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TRANSCRIPT
Digital Health 201: Digital health for pharmacy, genomics
Kyle McCormick, PharmDPharmacist Patient Care DirectorGatti Pharmacy
Ravi Patel, PharmDLead Innovation Advisor, Pharmacy and TherapeuticsUniversity of Pittsburgh School of Pharmacy
Conflict of Interest
Kyle McCormickI have no actual or potential conflicts of interest to report
Ravi PatelI have no actual or potential conflicts of interest to report
Disclosure
● The presenter for this activity has been required to disclose all relationships with any proprietary entity producing health care goods or services, with the exemption of non-profit or government organizations and non-healthcare related companies.
● No significant financial relationships with commercial entities were disclosed by any of the speakers.
Objectives
Why did you come today?
Objectives
1. Outline the current landscape of pharmacy and personal
genomics digital health tools
2. List at least 3 digital health tools for use in practice
3. Evaluate consumer digital health tools for recommendations to
patients
Outline
● Digital Health Review/Updates 101-104
● Introduction to Topics in Genomics
● Patient Resources
● Clinician Resources
● Discussion
Review/Updates
Review
Digital Health - Use of mobile and wireless devices to improve health outcomes, healthcare services, and health research
Growth - $4.5 Billion in 2015 ￫ $4.2 Billion first-half of 2019
Categories Covered - Apps, devices, virtual reality, bots, artificial intelligence, and blockchain
Updates on Previous Examples
Web resources - PatientsLikeMe (DH 101) acquired by UnitedHealth Group
App - Apple expands foray into health with ResearchKit (DH 102) and CareKit
Device - AliveCor (DH 101) launched 6-lead ECG
Virtual Reality - VR (DH 104) helps patients with severe pain
AI (DH 104) - DeepMind improves AKI detection
Bots (DH 104) - Clear Genetics’s Gia bot (DH 201) converses with patients about genetics, any time, any place
Blockchain (DH 104) - Walmart joins blockchain consortium to track supply chain
Regulatory/Access (DH 101) - Express Scripts to launch digital health formulary in 2020
What will we be learning?
Background
Definitions● Genetics - refers to the study of genes and their roles in inheritance● Genomics - study of all of a person's genes (the genome), including
interactions of those genes with each other and with the person's environment
● Direct-to-consumer testing - marketed directly to customers via television, print advertisements, or the Internet, and the tests can be bought online or in stores
HistoryCurrent State
What does precision medicine mean for you?
...for your patients?
Background
DefinitionsHistory - Inheritance of traits -> DNA -> Whole GenomesCurrent State
Background
DefinitionsHistoryCurrent State ● Science → Market → Regulation → Market ● Can affect healthcare whether users/clinicians participate
or not
Where is testing being done?
https://www.technologyreview.com/s/610233/2017-was-the-year-consumer-dna-testing-blew-up/
By the numbers...● More people took genetic
ancestry tests in 2017 than in all previous years combined
● Around 1 in 25 American adults now have access to personal genetic data
● As of August 1, 2017, there were approximately 75,000 genetic tests on the market
PatientsConsumers/Users
23andMe
Patient Experience
https://www.bloomberg.com/news/articles/2019-01-08/23andme-will-add-weight-loss-advice-to-its-dna-testing-services
Patient Information Resource
https://www.genome.gov/
NIH National Human Genome Research Institute (NHGRI)● Introduction to genomics● Facts and definitions● Frequently asked questions● Family health history● Genetic disorder/diseases
information
Patient Barriers to DTC
Testing
Sharing of DTC Test
Results● ~30% of DTC participants share results with healthcare providers
● Patients willing to share results are more health conscious and have fewer privacy concerns
● 35% who shared with PCP were very satisfied with interaction
● 22% expressed lack of PCP interest/engagement
Coverage and Reimbursement
● DTC genetic/genomic tests - generally not covered○ Predisposition rather than diagnosis
● Commonly covered○ Chromosomal abnormality testing○ Prenatal and preimplantation○ Specific disease states
● Less commonly covered○ Pharmacogenetic testing
Nebula - Genomics + Blockchain
● Data Ownership - Irrevocable (permanent) ownership of genomic data on a publicly-readable ledger. The identities of researchers who access a user’s data are immutably (unchangeably) recorded.
● Access Control - Genetic data are encrypted using multiple keys which are distributed between multiple, independent, non-profit research organizations.
