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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 Creates Virtual Hospital

Posted on March 16, 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.

A couple of years ago, I wrote an item describing the Mercy Virtual Care Center, a four-story, $54 million venture which describes itself as a “hospital without beds.” The Center, which launched in October 2015, has more than 300 staffers. After one year of operation, the Virtual Care program had cut emergency department visits and hospitalizations by an impressive 33%.

Now, Intermountain Healthcare is following in Mercy’s footsteps. Last month, Intermountain announced a launch of its virtual hospital service, Connect Care Pro, which brings together 35 telehealth programs and more than 500 clinicians. Its goals are to supplement existing staff and provide specialized services in rural communities where some types of care are not available.

Unlike Mercy’s offering, Connect Care Pro’s services aren’t located in a single building, but according to Intermountain, it can still provide much of the care that you find at a large, sophisticated hospital. It describes its approach as clinically integrated and digitally enabled. (I’m not sure what clinical integration looks like in telehealth, so I’d love to hear more about that in the future.)

In explaining why Connect Care Pro matters, Intermountain tells the story of an infant admitted to a southern Utah hospital which needed intensive services. Because the infant was supported via Connect Care Pro, it received a remote critical care consultation rather than having to be transferred to a different ICU in Salt Lake City. Avoiding the transfer saved over $18,000 and allowed the baby’s parents to remain in their community.

Now, all Intermountain Healthcare hospitals, including 10 of its rural hospitals, use the virtual hospital’s services to build on their existing offerings. Also, nine hospitals outside of the Intermountain system have signed up to use Connect Care Pro.

While I might’ve missed something in my searches, from what I can tell few hospitals systems have gone to the trouble of creating a fully-fledged virtual hospital service, though many are offering telemedicine options to support rural hospitals and clinics.

Part of the reason may be financial. After all, as noted above, Mercy did spend more than $50 million to create its hospital without walls. However, I’d argue that the main reason for hospitals haven’t created similar centers is that they simply don’t understand their benefits, and to some extent may be in denial about the extent to which medical care is becoming decentralized.

Despite the costs and effort involved, I do think we’ll see more virtual hospitals emerge over the next few years. I just don’t think most hospital systems are ready to move ahead just yet.

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.

Hospitals, Groups Come Together To Create Terminology For Interoperability

Posted on August 5, 2016 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.

A health IT trade coalition dedicated to supporting data interoperability has kicked off an effort providing fuel for shareable health IT app development.

The Healthcare Services Platform Consortium, whose members include Intermountain Healthcare, the American Medical Association, Louisiana State University, the Veterans Health Administration and the Regenstrief Institute, is working to increase interoperability by defining open, standards-based specifications for enterprise clinical services and clinical applications.

Its members came together to to create a services-oriented architecture platform that supports a new marketplace for interoperable healthcare applications, according to Healthcare Informatics. Stan Huff, MD, CMIO of Intermountain, has said that he’d like to see more shareable clinical decision support modules developed.

Now, in furtherance of these goals, HSPC members are throwing their support behind an initiative known as SOLOR, which calls for integrating SNOMED CT and Laboratory LOINC, as well as selected components of RxNorm. According to the group, SOLOR will provide a terminology foundation for CIMI (Clinical Information Modeling Initiative) efforts, as well as FHIR profile development.

“We hope SOLOR can serve as a foundation to deliver sharable clinical decision-support capability both within the VA and ultimately throughout the nation’s healthcare system,” said Veterans Health Administration deputy CMIO for strategy and functional design Jonathan Nebeker, M.S., M.D., in a prepared statement.

Ultimately, HSPC hopes to create an “app store” model for plug-and-play healthcare applications. As HSPC envisions it, the app store will support common services and models that vendors can use to shorten software development lifecycles.

Not only that, the evolving standards-oriented architecture will allow multiple providers and other organizations to each deliver different parts of a solution set. This solution set will be designed to address care coordination, gaps in workflow between systems and workflows that cut across acute care, ambulatory care and patient-centered medical home models.

Industry players have already created a small selection of apps built on the SMART technology platform, roughly three dozen to date. The apps, some of which are experimental, include a tool estimating a patient’s cardiac risk, a SMART patient portal, a tool for accessing the Cerner HIE on SMART and an app called RxCheck offering real-time formulary outcomes, adherence data, clinical protocols and predictive analytics for individual patients.

Now, leaders of the HSPC – notably Intermountain’s Huff – would like to scale up the process of interoperable app development substantially. According to Healthcare Informatics, Huff told an audience that while his organization already has 150 such apps, he’d like to see many more. “With the budget we have and other constraints, we’ll never get from 150 to 5,000,” Huff said. “We realized that we needed to change the paradigm.”

Cerner, Intermountain Form Major Development Partnership

Posted on October 1, 2013 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.

Normally, when I read the news of a vendor partnership, it’s a major snoozefest. After all, marketing deals and customer wins may be important to the vendor, but they don’t change our life much.

This time, though, I’m willing to go out a limb and say that the following is an important deal. Cerner, one of the leading players on the enterprise EMR front, has struck an agreement with healthcare chain Intermountain Healthcare under which the two will partner long-term on activity-based costing.

Intermountain, the largest health provider in the Intermountain West region of the US, is making a huge Cerner buy, Information Week reports. As part of its agreement with Cerner, Intermountain is tearing out its existing systems, including two EMRs, two billing systems and desktop integration system, and replacing them with Cerner technology.

In this deal, you can certainly chalk up one more win for Cerner, which has been gaining ground in the 200+ bed hospital segment of late. According to KLAS, the ratio of Epic-to-Cerner wins has fallen from 5-to-1 in 2010 to 2-to-1 in 2012 in this segment, according to the research firm.

But the agreement goes well beyond being a mere sale. Once the new, integrated Cerner system is in place, it will serve as the foundation for the long-term project partners have in mind.

Intermountain chose to partner with Cerner because of its system’s open architecture, which will allow for the addition of new content Intermountain plans to provide, CIO Marc Probst told Information Week.

The partners plan a closely-integrated relationship which involves the movement of several Cerner executives and staffers to Intermountain’s headquarters in Salt Lake City. Their work will include development of care process models, connectivity-based costing, advanced decision support and clinical workflows, IW reports.

Getting this work done requires little short of a wedding. ” “We’re looking at 20 plus years of collaboration. We have shared interests in making this be a great success,” Probst told the magazine.