By BETSY TAYLOR
A little over two years ago, Catholic Health Initiatives and Dignity Health launched the Precision Medicine Alliance as a 50-50 joint venture. The systems promised to pool brainpower and capital to build the largest community-based precision medicine program in the country.
Medical oncologist Dr. Panayiotis Savvides has used the Precision Medicine Alliance platform in his work. He is shown here with a patient at the University of Arizona Cancer Center at Dignity Health St. Joseph’s Hospital and Medical Center in Phoenix.
The Precision Medicine Alliance does not treat patients directly, nor does it offer second opinions. Instead, the alliance has built and continues to expand an information platform to support community-based providers as they deliver precision medicine cancer treatment — therapies now principally available through academic medical centers. The alliance is bringing genomics-based decision support tools to community-based doctors and specialists who deliver most of the care for U.S. patients.
The alliance's chief executive, Damon Hostin, and two of its board members, Manoja Lecamwasam and Dr. Robert Weil, spoke to Catholic Health World about progress made thus far.
Through the Precision Medicine Alliance, Hostin oversees eight employees, including clinicians and project and program managers, though many others employed by CHI or Dignity Health have aided in its development. (CHI and Dignity Health plan to combine in a new nonprofit system.)
Precision medicine is an approach for disease treatment and prevention that takes into account unique characteristics of individuals including variability in their biology and genes, behaviors and environments.
Weil said, "We are at present most focused on advanced diagnostic tumor profiling and bringing this resource to oncologists and their patients in the communities where they live." The alliance has rolled out in three markets the data platform which would facilitate tumor-type specific treatments. Those markets are CHI Health in Omaha, Neb.; CHI Franciscan Health in Tacoma, Wash.; and Dignity Health Arizona, in the Phoenix region.
In a joint news release issued when the systems created the company, they cited the Precision Medicine Alliance's objective to improve diagnostics and treatment protocols at nearly 150 CHI and Dignity Health points of care in the U.S. Hostin said about 80 percent of the systems' cancer patients will be managed through the platform by the end of 2019.
How it works
Lecamwasam, executive director of intellectual property and strategic innovation at Dignity Health, said in the three initial markets providers employed by CHI or Dignity Health can log into the Precision Medicine Alliance data system to see the patient's electronic medical record including pathology and other lab reports. Tumors found in early stages often do not require genotyping to determine the best course of care, but in latter stages genetic sequencing of biopsied tumor tissue can lead to a more precise diagnosis and targeted treatment plan. In those cases, the laboratory performing the genetic sequencing sends the results back through the Precision Medicine technology platform.
The tool allows a doctor to study prior cases involving similar tumor types and assess treatment outcomes.
The platform allows for a detailed search to be done of effective medications already in use and developers are piloting a feature that would identify open clinical trials that might be appropriate for a specific patient.
Although there are drugs known to be effective against cancers with specific genetic changes, the National Institutes of Health's National Cancer Institute says a precision medicine approach is not yet routine care for most patients. There are also many drugs related to precision medicine currently in clinical trial.
Mining big data
Building the alliance is a "data-rich endeavor," Hostin said, so early work focused on how to bring together detailed data in an integrated system that would link physicians to searchable and specific information that allowed them to best treat patients. "None of this is easy," he acknowledged.
Much of the foundational work for the Precision Medicine Alliance has been to get the platform integrated with existing workflows and data systems, while expanding on how data can be mined to help patients. Hostin said that in addition to physicians, genetic counselors, nurse navigators, financial navigators and research coordinators use the platform.
The two health care systems use different electronic medical record systems, and oncologists in different markets may rely on different ways to gather and sort data, so work had to be done to bring together and synthesize data. Hostin said CHI and Dignity Health maintain their own databases and that information is being shared through the platform created in partnership with an outside vendor, Syapse.
After additional work in oncology, the alliance next plans to focus on cardiovascular genomics, polypharmacy — the use of multiple drugs to treat one condition — and neonatal genetics, Hostin said. "We're just entering the age of advanced therapeutics, where the underlying biology dictates the way you treat the disease," he said.
Dignity Health and CHI have not disclosed how much they have invested in the Precision Medicine Alliance. Its database tool is currently available at no cost to clinicians, though the systems would hope to develop ways to offset the cost of developing and supporting the tool as they prove its effectiveness over time.
Weil said the Precision Medicine Alliance is creating a foundation that can be used beyond its current genetics focus, as it is pursuing strategies for providing care differently and reducing barriers to care. The alliance is setting up systems to better understand who is at risk for certain illnesses, who is biologically able to respond to certain therapies and who is at risk for complications from them.
Lecamwasam said some of the logistics issues — such as how a piece of data could or could not be gathered across the platform, or how to resolve a privacy issue — become less daunting when all involved think of the people who will be helped. "When we get frustrated with the technical aspects, we always seem to talk about what this is going to allow for — a father to walk a daughter down the aisle, or a mother to be there for a graduation because we provided better quality of care or a little more time to fight a disease that is horrendous."
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