In my first blog, I explored the findings and opportunities that precision medicine presents Canadians (from a two-day workshop co-hosted by Dalhousie University and Orion Health). Despite the many compelling insights shared during the workshop, there remain hurdles that must be overcome if society is to realise the full potential of precision medicine. This blog will explore the challenges and opportunities highlighted by the workshop participants who held diverse and unique perspectives.
There’s no avoiding the fact that budget constraints will always impact the ability to embrace new technology and healthcare procedures. The average health expenditures budget in Canada has grown by 7% per year over the last decade. As budgets have grown, so have the demands and needs of the populace and the healthcare organisations that serve them. Organisations will need to find the means to spend in precision medicine, on top of everything else.
Waste continues to burden the healthcare system. Issues like over-prescription and needless testing put unnecessary pressure on budgets. Healthcare authorities need to implement guidelines and education mandates to help tackle this issue. Because of the scrutiny over healthcare spending, it’s crucial that precision medicine is applied in a way that drives down costs and that these cost-savings are visible to the public.
Expanding Data and Information Sources for Precision Medicine
Clinical information only provides 10-to-20% insight into what impacts a patient. Environmental, lifestyle and genomic factors are also essential information when trying to obtain a holistic view of the individual. It comes as no surprise that access to this additional data is a vital component in embracing precision medicine. Healthcare organisations will need a front-end application for care providers to analyse patient data and present useful findings that will influence clinical decisions.
Workshop participants discussed the need for a shared data platform, both for collaboration and to provide up-to-date patient information to care providers for enhanced decision making. However, achieving this will require more than a technology upgrade. Ethical, regulatory and security challenges will be need to be overcome to ensure all rights are respected and that a representative diversity of patients is included in the process.
Opportunities in the Canadian Context
As I alluded to earlier, encouraging public engagement will be critical to bringing the Canadian public up to speed on precision medicine. Canadians are hearing through the public media of commercial initiatives, such as 23andMe where one can invest a few hundred dollars and submit an oral-swab, to receive a report that outlines genetic characteristics and an ancestry profile. Is it important today for the average, healthy Canadian to have their genome profile available electronically? No. However, as the cost for full genome assay declines dramatically in the not-too-distant future, we could envision a time when the public health system will recognise the value in routinely capture genomic data for everyone, perhaps beginning with the next generation of newborn infants.
Information sharing can also be applied to the academic world. One idea that surfaced was a ‘Precision Medicine Sandbox’ created for multiple disciplines to collaborate through, and to find new discoveries and improvements. This would be paired with fundamental courses on digital health and informatics offered to all undergrad students in medical professions.
However, at the end of the day, success will come from the availability of front-end, informatics-based decision support, and patient management services that highlight the value-add of precision medicine. The capability for large scale data integration is incredibly valuable and can shape our interpretation of the information received. In Canada, we need to connect and utilise data that already exists in the various electronic health record (EHR) systems across the country. Workshop participants also shared the possibility that secure access to data not be limited to care providers, but also available to qualified researchers to foster the improvement of care provision.
Exploring How to Apply Precision Medicine
When taking those first steps forward, there were several ‘must haves’ considered by the workshop attendees:
- A shift in focus from illness to wellness
- The implementation of new technology to handle the increased data brought about by precision medicine
- The interplay between evidence-based clinical knowledge and mathematical models needs to be validated by clinical knowledge before being adopted by medical professionals.
- The addition of precision medicine into clinical practice with measurable outcomes
- Development of patient-facing applications that deliver the benefits of precision medicine to patients and physicians
- The inclusion of wearables, personal devices, and stakeholder-facing applications to help articulate the value proposition of precision medicine to the public
If stakeholders want to move forward successfully, then it will be the early adopters who are the key to driving change and adoption. It will take time, effort and money to get users engaged, and proper change management to maximise success, but it will be innovators who break ground and pave the road forward. A combination of will and some modest steps forward will set us on a path to great change.