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Precision health will be achieved only if people and companies from various sectors work together. That's why President Barack Obama started his precision medicine initiative in an effort to bring researchers, doctors and patients together and to encourage hospitals and people to share data in order to better understand certain diseases and discover cures.
A small company of 30 people in Lexington, Mass., called iSpecimen, is working towards a similar goal by bridging the gap between hospitals -- and the specimens collected and stored there -- and researchers.
How iSpecimen works
ISpecimen works with two groups, researchers and providers, Chris Ianelli, founder and CEO of iSpecimen, said. Researchers have a growing need for patient samples and specimens -- including everything from blood, serum, plasma and tissue -- and providers such as hospital systems, practice groups, commercial labs and blood centers often take and collect specimens from patients.
ISpecimen saw an opportunity here.
Researchers often are looking for very specific specimens, Ianelli said. And hospitals may have what the researchers are looking for; however, the researchers have no efficient way to find those specimens and request them in a way that is HIPAA compliant. And that's the service iSpecimen provides.
"We typically go out to hospitals and contract with hospital systems to tap into their EMR [electronic medical record] data and their lab data to do this," Ianelli said. Once this is done, if researchers are looking for a specific specimen, iSpecimen can see whether a hospital has it. If they do, they can send a message to that hospital requesting the specimen and have it sent to the researchers.
ISpecimen outfits the hospital with software enabling them to visualize data so that the sample flow happens in a compliant manner, Ianelli said. They also give hospitals access to the cloud environment where the deidentified data from the electronic health record (EHR) and the specimens are collected and combined. Ianelli explained that hospitals usually put up servers and virtual machines to be able to host the cloud on their end.
In the hospital's lab, iSpecimen provides a computer system with access to iSpecimen's software, a label printer, racks, tubes, a barcode scanner and more. That way, when a request for a specimen comes in, the hospital lab has everything needed to scan the barcode of the sample, put the sample into tubes, print labels, put the samples in a box, print FedEx labels and send it off, Ianelli said.
All of this is at no cost to the provider, he added.
Union Hospital, the DHIN and iSpecimen
Although iSpecimen often approaches hospital systems or providers individually, in order to scale their services, the company approached the Delaware Health Information Network (DHIN), a statewide health information exchange.
"We approached the Delaware Health Information Network ... because they are the keepers of the data for numerous healthcare providers in that area," Ianelli said.
ISpecimen's software interfaces with the systems the DHIN uses to "collect data, harmonize those data sets from all the different institutions ... and store it," Ianelli explained.
One hospital that is part of the DHIN and is participating with iSpecimen is Union Hospital in Elkton, Md. Since Union Hospital is close to the Delaware border, some patients also get care at Delaware hospitals, Anne Lara, CIO at Union Hospital, explained. That's why Union Hospital decided to participate in the DHIN and, subsequently, with iSpecimen.
Ianelli explained that with the DHIN, participating hospitals have the option to opt-in or opt-out. "If the hospital agrees to it, they get consent and they sign a separate addendum to their agreement with the DHIN," he said. "Then the interface between us and the DHIN is simply DHIN sending us an HL7 message or actually any type of message or data format that suits them just to share data."
ISpecimen monitors the hospitals that are part of the DHIN that have decided to participate with iSpecimen for specific specimens that researchers are looking for. When a match is found, iSpecimen notifies the hospital that has the sample, and the sample information is deidentified, brought into iSpecimen's cloud environment and harmonized with information from the patient's EHR.
Chris Ianellifounder and CEO, iSpecimen
"The interface between us and the DHIN is really them just pushing deidentified data with hospital permission over to us so we can see what's available," Ianelli said.
At Union Hospital, one PC workstation is dedicated to collecting and sending out samples requested through iSpecimen. "I imagine that in bigger laboratories if they needed more than one workstation and there was more than one or two people being involved in the situation, then they could do that," Lara said. But for Union Hospital, one workstation and one PC, "for our workflow and for our laboratory, that makes sense for us."
Meaningful use and precision health
The most immediate benefit of iSpecimen is the ability for hospitals to show that their EHRs are being meaningfully used because "it allows them to actually make use of the data in that EMR system and justify the expense of putting it in place ... not only because they're delivering better patient care with an EMR, but they're using it for research and generating revenue with the data that the EMR handles," Ianelli said.
But the benefit that is not immediately apparent is that iSpecimen is an important step towards discovering new ways to treat diseases, Lara said. Which will hopefully, ultimately lead to precision health.
"By providing those types of specimens to clinical trials for pharmaceutical research or in the diagnostics world, ultimately through that research, there'll be new ways of detecting certain diseases," Lara said. "There may be new ways of treating certain diseases and conditions."
Ianelli said that often, researchers are looking for specimens from patients who have or have not responded to a particular treatment in order to understand why that is the case and to see if there is an alternative treatment. If there is an alternative treatment, researchers also want to know if there is a way to test people to predict whether that person will or will not respond positively to the treatment.
"You save everybody the cost of prescribing the wrong drug, you save the patient from the risk of getting something that has little chance of working," Ianelli said. "[And] it saves the healthcare system the money."
Not only that, but participating hospitals ultimately generate revenue by participating in iSpecimen because the researchers pay for the service, and iSpecimen gives some of the money to the hospitals.
"It has to flow from [the research] side to the healthcare side because it's the healthcare side that's in need of revenue streams, and it's the healthcare provider side that actually has all the patients, and they should be paid for this service,” Ianelli said.
Lara believes that Union Hospital's participation with iSpecimen is "one of the ways that we're driving towards precision medicine."
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