One of the next big shifts in patient care will be precision medicine will be "an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment and lifestyle for each person," as the Precision Medicine Initiative describes it.

For physicians and researchers this means predicting more accurately which treatment and prevention strategies for a particular disease will work in particular groups of people. 

This is completely different from the traditional one-size-fits-all approach, in which treatment and prevention strategies are developed for the average person, with less consideration for the differences between individuals.

What does this mean for healthcare and health IT? A lot of new challenges. Because precision medicine and genomics generate massive volumes of varied and granular data, new approaches to data storage and exchange and new designs for electronic health records, for example, may be required. Physician education and patient communication are two other areas that will demand attention

Some advanced healthcare provider organizations, such as large academic medical centers, are already well-advanced in their precision medicine efforts. But most providers are still early in the journey, if they're attempting it at all. But many are preparing today for what many think will be the next step in the evolution of healthcare.

This story, focused on precision medicine and other emerging technologies, is the sixth and final installment in Healthcare IT News' feature series, "Health IT Investment: The Next Five Years."

The series offers interviews with primarily CIOs to learn from them the path forward through the priorities they set with their investments in six categories: AI and machine learning; interoperability; telehealth, connected health and remote patient monitoring; cybersecurity; electronic health records and population health; and precision medicine and other emerging technologies. Click here to access all the features.

The six health IT leaders discussing their plans for the next five years in this sixth and final installment in the series include:

• Cara Babachicos, senior vice president and CIO at South Shore Health, a health system based in Weymouth, Massachusetts
• Dr. Shaun Grannis, vice president for data and analytics at Regenstrief Institute in Indianapolis
• Matt Hocks, COO at Sioux Falls, South Dakota-based Sanford Health, a $6 billion health system serving a predominantly rural population over a four-state footprint, with both payer and provider arms
• Dr. Matthias J. Kleinz, senior vice president and head of translational sciences at UPMC Enterprises, the innovation, commercialization and venture capital arm of UPMC
• Mike Mistretta, vice president and CIO at Virginia Hospital Center in Arlington
• B.J. Moore, CIO of Providence, a health system that operates 52 hospitals across seven states – Alaska, Montana, Oregon, Washington, California, New Mexico and Texas

Big investments in precision medicine

Precision medicine has been an organizational priority for UPMC for more than a decade, and it has an ambitious vision of using it to provide better, more personalized care and improved outcomes for patients.

"Through these efforts, we aim to create new insights into the drivers of health and disease to allow the discovery of innovative therapies and models of care, while also lowering the cost of care by avoiding diagnostic delays and therapeutic dead ends," said Kleinz of UPMC.

"As one of the largest integrated healthcare delivery and insurance organizations, UPMC has the scale, capabilities and ambition to lead the discovery, assessment and clinical deployment of impactful precision medicine approaches," he continued. 

"The tangible benefits are streamlined clinical workflows, improved patient outcomes, and the potential to optimize resource allocation and reduce the long-term cost of care."

Dr. Matthias J. Kleinz, UPMC Enterprises

"Our efforts are led by the Institute for Precision Medicine, which was established in 2014 in collaboration with our academic research partner, the University of Pittsburgh."

The mission for the institute is to accelerate translational and clinical research in precision medicine and to deliver the most advanced prediction and treatment of disease, tailored to an individual's unique circumstances, history and condition.

"In this context, we have and will continue to make significant investments in established molecular and genomic tests [and] emerging proteomic, metabolomic, and microbiome assay technology, and drive the discovery of highly personalized precision therapeutic approaches, including cell, gene and regenerative medicines," Kleinz explained.

The most important technologies

Investment in deployment and development of novel technologies is an important pillar in unlocking the value of precision medicine.

UPMC has made a number of significant initial investments in the following areas, Kleinz noted, and is continuing to evaluate new opportunities:

• Clinical next-generation sequencing through the establishment of the UPMC Genome Center, a high-throughput CAP/CLIA genome sequencing facility that supports clinical genomics in a number of key areas
• Pharmacogenomics in a range of populations at high risk of adverse events or undesirable drug-drug interactions
• Innovative precision therapeutics. Through UPMC Enterprises, UPMC provides financial and strategic support to a group of innovative life sciences startups in Pittsburgh and around the globe
• Data infrastructure for the streamlined delivery of results, and provider and patient education to maximize the impact of precision medicine

"UPMC's leadership strongly supports this vision and already has invested heavily in the implementation of precision medicine," he said. "The appropriate use of precision medicine approaches benefits first and foremost our patients, but also supports our providers as they deliver care across the UPMC system.

"The tangible benefits are streamlined clinical workflows, improved patient outcomes, and the potential to optimize resource allocation and reduce the long-term cost of care," he continued. 

"We are dedicated to continuing the aggressive rollout of precision medicine, both through internal efforts and increasingly through creative partnerships with industry, such as our partnership with proteomics company Somalogic."

Another org diving into precision medicine

Sanford Health believes precision medicine will be the future of healthcare, so it continues to make significant investments in this space.

"Leveraging machine learning and high computational power to analyze data sets containing genetic, clinical and socioeconomic data will not only help design the best personalized treatment for our patients, but also will help identify those patients or patient populations that would benefit most from early screening and interventions to prevent disease," said Hocks of Sanford Health.

"Precision medicine will allow us to concentrate our efforts on prevention and early screening, diagnosis, and care that will help keep our patients healthy and thriving for generations to come."

