will only improve as additional research is carried out, healthcare providers and patients alike will both benefit.
Genomics + Economics
Here’s something that I’m really looking forward to, and it’s something that I don’t think has been covered in great detail elsewhere: the intersection of precision medicine and the social determinants of health.
Genomics analyzes the building blocks of biology to arrive at insightful care plans for each individual patient. The social determinants of health analyze the building blocks of an individual’s socio-economic situation to do the same.
It’s zip code meets DNA code. If I can tell that, based on his or her zip code, my patient is in a food desert with limited access to transportation, I know that I need my case manager to coordinate a rideshare service like Lyft and probably set up Meals on Wheels for that person as well. Then, if I can tell based off their genetic code that they are at risk for a dangerous medication side effect, I know to prescribe something else. Combine these two properties and suddenly you’ve addressed the three most serious problems that can arise during that person’s care journey.
This is an exciting place to be if you’re in the healthcare field. Here we have these two areas of study that could not be more polar opposites. They’re completely new ways of looking at patient care, but when brought together, they address some of the most serious issues that prevent an individual from living their best life. It’s through advances in these disciplines that we’re going to see some of the most innovative developments in the healthcare world.
We’re not yet in a place where every patient has their genome sequenced or that physicians order such a test the moment a patient comes in for treatment. But that reality isn’t far away. And the sooner that hospitals, post-acute facilities and organizations of all types prepare and start planning their transition processes based off of this information, the better things will be for patients.