integrating genomic medicine into patient care with trish brown, ms, cgc
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Integra(ng Genomic Medicine into Pa(ent Care
Presenter: Trisha Brown, MS, CGC
DNA Direct Overview
Our Mission:
To bring the power of personalized medicine to patients, providers, and payors – reducing health risks, preventing disease, and better targeting therapies
Agenda
• Personalized Medicine – What is it?
– Barriers • Integra=ng Genomic Medicine
– DNA Direct’s Solu=ons – Physician/Pa=ent Educa=on & Decision Support – Payors, Humana – Hospitals, El Camino Genomic Medicine Ins=tute – Pa=ent Compliance Programs
Personalized Medicine
Barriers to Personalized Medicine • Lack of healthcare provider knowledge
– 90% of MDs surveyed want to use gene5cs, but only 40% are comfortable ordering a gene5c test, and 63% have limited or no access to experts
• Lack of Experts – Gene5c Counselors: MS, cer5fied professionals who assess risk and educate, <2,400
– Clinical Gene5cs: MDs, provide gene5c diagnos5c and therapeu5c management, <500
Trinidad, et al 2008, Sources: Washington G-2 Reports Advisory Services’ 2008 Molecular Diagnostics Survey, internal analysis, LabCorp study
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There are only a liPle over 500 gene=cists and 2400 gene=c counselors who see pa=ents in the U.S.
0 geneticists who see patients (4)
1M - 3M per geneticist (11)
500K - 1M per geneticist (22)
<500K per geneticist (14)
Ratio of geneticists to population by state
As a result, genetics is pushed to the PCP, who is often not prepared
for genetics
Source: ACMG, 2007 & NSGC 2009
Barriers to Personalized Medicine • No evidence yet that PM has a significant impact on common, chronic disease – Affects >50% of the US popula5on, and accounts for ~75% of the total healthcare spend
• Adop=on of standards into clinical prac=ce can lag by over a decade – In one study, only 32% of eligible women had her2 neu tes5ng
– Across studies, only 30-‐55% of eligible pa5ents are prescribed warfarin
Balas & Boren, (2000) Yearbook of Medical Informatics pp 65-70 Phillips, K (2008) JAMA 300(21):2542-44, Partington, et all (2007) Thrombosis Research 120, 663–669
Barriers to Personalized Medicine
• Pa=ent non-‐compliance – Only 20-‐30% of people recommended to have colon cancer screening do it
– 30% of people with adenomatous polyps do not return for follow up colonoscopy
– By 6 months of therapy ini5a5on, up to 55% of people stop taking their cholesterol medica5ons
Siddiqui et al Alimentary Pharmacology & Therapeutics. 2006;24(11):16 23-1630, Inadomi Journal of Gastroenterology and Hepatology 23 (2008) Suppl. 2; S198–S204, JPMorgan MedCo 2010, presentation http://phx.corporate-ir.net/External.File?item=UGFyZW50SUQ9MjYzNDR8Q2hpbGRJRD0tMXxUeXBlPTM=&t=1
Integrating Genomic Medicine
• “In order for personalized medicine to progress as many US researchers want it to, it will require a more focused commitment from better informed federal agencies, smarter collaborations across public and private sectors, bigger studies and bolder science, and intelligent changes in the healthcare system overall”
-Francis Collins, January 2009
DNA Direct Solutions
Proprietary Technology
Architecture Unique to Genetics
National Call Center of Genetic Experts +
Guidance & Decision Support for Genomic Medicine
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Access to Experts
Physician Educa=on
Secure portal to access comprehensive tools and resources
Preauthorization wizard
Latest news and updates on tests and technology
CME sessions and forum for physicians
Pa=ent Educa=on
Genomics 101 developed for consumer audience
Clinical Decision support tools to help understand test appropriateness
Multimedia videos and testimonials as a learning tool
Immediate access to genetic experts
Pa=ent Decision Support
Customizes content based on family and medical history
Integrates video to share patient stories and perspectives
Enables exploration of various decision options
Explains possible next steps based on test results
Gene=c Guidance Programs Payors -‐ Humana
Prior-authorization system & call center for molecular diagnostics
Helps physicians find the right test for their patient at the right lab
Genetic counselors available to physicians and patients to answer questions about tests
Genomic Medicine Ins=tute Physicians – El Camino Hospital
Refer patients to genetic counseling
Web-based clinical decision support and tools
Key specialty area overviews and guidance for testing
CME education and Training
Genomic Medicine Ins=tute Physicians – El Camino Hospital
Test Appropriateness Questionnaire
Test background and use
Clinical guidelines and evidence
Controversies and references
Genomic Medicine Ins=tute Pa5ents -‐ El Camino Hospital
Literacy level appropriate
Comprehensive content to inform the lay person
Call to action: contact physician or learn about genetic counseling
Genomic Medicine Ins=tute Pa5ents – El Camino Hospital
Easy-to-understand result interpretation
Next steps and actions
Personalized message from physician
Letter for family and support physicians
Tes=monials
“Just wanted to let you know that I really enjoyed this great experience in learning about such breakthrough technology, and was amazed how it can help human beings' fundamental but also complex health issues be answered”
-El Camino Patient
“Instead of referring my patient to another center and making them wait weeks to get in, I can get the information I need and refer patients to DNA Direct for immediate help.”
-El Camino Physician
Decision Support Tools Payors, Providers, Medical Centers, Labs
Over 600 users in a small pilot in 40 practices, patients and physicians very satisfied.
Pa=ent Compliance Programs Payors, Employers, Medical Centers, Labs
• Stool DNA Colon Cancer Screening Program – Large US employer distributed kits to 50+ year old employees at health fair
– DNA Direct provided educa5on as needed, and followed up with employees to help them return kits
– Return rate increased by 40%
Pre / Post Test Decision Support
Phone Counseling
Physician Consultation
Integra=ng Genomic Medicine Into Pa=ent Care
Thank You!
trish@dnadirect.com
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