Matt Hocks, Sanford Health

"Precision medicine will allow us to concentrate our efforts on prevention and early screening, diagnosis, and care that will help keep our patients healthy and thriving for generations to come," he added. "Cancer care and chronic disease management are burdensome to patients, communities and health systems. Concentrating resources to prevent these conditions will benefit us all."

Remote patient monitoring and mobility

Mobile health is an area of health IT that has been emerging in recent years. The same with remote patient monitoring, which has especially gained ground during the COVID-19 pandemic. Virginia Hospital Center is on top of both.

"Virginia Hospital Center does not view itself as cutting-edge when it comes to technology," Mistretta said. "It considers itself more of a fast, early adopter of new technology it believes may provide an advantage to its patients.

"We are extremely patient-focused, so many of our investments moving forward are going to be in that realm," he continued. "We will be investing in hospital-at-home and remote patient monitoring features in depth, along with other patient engagement functions to empower our population and maintain low-touch care to minimize costs."

"Virginia Hospital Center considers itself more of a fast, early adopter of new technology it believes may provide an advantage to its patients."

Mike Mistretta, Virginia Hospital Center

Mobility is in demand by patients, so connecting through web and app technologies will be a high priority, he added.

"We need to make care convenient for patients and provide care on their terms," he observed. "In our Northern Virginia/D.C. market, we hear about this frequently due to traffic and distance considerations."

Thus the development of pilot programs like the organization's OB Connect, where patients followed for maternity care are issued home equipment, post results and are able to skip the office if everything is within expected limits. Mistretta believes this kind of technology will permeate the market.

"These types of technologies will be required to sustain significant growth for health systems," he said. "Combined with the effective use of data to produce appropriate metrics, we should be able to pinpoint more specific markets and what treatments produce more effective outcomes.

"It also is the only way we will be able to meet the significant demands that will be placed on the care system with the shortage of nursing and primary care resources predicted to hit in the coming years," he added. "We simply will not be able to continue to experience the same results and levels of treatment enjoyed today as the population grows and ages without providing increased care outside the walls of our traditional organizational structures."

Leadership buy-in on a different approach will take some time, but with successes along the way (and supporting data to reinforce), healthcare organizations will be able to achieve what will be needed, he said.

The internet of things

Providence pledged to invest $50 million over five years in health equity. Here is a recap of how it invested in year one.

Elsewhere, Moore is concerned with the internet of things.

"The internet of things is it – it's smart devices," he said. "We may give our patients smart devices that sit in our care delivery environments, and have the telemetry information, and go into our big data model. Because that's how we're really going to make these machine learning and artificial intelligence models shine.

"Getting that remote care delivery data is important, like a temperature four times a day, or real-time streaming of oxygen or heart data."

B.J. Moore, Providence

"We in healthcare say big data, but until you're working with streams of data, it's not really big data, it's just large data warehouses," he continued. "So getting that remote care delivery data is important, like a temperature four times a day, or real-time streaming of oxygen or heart data."

Moore believes the IoT and the streams of data it can provide are things healthcare executives should be talking about more. "It's all about data volumes: The bigger the volume, the better," he said.

AI bias and health equity

Regenstrief is in the process of developing tools and processes to identify bias in algorithms to improve health equity, said Grannis of Regenstrief Institute.

"As AI becomes more ubiquitous, researchers, clinicians, health systems, industry, government and others must be wary of unintended consequences," he stated. "Our research scientists are working on best practices as well as novel analytical tools to regularly monitor for bias in algorithms, a process Regenstrief and CEO Dr. Peter Embí have coined "algorithmovigilance."

"Over the next five years, Regenstrief will be working with individuals and organizations around the world to implement," he added.

"As AI becomes more ubiquitous, researchers, clinicians, health systems, industry, government and others must be wary of unintended consequences."

Dr. Shaun Grannis, Regenstrief Institute

Regenstrief also is investing in the broader ecosystem required to sustain advanced AI and machine learning methods. In the same way that clinical decision-makers, including physicians and other care providers, undergo regular training updates and certification due to healthcare's evolving nature and potential for bias, advanced algorithms will need frequent updates and certification to minimize bias and or errors, Grannis said.

Frameworks for overseeing algorithms and analytics are nascent. Developing and evaluating approaches to accurately and efficiently monitor AI and machine learning will become increasingly important in the future of healthcare analytics, he added.

"We also are investing in patient ergonomics – the application of human factors, engineering and psychology to the design and evaluation of patient-facing technology to enhance delivery of healthcare," he explained.

"Institute scientists are using user-centered design to create apps that help informal caregivers provide care for their loved ones with Alzheimer's and other chronic conditions. Other apps are exploring the benefits of specific diets and brain-stimulating games."

Patient access centers

Babachicos of South Shore Health believes tools that assist patients with care navigation will allow for a more improved and directed patient experience.

"These tools combined with the next-generation call centers – also known as patient access centers – can be accessed 24/7 by patients looking for care options and direct patients to the right place at the right time for their care needs," she explained. "These patient access centers will use multichannel options such as text, voice and chat while allowing patients to perform many self-service functions, as well.

"These patient access centers could potentially deliver virtual visits/consults as well as potentially manage patient medications and vitals for subscribed patients in the community."

Cara Babachicos, South Shore Health

"These patient access centers might also be staffed by care navigators for a more human connection when necessary," she concluded. "The same centers could potentially deliver virtual visits/consults, as well as potentially manage patient medications and vitals for subscribed patients in the community."

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.