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Henry Ford Flowchart Helps Clinicians Navigate Precision Medicine Workflows

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CHICAGO (GenomeWeb) – As Henry Ford Health System ramps up its clinical genomics programs, the Detroit provider organization is, like so many others, struggling with integrating data from multiple sources. Unlike more than a few other health systems, though, Henry Ford has a concrete plan to standardize workflows to determine which cancer patients are eligible for precision medicine.

Henry Ford has visualized this plan in the form of a care flowchart that came from Henry Ford Cancer Institute but is now slowly being extended to other parts of the organization.

"We make sure that everyone with advanced disease receives molecular profiling," Steven Kalkanis, medical director, Henry Ford Cancer Institute, and chair of neurosurgery at HFHS, said in March at the 2018 Healthcare Information and Management Systems Society conference in Las Vegas.

An in-house pathology lab performs next-generation sequencing with three-day turnaround, then molecular tumor boards review cases and compare test results with records from other organizations that are part of the Oncology Precision Network (OPeN) consortium, which aims to link and share aggregated clinical, molecular, and treatment data between its members using Syapse technology. Henry Ford in June 2016 joined OPeN and announced a collaboration with Syapse for data integration.

Treatment recommendations help specialists develop new care protocols, identify subjects for clinical trials, and inform development of new treatments. The flowchart also helps with coordination of care, development of guidelines and standards of care, and adherence to those guidelines.

While the idea to form a precision medicine program dates back several years to a series of meetings among Kalkanis, Henry Ford Cancer Institute Executive Director Spencer Hoover, and HFHS executives, the flowchart materialized in the last year and a half or so.

The rationale for the flowchart was to answer the question "How do we execute on it on a daily basis?" said Nadia Haque, director of the precision medicine program. Prior to taking her current role in late 2016, Haque led group practice improvement for the affiliated Henry Ford Medical Group.

Health system leadership was completely on board with the decision to standardize workflows to determine who was eligible for precision medicine, according to Haque, though oncologists with expertise in genomics had a major say in the chart's development.

"It just wasn't a decree. We did a lot of planning with the people that were on the ground," Haque said in an interview this month.

While the flowchart is a workflow plan rather than a technology plan, IT is a major part of it. "I think the technology part is huge in the sense of just getting all of this data and talking to each other," Haque said.

"The actual ordering of the tests, that part was very clinical, but if we want to actually capture anything in terms of outcomes or quality ... it's a pretty big list to be able to get all of these systems to be talking to each other. In that sense, I would say it was pretty technology-heavy," Haque said.

That list includes data from the Epic Systems electronic health record, as well as disparate genomics laboratory, radiation oncology, and even finance and billing platforms at the Henry Ford Cancer Institute, the precision medicine program, and the health system as a whole.

Many genetic tests come from outside labs, including those at Foundation Medicine and Tempus. "Integrating that data into our enterprise data warehouse has been somewhat of a challenge, but it's getting done," Haque reported.

"I think Foundation has this down pretty pat," Haque said, and is sending back some files electronically. "We're working on the same thing with Tempus, of how to get it back." Agilent is helping to work out some of the details of moving data from the genomics lab into the EDW, she said. 

Meantime, the molecular tumor board is meeting twice a month and development of standards for ordering genetic testing for several cancers is in progress, Haque reported. Plenty of work remains, however, as cost, scalability, data storage, and data analytics still have to be worked out.

On the cost side, the parent organization has negotiated with its own Henry Ford Health Plan to cover the cost of testing, Kalkanis noted at HIMSS.

But the timeline for data integration remains "pretty open-ended," Haque said.

"We have some grander plans of building a genomic warehouse where we could actually do some machine learning, artificial intelligence — I mean really get down to the nitty-gritty of it all," she said. "But right now, we're such in the process of getting all the data together and the infrastructure and the interoperability together, that I would say it's going to be probably at least six months to a year before even that comes together."

The organization might be a year away from starting deep analysis of combined genotypes, phenotypes, and research data, she estimated. We're still going back and forth on … the things that we want to measure," Haque said.

HFHS also is looking to extend the program beyond cancer, perhaps into pharmacogenomics or other, specific disease states, but no decisions have been made. The precision medicine program also is trying to evaluate the clinical genomics work that already has been done, and that has proven to be laborious.

"A lot of it right now is somewhat manual pulling until we get everything really squared away," Haque said.