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What Precision Medicine Is Today and Where Is it Heading?

Posted on October 30, 2018 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In our latest series of Healthcare Scene interviews, we had the chance to learn about precision medicine with Nino da Silva, Executive Vice President at BC Platforms. For those not familiar with BC Platforms, they’re a company that has been working in precision medicine for a long time and one thing that makes them unique is their ability to marry genomics with other clinical information.

In this interview, Nino shares more information about BC Platforms and the work they’re doing and then we dive into where he really sees healthcare organizations having success with genomics and precision medicine today. We also ask Nino what a healthcare organization’s strategy should be for precision medicine and whether precision medicine is going to just be something done by large organizations or if it will be accessible to healthcare organizations of all sizes.

Finally, we dive into what BC Platforms is doing to push genomic medicine to the point of care and what it will take to make this a reality everywhere. And then we ask Nino to take a look into his crystal ball and predict where precision medicine is heading in the future.

If you’re interested in precision medicine, what’s happening with it today and where it’s headed, you’ll enjoy this interview with Nino da Silva, Executive Vice President at BC Platforms

Be sure to check out Healthcare Scene’s full list of healthcare IT interviews and subscribe to the Healthcare Scene YouTube channel.

Pocket Health Sensors

Posted on September 5, 2018 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

We’ve long talked about the explosion of wearable sensors that’s happening in the market. The number is amazing. Now I’m just waiting for them to go a little deeper as far as what they can offer that’s clinically relevant. That said, I’m also impressed with how small these sensors are becoming. They can easily fit in your pocket or purse with no problem.

An example of this movement is the ECG that was recently sent to me by SnapECG. They have a wide variety of ECG sensors, but they sent me the SnapECG Handheld ECG Recorder (Available on eBay and Amazon). I have to admit that receiving it was a bit underwhelming. It was so simple to use that it didn’t need much information. That said, it would have been nice to have a little card that said basically that there was nothing for me to do other than download the app on my smartphone and get started.

Regardless it was super easy to unpackage it, download the app and pair it with my smartphone. No doubt I’m a more advanced user and so a few more prompts on the mobile app might be a good idea, but all in all, it was amazing how simple it was to start using the sensor. Plus, there’s something calming about watching the ECG being recorded (maybe they should pair it with a mindfulness app).

After doing the reading, the next challenge was figuring out what to do with the data. There’s an option on the app that says “Professional Advice” but it required a login and so I didn’t want to go that direction. Plus, how did I know the quality of the professional advice? As someone active on social media, I decided to share my report on Twitter and ask my community what else I should do with the reading. The amazing part was how simple it was for me to share that report on social media. It made me really wish that sharing the report with my doctor was that easy…but I digress.

Along with some great snarky replies, I also learned about the difference between a single lead ECG and one that would be used in a doctors office. I even had a doctor reply with the following:


The doctor went on to share that it can measure resting heart rate, target exercise heart rate, and rhythm regular/irregular. Although, he did make clear that the key is for the data to come from a wearable that produced accurate data.

I was aware of this possible issue, but I wonder how many consumers wouldn’t think twice about how accurate the readings from the wearable were for them. I can hear someone reasoning that they bought it at BestBuy or Amazon and so they must have vetted the quality of the reading, right? I’m sure some of you are laughing, but I’m quite sure this is how much research many people do on the accuracy of their wearable devices. I instead look for the FDA clearance which SnapECG has said they’re working on and they’re planning to have it cleared in the middle of September.

The SnapECG was originally launched in China and now they’re bringing it to the US. I’ll admit I’m not that familiar with the Chinese medical device world, but the device has been awarded CE certification (EU) and China’s CFDA certification. A lesson that many chinese companies learn is that those don’t really seem to carry much weight to those of us in the US.

In fact, it should come as no surprise that many people in the US will be skeptical of wearables coming from China and other overseas countries. The smartest thing a company like SnapECG can do is to partner with a trusted US brand like the Mayo Clinic or Cleveland Clinic. Most people in the US will trust something that has been vetted by those organizations who are extremely protective of their brands. Plus, it’s easy to see why their “Professional Advice” app feature would carry a lot more weight if that advice was tied to a well known US healthcare organization than a basically anonymous one with Chinese ties.

At the end of the day, the real question for all of these wearables is what value can you provide the patient and how quickly can you provide that value? Plus, will patients understand the value that a single lead ECG can provide them? And will they understand the limitations of what it can and can’t tell you? This is why the software that comes paired with the device is so important. Plus, as these devices become more and more clinically relevant, you’re going to want that data available to a care provider you trust as well.