● Secure Sharing - If access to data is shared by a user, it will remain in a secure computing environment.
https://blog.nebula.org/dna-privacy/
Goal - Speed up health research and medical breakthroughs by creating a research community of one million participants sharing data
GenoPalate - The Limitations
● Claims to analyze SNPs that impact food metabolism
● Provides a customized nutritional report based on this analysis
● Limited data
Bottom-line: A healthy diet is a healthy diet
From “Bold Plan” to Bust
https://www.wired.com/story/helixs-bold-plan-to-be-your-one-stop-personal-genomics-shop/
https://www.bloomberg.com/news/articles/2019-05-08/-app-store-for-dna-fizzles-as-health-startup-shifts-strategy
CliniciansPharmacists
Clinician KnowledgeNeeds - Digital Health Context
Resources/History: CE, October 2013
Resources: A through Z (easy as C-D-C, 1-2-3)
https://medical.23andme.com/
Resources: CPIC, Director is a PharmD
Discussion
Question
A patient comes to your practice site and posed the question:
"I got these 23andMe results, what do I do?"What do you use/consult?
Objectives
Did you accomplish what you came here for?
● https://rockhealth.com/reports/2019-midyear-digital-health-market-update-exits-are-heating-up/● https://www.mobihealthnews.com/content/unitedhealth-group-acquires-patientslikeme● https://www.apple.com/researchkit/● https://venturebeat.com/2019/05/13/fda-clears-first-6-lead-consumer-ecg-alivecors-150-kardiamobile-6l/● https://www.cedars-sinai.org/newsroom/new-study-shows-value-of-virtual-reality-for-pain-management/● https://venturebeat.com/2019/07/31/deepminds-ai-predicts-kidney-injury-up-to-48-hours-before-it-happens/ ● https://www.cleargenetics.com/● https://www.coindesk.com/walmart-joins-pharmaceutical-tracking-blockchain-consortium-mediledger● https://www.mobihealthnews.com/news/north-america/new-pbm-programs-offer-road-validity-adoption-digital-therapeu
tics ● https://www.cdc.gov/genomics/about/file/print/Reed_Edelman_slides_2018_508.pdf, Access June 5th 2019● https://doi.org/10.1186/s13059-018-1506-1● https://www.bbc.com/news/health-48254137● https://doi.org/10.1186/s13059-018-1506-1● https://doi.org/10.1186/s13059-018-1506-1● https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5987210/
Works Cited
● https://mediacenter.23andme.com/press-releases/national-survey-shows-strong-interest-dna-testing/● https://www.singularityweblog.com/23andme-dna-test-review-its-right-for-me-but-is-it-right-for-you/● https://mediacenter.23andme.com/press-releases/national-survey-shows-strong-interest-dna-testing/ ● https://www.ncbi.nlm.nih.gov/pubmed/?term=Darst+BF%2C+et+al.+Health+Commun+(2014) ● https://www.ncbi.nlm.nih.gov/pubmed/?term=van+der+Wouden%2C+CH.%2C+et+al.+Ann+Intern+Med+(2016)● https://ghr.nlm.nih.gov/primer/dtcgenetictesting/dtccost● https://www.genome.gov/about-genomics/policy-issues/Coverage-Reimbursement-of-Genetic-Tests● https://nebula.org/● https://allofus.nih.gov/sites/default/files/genetic-counseling-resource-funding-opportunity-webinar-december-10-2018.p
ptx● http://www.ncpa.co/issues/APOCT13-CE.pdf● https://www.uptodate.com/contents/personalized-medicine?sectionName=DIRECT-TO-CONSUMER+TESTING&topicRef
=2904&anchor=H2097388&source=see_link#H2097388● https://www.fda.gov/medical-devices/safety-communications/fda-warns-against-use-many-genetic-tests-unapproved-cl
aims-predict-patient-response-specific#actions
Works Cited, Contd
● https://www.technologyreview.com/s/609103/how-to-spend-1900-on-gene-tests-without-learning-a-thing/● https://www.genome.gov/about-genomics/policy-issues/Coverage-Reimbursement-of-Genetic-Tests● https://twitter.com/genome_gov● https://www.test2learn.org/● https://www.cdc.gov/genomics/resources/a.htm● https://www.clinicalgenome.org/● https://cpicpgx.org/
Works Cited, Contd
