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Advances in precision medicine technology spur new EHR functionality

EHRs need to support substantial amounts of health data and interoperability in order for precision medicine to become more accessible to patients.

The first wave of changes in EHR products was the result of market supply and demand. Physicians looking to adopt certified EHR packages and meet the criteria set by the CMS incentive program had a lot to do with the increased demand, and vendors quickly recognized the urgency with which they needed to get their products certified. As the last stage of meaningful use approaches, as well as the new programs introduced as part of MACRA, a new chapter of EHR functionality is being called for. Precision medicine is becoming a widely discussed subject and is the new accelerant of changes that many of today's EHRs will adopt.

The field of precision medicine has been gaining significant popularity in recent years, thanks to advances in research technologies, a greater understanding of human genes and tools that help track vast amounts of health data. Research studies show how some cancers and other diseases can be targeted with customized drugs and treatment to have a far better outcome than traditional medicine. For some time, this type of treatment was considered out of reach for many patients as the costs for genomic testing was simply unattainable. However, advancements in precision medicine technology and the genomics field are making it a much more affordable and accessible option.

The new approach to treating disease by leveraging the insights discovered from genes allows patients to receive customized treatments that are based on their individual lifestyle and environment. As a result, clinicians need to access more data sets than traditionally used. Clinical data, patient environmental details, genomics and labs are all critical to the success of precision medicine. As we look at the majority of packages in the marketplace today, few can support these data sets and precision medicine. Several factors seem to be causing significant roadblocks, such as limitations around interoperability that make it difficult for researchers and clinicians to gain access to the full patient record. The patient record can provide critical data elements that can help determine the appropriate treatment plan.

In response to numerous calls and recommendations made by the Office of National Coordinator (ONC) and a 2015 State of the Union address by President Obama in which he introduced the Precision Medicine Initiative (PMI), EHR vendors recognized the need to accelerate the implementation of features around this branch of medicine. Vendors such as AllScripts, Cerner, drchrono and NextGen were early adopters of functionalities required by precision medicine as part of pilot programs led by the ONC and National Institutes of Health. This enabled many vendors to also offer these capabilities in the packages they offer physicians in the marketplace. The new functionalities shipping with some products include the support of personalized recommendations based on genomics screening, genetic testing order sets, data-driven analysis of conditions and decision support systems, and connectivity to the PMI Cohort program to enable participation in the federally sponsored research program.

Clinical data, patient environmental details, genomics and labs are all considered critical to the success of precision medicine.

Patients -- especially those who face complex, serious and unique diseases -- are becoming more aware of the potential impact precision medicine technology can have on their health. With the high rate of cancer patients in the world, precision medicine offers a unique opportunity in the oncology field to help win the fight against it by offering means to learn more about the tumors and how they can be successfully treated. But more data must be captured in order for more discoveries to be available, requiring more patients to participate as their providers encourage them. This would also likely translate to more patients becoming more active in their own digital health data.

Data security and interoperability may still present a barrier to accessing all of the data precision medicine requires. The ONC has engaged the National Institute of Standards and Technology to help address security concerns by working on developing a new cybersecurity framework that is focused on precision medicine.

Precision medicine stakeholders such as patients, payers and clinicians will find that this new approach to treating diseases offers significant benefits and gains across several areas. Improved patient outcomes, reduced costs and added new efficiencies are all part of what is to be expected. But with the amount of data that EHR vendors will likely face, there are concerns about whether these products can adequately support the requirements of precision medicine technology. Thus far, a few EHR vendors have stepped up to the plate and are delivering some functionality, while others are simply sitting on the sideline wondering what their next move is.

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