Yes, I understand some of the challenges of over monitoring and how that can lead to false positives and unnecessary care that has a wide variety of bad consequences. However, over time I believe we’re going to have the right mix of devices, data analytics, and software that will effectively analyze wearable device data and make it actionable and useful to you as a patient and to your doctor. We’re not there yet, but it’s amazing to see how things continue to evolve even since AliveCor offered the first single lead ECG for mobile devices. It still feels like we’re just getting started and none of us can even imagine what we’ll have 10 years from now.

Geisinger Integrates Precision Medicine Into Care

Posted on May 21, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Lately, it seems like we read about new advances in precision medicine every day. Increasingly, physicians are able to adjust drug therapies and predict conditions like cancer and heart disease before they blossom, particularly in the case of some cancers. However, many health organizations are still focused on research rather than delivering genomic medicine results to consumers.

The process of basing medical decisions on genomic data has certainly begun, with a number of health systems jumping on board. For example, a few months ago Intermountain Healthcare begin the process of validating and launching several tests designed to identify hereditary genetic patterns that might lead to disease. Intermountain expects this work to be particularly fruitful for individuals with a family history of breast cancer or ovarian cancer. The test should identify both those previously diagnosed with cancer and healthy individuals with hereditary cancer gene mutations.

Now, at least one health system is taking things even further. Geisinger Health says it has announced that it plans to expand its genomics program beyond its research phase and into everyday care for all patients. The new program will not only target patients who have obvious symptoms, but instead, all patients Geisinger treats. The health systems clinical DNA sequencing efforts will begin with a 1000-patient pilot program taking place in mid-to-late 2018.

According to David Ledbetter, Ph.D., Geisinger executive vice president and chief scientific officer, the program will not only help current patients but also amass data that will help future patients. “As we sequence the exomes of our patients and learn even more about particular genome variants and their impact on different health conditions, we predict that as many as 10 to 15 percent of our patients will benefit,” he said.

The new strategy follows on the success of its MyCode Community Health Initiative, which it launched in 2014 in collaboration with Regeneron Pharmaceuticals. Since then, Geisinger has been analyzing the DNA of patients participating in the program, which has attracted more than 190,000 patient sign-ups to date. To date, more than 500 MyCode participants have been notified that they have a genomic variant which increases the chance that they’ll develop cancer or heart disease.

Geisinger’s effort sounds exciting, there’s little doubt. However, programs like these face some obstacles which the health system wouldn’t call attention to a press release. For example, as my colleague John Lynn notes, integrating genomic data with other clinical information could be quite difficult, and sharing it even more so.

“Healthcare organizations have problems even sharing something as standard and simple as a PDF,” he wrote last year. “Once we have real genomic data and the markers behind them, EHRs won’t have any idea how to handle them. We’ll need a whole new model and approach or our current interoperability problems will look like child’s play.” Let’s hope the industry develops this new approach soon.

Intermountain Readies Tests For Hereditary Cancer Syndromes

Posted on February 23, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Intermountain Healthcare has begun the process of validating and launching several tests designed to identify disease-causing hereditary genetic patterns. The work will be done through Intermountain Precision Genomics, which analyzes a patient’s genetic makeup. The data is then used by a team of molecular tumor specialists to plan a patient’s specialized course of treatment.

In a prepared statement, Intermountain notes that one area in which genetic testing can be particularly fruitful is in women with a history of breast and ovarian cancer. The statement cites a study noting that fewer than one in five individuals with a family history of breast cancer or ovarian cancer meeting certain guidelines have undergone genetic testing. Moreover, most have never discussed testing with a healthcare provider.

In its efforts, Intermountain hopes to find both individuals previously diagnosed with cancer and healthy individuals with hereditary cancer gene mutations. When these individuals get genetic counseling and testing, it sets the stage for them to get more frequent cancer screenings at younger ages, which in turn leads to critical early detection and treatment of many of these cancers.

In investing heavily in cancer prediction and treatment, Intermountain is hardly alone. What once was at best a specialty practice by cancer-specific hospitals is quickly becoming mainstream.

The practice of screening women for genetic triggers that might boost the risk of certain cancers has moved quickly from idea to action among hospitals. I don’t have a number to hand, but I remember reading that it can take decades before a scientific discovery in healthcare actually impacts patients.  Clearly, the growth of precision medicine is a dramatic exception.

Given the increasing benefits to be had from genetic testing and targeted treatment, we are seeing nothing less than an explosion in awareness and investment. Not surprisingly, hospitals are jumping into the market with both feet as, to be a bit crass, there’s a lot of money in effectively treating cancer.

Of course, some of the buzz around precision medicine may turn out to be just that, buzz. As my colleague has pointed out, EMR systems weren’t built to enable precision medicine, but rather, billing engines. He also notes that these systems aren’t built for real-time availability of data analytics, which makes it hard to use them for personalized medicine. As he puts it, “I’ve heard precision medicine defined as a puzzle with 3 billion pieces.”

