How our independent healthcare system launched a state-of-the-art precision medicine program

November 3, 2022 |  Health IT, Genomics

I still remember the day three years ago when our President & CEO, Tom Kleinhanzl, visited my office and tasked me to lead one of our organization’s most technologically advanced new initiatives — the development of a precision medicine program that would enable all providers at Frederick Health to leverage the power of genetics. Little did I know at the time that the initiative would launch Frederick Health to the forefront of genomic medicine.

pat-rice-quote-1Though I was initially a little nervous about the size and scope of such a project, it was really a dream come true. I started my career at Frederick Health 30 years as a nurse on the inpatient oncology unit. Always eager to learn, I went back to school to become a nurse practitioner and decided to make oncology my specialty. I had traversed the cancer journey with so many patients and their families over the years. I witnessed, firsthand, the hardships and complexities that come with a diagnosis of cancer, especially in advanced stages. I wanted to find a way to get involved earlier so I could prevent or at least mitigate some of these devastating consequences. 

That’s sparked my interest in hereditary cancer genetics. While working as a nurse practitioner in oncology I took a series of additional courses to obtain my certification as an advanced practice nurse in genetics. Now, I could begin seeing patients at risk for cancers and intervene earlier. I grew that part of the practice from five patients in 2005 to over 250 in 2019. That’s when leadership really began to notice.

Around the time Tom approached me to discuss a dedicated precision medicine program, I was beginning to realize just how powerful genomic medicine could be, and how its use could extend far beyond oncology or even the other specialties that have historically used genetic testing (like neurology, maternal and fetal medicine, and a few others). A patient’s unique genetic profile is relevant and valuable for every specialty, including the more general specialties like family and internal medicine. We’re just now reaching a point where the cost of both genetic testing and data storage has fallen so low that it’s technically and financially feasible to test many more patients than ever before and store their genetic results right in the electronic health record.

Partnership with MEDITECH and Expanse Genomics
That’s where our partnership with MEDITECH came into play. To be clear, we had already launched our precision medicine program before we learned that MEDITECH was developing a genomics pat-rice-quote-2solution. But Expanse Genomics has helped us take our program to the next level. It significantly streamlines our provider workflows by folding all of our core genomics routines into the EHR. Processes that were once performed manually outside of the EHR are now automated — from ordering tests to importing results to providing interpretation and guidance. Some of our early analytics show that order entry time is substantially reduced. It still amazes me that any provider at Frederick Health can now order a certain genetic test directly from the EHR just like any other test; receive the results back from the lab as discrete data, parsed into the patient’s record; and view the results in the chart with interpretation and guidance for counseling their patients. This process is far better than completing complex paper orders, wondering when or if your genetic test is complete and searching for the test under random tabs in the EHR. 

To the best of my knowledge, MEDITECH is the only EHR vendor bringing discrete and actionable genetic data directly into the EHR and storing it. That allows any authorized provider at Frederick Health to leverage a patient’s genetic test results to make more informed clinical decisions. Andpat-rice-quote-3 isn’t that what personalized medicine is all about? Having discrete genetic data available also enables one of the most powerful tools now available to our providers: Built-in pharmacogenomic decision support. Working with MEDITECH and First Databank, we now have automated drug-gene checking, so that patients get the right dose of the right medication the first time based on their genetic profile. This is a huge plus for patient safety, since the standard dose of a medication for one patient might be just right, but far too little to have an impact on a second patient, and dangerously too much for a third. It’s also a huge plus for patients, who get the right medication and dose more quickly, which can provide more immediate relief from symptoms they may be experiencing.

Educating Provider and Patients
Of course none of this was easy. MEDITECH has worked hard to make Expanse Genomics a very robust and usable solution, but we had a lot of work to do ourselves — not the least of which has been educating providers on the value of genetic data to their specific practice. This is certainly an ongoing challenge, because most providers received very little training in genomics during medical school or residency if they didn’t specialize in a field of medicine that required it. We are slowly but surely bringing our providers into the “buy-in phase” and showing them meaningful use.

pat-rice-quote-4It’s also very gratifying to see patients light up when they understand how their genes are impacting their health, and why they may be experiencing what they’re experiencing. You can then assure them, they did nothing wrong and it’s not their fault. They can then move forward with a treatment plan and solution for improved health and well-being. We are also seeing patients outside our typical service area, from larger nearby urban centers with larger hospitals, because they’ve heard about our precision medicine program. We are truly unique, as our genetic services are multidisciplinary and are not in the silos one may experience in a larger hospital setting or academia. 

Precision Medicine for All
And that leads to my last point: We’re demonstrating that precision medicine isn’t something that’s only possible at large urban hospitals with unlimited financial and human resources. As Tom told me early on, sometimes it’s the smaller independent organizations that can be more nimble, make decisions faster, and be better incubators for innovation. That describes us well. There are certainly other organizations leveraging the power of genomic medicine, but we’re one of the first to bring it into our EHR and make it easy for all providers to use regardless of specialty. I consider it a privilege to be leading this endeavor with an amazing team. 

Someday I think we’ll look back at the practice of medicine before genomics and be shocked that clinical decisions were being made without first understanding a patient’s genetic profile. That’s why I’m so thrilled to be working with other leaders at Frederick Health to usher in a new era of medicine. And I’m still thankful it was my door Tom knocked on three years ago.

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Written by Patricia Rice, CRNP, Frederick Health

Patricia Rice is Clinical Director Precision Medicine and Genetics at Frederick Health in Frederick, MD. Ms. Rice led the design and launch of her organization's precision medicine program and now educates physicians, staff and patients on the benefits of genetic testing across specialties and disciplines. Prior to leading the precision medicine program she was an advanced practice nurse in Oncology. Ms. Rice holds a Masters of Science degree in Adult Health Nursing from the University of Maryland, Baltimore Graduate School, a Bachelors of Science degree in Nursing from The Catholic University of America, and certifications in oncology nursing and Advanced Practice Nursing Genetics.