Ontario Shores integrates genomic data with EHR to personalize doses

Ontario Shores Centre for Mental Health Sciences in Whitby, Ontario, is the first mental health organization in Canada to use pharmacogenomics on a routine basis to prescribe anti-psychotic medications to inpatients diagnosed with schizophrenia and schizoaffective disorder.

The milestone, achieved in September, was made possible by Ontario Shores’ acquisition of MEDITECH’s Expanse Genomics solution, which brings discrete genetic data into MEDITECH’s Expanse electronic health record (EHR).

“Anti-psychotic pharmacotherapy is often a trial-and-error process,” said Dr. Phil Klassen, Ontario Shores’ vice-president of medical affairs and research. “While psychiatrists do have some guidance based on research, clinical experience and a patient’s personal and family history, without genetic data, their ability to tailor medication choices to an individual’s unique needs is limited.”

The effectiveness of an antipsychotic drug, and risk of side effects, can be dependent on a patient’s genetic profile and the rate at which they metabolize a drug. Genetic testing provides psychiatrists at Ontario Shores with guidance on prescribing and dosage based on a patient’s genetic makeup and whether they are slow or fast metabolizers.

Without this information, it can take weeks or months to know if a drug or dosage is effective, potentially suggesting that patients are non-responders to a particular drug. During this time patients may be prescribed different drugs and different doses on a trial-and-error basis. Using pharmacogenomics, psychiatrists are more likely to prescribe the right drug and the right dose the first time.

“This is important because schizophrenia and schizoaffective disorder are responsible for 50 percent of all bed days in mental health,” Dr. Klassen said. “Administering the right drug and the right dose,” he added, “can improve a patient’s experience and potentially shorten their length of stay.”

“To my knowledge, no one in Canada’s mental health field routinely uses pharmacogenomics. While tests can be ordered, there is an out-of-pocket cost. Occasionally, a physician might have paid for a genetic test if they were particularly concerned about a patient. This will be the first time all patients with these conditions are offered pharmacogenomic testing.”

Ontario Shores is able to order tests from Dynacare directly from the Expanse Genomics solution.
“It’s important to note that the genetic testing we’re ordering does not diagnose genetically-based illnesses,” said Dr. Klassen. “The genetic testing that we’re doing looks only at the genetic pattern a patient has in relation to metabolizing drugs.”

Reports from genetic testing have traditionally been available as up-to 50-page PDFs, which are difficult to access, said Jennifer Ford, MEDITECH’s manager of clinical strategy and genomics.

MEDITECH, however, brings the discrete genetic data into the EHR so it’s easily accessible. It also links to clinical practice guidelines from the Clinical Pharmacogenomics Implementation Consortium (CPIC) and the Dutch Pharmacogenomics Working Group through First Databank’s drug database to generate alerts if a physician prescribes a drug or a dose that doesn’t align with the patient’s genetic profile.

“Having discrete data in the EHR is important because you can’t easily update a PDF with new information about a gene or drug,” Dr. Klassen said. “Plus, you need this data for proper research. Researching from PDFs is tedious; you’d have to hire someone to sift through them manually. With discrete data in an EHR, you can load it and get to work right away.”

While routine genetic testing is currently being performed only for inpatients with schizophrenia and schizoaffective disorder, Dr. Klassen expects to see expansion of testing for patients with other conditions and potentially for ambulatory patients as well.

Next steps for advancing the use of pharmacogenomics will be guided by research made possible through the recent appointment of Dr. Daniel Mueller by Ontario Shores and the University of Toronto as a joint chair in precision medicine.

Expanse Genomics has been in development for almost a decade and has been in use by early adopters in the U.S. for several years, notes Ford. For one of the most promising use cases, oncology, the solution also allows for clinical trials and alternative therapy matching.

“With the specific genetics of a patient’s cancer, their hereditary risk and all of the demographic and other information in the EHR, Expanse Genomics is able to search clinical trial databases and find a match,” Ford said. “And if a new therapy hits the market that might be better for the patient, we can immediately match them to it by having all the information in the EHR.”

Evidence from early adopters indicates significant time savings for clinicians in ordering genetic tests and prepping patients for appointments because all the relevant genetic and demographic information is so easily accessible.