Genomics: The Future Gold Standard of Medicine?

Personalized medicine, with care tailored to the unique genetic blueprint of each patient — perhaps once thought of as science fiction — is becoming a strategic imperative across the entire health care field. At NorthShore University HealthSystem, in the north Chicago suburb of Evanston, Ill., integrating genetics into everyday care has become its driving force, says President and CEO Mark Neaman. Personalized medicine touches on so many of the hot-button issues that keep hospital executives tossing and turning at night — meeting the demands of consumerism, treating the health of patient populations and preventing hospital readmissions, to name a few.

“It’s what’s next in the practice of medicine,” he says. “We’re positioned to make this next move, but you can’t just put up a sign and say, ‘We’re into personalized medicine.’ It takes so many other components, including the talent and the commitment, the technology, and the underlying electronic health record system. You’ve got to have all of these building blocks.” NorthShore patient Sivan Schondorf has a history of breast  cancer in her family, and initially had genetic counseling in 2000. With a simple blood test in 2005, she found she had a mutation of the BRCA1 gene, meaning an 87 percent chance of developing breast cancer, along with a higher risk for ovarian cancer. After years of genetic counseling and monitoring, she decided to have a double mastectomy in 2009. Since moving back to the Chicago area in 2011, Schondorf has worked with doctors at NorthShore to develop a genetic care plan and has visited every six months or so for screenings to ensure that she doesn’t develop ovarian cancer.

The idea of tailoring care to each individual based on his or her genetics isn’t new, but it’s picked up steam with several advancements in recent years, says Kathy Hudson, deputy director for science, outreach and policy at the National Institutes of Health, which is spearheading the president’s initiative. Those include improved cost-effectiveness of collecting genetic information from patients, expanding knowledge on how to analyze data at a precise molecular level, and the ability to mine details from electronic health records and mobile devices to gain further insights into a patient’s health, she says. Already, NIH has convened a panel of experts to figure out the course to making precision medicine a reality. As part of the initiative, President Obama earmarked $130 million toward gathering genetic, environmental, lifestyle and behavioral data from 1 million people across the country — which Hudson acknowledges is an “audacious endeavor.” The work group is slated to deliver a preliminary report to the president in September.

While the Center for Personalized Medicine isn’t yet a revenue generator, Khandekar believes it will have a direct impact on the bottom line in soon. “This is the investment that you make for the future,” he says. “I was speaking at one hospital recently and one of the first questions was, ‘So how much money do you make?’ I said, ‘I don’t think we make any direct money at this time,’ but in a very short time, if we don’t do this, we will lose a lot of money because patients will leave us.”

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