Still, as a middle-aged lady with a history of cancer in her family, these developments give me hope. Someday, genetic testing like Intermountain’s will improve my care should I ever face breast or ovarian cancer. If nothing else, we are off to a good start.

Smart Bottles, Incentives & Social Support Not Enough for Adherence

Posted on July 10, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

The Journal of the American Medical Association recently released the results of a study that looked at the effect of technology and behavioral interventions on patient outcomes following a heart attack.

The researchers found no significant difference between the medication adherence or clinical outcomes of those in the control group vs those that were given a combination of technologies and incentives.

According to one of the study’s authors, Dr. David Asch, executive director of Penn Medicine’s Center for Health Care Innovation, “It was a surprise. We went into this study thinking that it would be effective and it wasn’t”. Fellow author, Dr. Kevin Volpp echoed that same sentiment: “What we found was a little bit surprising and a little bit disappointing”.

The study was conducted at the University of Pennsylvania Health System (UPHS) over a span of 12 months. There were 1,509 patients involved in the study; all hospital inpatients who had experienced a heart attack and had been hospitalized between 1 and 180 days. The average age of the study group was 61 and they were all insured with five carriers who had Medicare fee-for-service arrangements with UPHS. All of the patients had been prescribed at least two daily medications (statin, aspirin, beta-blocker or antiplatelet).

The control group of 506 patients was given the standard post-discharge medication instructions and treatment. The remaining 1,003 patients were given additional tools to help them post-discharge:

  • A smart pill bottle that tracked whether or not it had been opened at the prescribed intervals
  • Participation in a daily lottery with a 1 in 5 chance of winning $5 and a 1 in 100 chance of winning $50 each day medications were taken as prescribed
  • An option to enlist a friend or family member to receive notifications if the participant failed to use the smart pill bottle twice in any 3-day span
  • Access to social work resources
  • A hospital-based advisor to answer questions and reinforce medication adherence over the phone

On the surface, the failure of this level of support and intervention is disheartening for anyone developing medication adherence technology or involved with helping a loved one recover from being hospitalized. However, if you listen to the post-study podcast or spend time looking at how the incentives/technology was administered to the study group, important clues emerge as to why this failure may not mean abandoning hope for technology-based interventions.

First, only 878 of the 1,003 patients activated their smart pill-bottles and only 70% of that same group fully participated in the incentives and technology. This indicates that the lack of adherence may not have anything to do with technology when its working, but rather that there is a challenge to get patients using that technology in the first place.

Second, the fear of another heart attack may have been enough of an incentive to keep patients on their medication regimens. Put another way, perhaps the control group already had sufficient incentive to follow their prescriptions and thus technology would have little impact.

Third, and perhaps most significantly, an average of 41 days elapsed between the time the patients were discharged from the hospital and the time they were activated on the incentive/intervention program. This delay was attributed to the delay in the insurance process. According to Dr. Volpp:

If we had been able to engage these patients earlier, for example. If this had been a hospital-based intervention and this could have started at the time of discharge [rather than weeks later], then we would have had a greater opportunity to influence these patients and change the course of their care

I personally found this last point by Dr. Volpp fascinating. This study may have inadvertently shown that the timeliness of implementing post-discharge behavior and technology incentives matters as much as the types being implemented. 41 days after discharge is a long time – almost a month and a half.

Consider this example. Say you get caught for speeding and as part of the ticket-writing process the police officer activated a reminder system in your car that (a) warned you when you were 5 miles over the limit and (b) sent a message to your significant other whenever you receive two such warnings in the same day. From personal experience I can tell you that the week after I got a speeding ticket, I followed every posted speed limit. Why? Because the trauma of getting caught was still fresh in my mind.

Now imagine the same scenario but instead of immediately activating the warning system it took until 41 days after getting your ticket. By the time the system was in place you would have already fallen back into old habits and assured yourself that you were “fine” driving the way you were.

It would be interesting to see if analysis of this study’s data revealed a correlation between the length of time before incentive implementation and adherence. Even if it doesn’t, this study holds a cautionary tale for anyone in HealthIT – timeliness of implementation may matter as much as your solution itself.

Genomics is Going to Really Blow Up Our Interoperability Issues

Posted on June 12, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Today I slipped over to the Precision Medicine Summit in Boston that’s hosted by HIMSS Media. I heard some good speakers which I’ll write about in the future including legal issues related to genomics and gene editing. However, this tweet from the conference really stuck with me:

This is a sad example of the reality of healthcare interoperability today. Healthcare organizations have problems even sharing something as standard and simple as a PDF. Once we have real genomic data and the markers behind them, EHRs won’t have any idea how to handle them. We’ll need a whole new model and approach or our current interoperability problems will look like child’s play.

By the time we figured that out, our proverbial child might be graduating high school.