Pharmacogenomic systems being integrated into the electronic record

LAS VEGAS – Two forward-thinking organizations described how they’re integrating genomic data into their MEDITECH electronic health records during the HIMSS conference in March. Ontario Shores Centre for Mental Health Sciences, based in Whitby, Ontario, near Toronto, and Frederick Health, located outside Baltimore, Maryland, have both made strides in capturing and using personalized data for clinical decision support.

The two organizations are users of MEDITECH’s Expanse Genomics solution, which brings discrete genetic data into their MEDITECH Expanse electronic health record (EHR) systems.

For its part, Ontario Shores, a mental health facility, has been using the solution to allow its physicians to more precisely gauge the right medication dose for their patients. Using the data, they can also determine if certain medications will work at all.

“Before, there was a lot of trial and error,” said Sanaz Riahi, PhD, vice-president, clinical services, practice and chief nursing executive at Ontario Shores. “Now, dosing is more precise.”

Some of the patient population have severe challenges, such as schizophrenia, and dosing can be difficult. “It’s sometimes hard for the clinicians to make decisions,” she said. Using genomic testing and the digital support system, these decisions have become much easier.

The hospital has been offering the genomic testing service to its inpatients, and Dr. Riahi said that about 60 percent have been agreeing to go ahead with it on admission.

It’s planning to start offering the service to ambulatory patients, too, starting in April 2025.

Not only is the data gathered useful to clinicians at Ontario Shores, it’s also helpful to the patients and their doctors when they visit other medical centres, as well, she said.

In the U.S., Frederick Health has become a leader in the application of genomic data to the EMR.

It started its own program in 2022, using Expanse Genomics from MEDITECH.

In the first six months, 96 patients had their treatment changed due to the information and decision support available with the digitized system.

Moreover, for cancer patients, the system logs the availability of clinical trials and automatically matches patients to them. In the first six months, Frederick Health made 56 referrals to clinical trials, compared to only two in the six months prior.

“Before, we had to manually go through the charts looking for genetic markers and match them to the right trials,” said Jackie Rice, vice president and CIO at Frederick Health. “Now it’s automated,” making the process much easier.

The organization has itself ramped up from four clinical trials to 19 since last July.

As Rice noted, before the hospital digitized its solution, pharmacogenomic tests would come back as 30-page PDFs. They were difficult to analyze and didn’t flow through the electronic medical record system.

Moreover, there was little standardization in terminology. “Our lab systems weren’t set up for genetics,” she said.

It took some time and effort working with the EMR partner, MEDITECH, to standardize the genetic data coming from four different labs.

Now that data appears in a standardized format and is collected in a meaningful way, it takes a provider only five minutes to order a pharmacogenetic test for a patient, compared with 30 minutes earlier. The data is also integrated with decision support systems.

“We can measure if you’re a fast or slow metabolizer,” said Rice. “Or whether the medication will work as expected.”

There are a range of medications this applies to, including antidepressants and pain, as well as heart and cancer drugs.

She described the experience of one teenaged patient who was suffering from anxiety at college and was failing. “She was a fast metabolizer and wasn’t getting the right drug,” said Rice. She had pharmacogenetic testing and the results showed clinicians a different care path for her.

“Now she’s doing well at college,” said Rice.

Pat Rice, clinical director of precision medicine and genetics at Frederick Health, (and no relation to Jackie Rice) said the organization had to develop a business strategy for the program that was presented to its board, to get it off the ground in 2022.

As part of the strategy, the team had to show return on investment. Rice said this presented some challenges: “It’s hard to capture a negative event. How can you be sure that you prevented a heart attack?”

However, over time, you can show numbers such as a decrease in admissions, she said.

As well, there are initial barriers to overcome when launching a genomics program, such as provider and patient resistance. But again, over time, as the results are seen, this resistance is overcome.

“There is buy-in now,” said Rice. “Providers didn’t have this information before. Now they see it, and they are acting on it.”

That information is resulting in more effective treatment for mental health disorders, cancer, heart disease and more.

“It’s really helping our primary care physicians and specialists with dosing,” said Rice. “It’s really valuable information. One day, we’ll probably be saying, we can’t believe how we did things without it.”