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Pathway Inks Deal with EMR Provider to Allow Doctors to Integrate Genetic Test Results into Care

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Originally published March 19.

The approximately 150,000 doctors using Practice Fusion's web-based electronic medical records services will now have access to genetic testing offered by Pathway Genomics.

In its latest move to expand its direct-to-physician genetic testing services, Pathway Genomics inked a partnership with Practice Fusion, a company that markets free online EMR software to help doctors keep track of information about their patients, including medical charts, e-prescriptions, lab test results, and referrals.

Under the terms of the deal, Pathway Genomics will be listed in Practice Fusion's laboratory database but Practice Fusion will not market Pathway's genetic testing services to doctors. "They're not selling for us," Todd Johnson, Pathway's chief commercial officer, told PGx Reporter. Rather, "we will be able to take an order and we will be able to send the reports electronically through Practice Fusion's database and interface."

As a direct-to-physician testing service, Pathway independently markets and educates physicians about its genetic testing services.

Practice Fusion offers its physician customers a "lab integration solution" through which practices can receive test results that are reported back electronically to a specific patient's chart. In this way, doctors who choose to genetically test a patient using Pathway's services will be able to receive the test results electronically within a patient's record.

"This is our first opportunity to bring genomic test results into our EMR ecosystem," Todd Martin, Practice Fusion's senior VP of business development, told PGx Reporter. "This is important especially as drugs become more specialized and genetic targeting for effectiveness becomes a bigger factor in treatments."

Pathway offers genetic tests that doctors can use to get additional information about their patients' cardiac conditions; to gauge if patients are likely to respond to or experience adverse reactions to a drug; to assess how patients' genes influence their response to diet, nutrition, and exercise; to help those interested in having children learn of heritable conditions they might pass on; and to determine if patients have a heighted genetic risk for certain serious illnesses.

A number of personalized medicine advocates have argued that in order for genetic tests to be used more broadly by doctors in medical practice, the results have to be stored in patients' medical records so the information is accessible at the time of care and then over the continuum of their care. By collaborating with Practice Fusion, Pathway is aiming for just that.

"EMRs in general allow companies, such as [Pathway], to connect digitally with physicians, and deliver reports electronically and hopefully, one day, be able to receive orders through Practice Fusion electronically, and so have a true bidirectional interface," Johnson said.

By offering its genetic testing services through an EMR provider, Pathway is hoping that doctors will be able to use genomic testing information more efficiently in patient care. "What this is going to do for physicians … is increase productivity, decrease the amount of time spent on paper requisitions, and be able to allow physicians to have the opportunity to spend more time with more patients," Johnson noted. "And that's going to be the name of the game, especially with … changes" due to healthcare reform.

Under certain provisions of the Affordable Care Act, physicians will have to meet certain quality metrics and reduce the total cost of patient care. This will require doctors to figure out ways to use their limited time with patients more efficiently and prescribe treatments that are cost-effective and improve outcomes.

Genomic information on a patient can help guide treatment strategies while considering both costs and outcomes. For example, testing cardiac patients who have undergone a stent procedure for mutations in CYP2C19 genes can reveal whether they are poor responders to the antiplatelet drug clopidogrel. Based on this information, the doctor can determine whether to treat the patient with a brand name antiplatelet drug or the generic clopidogrel.

"In the case of Pathway, and genomic testing in general, we’ve long known that this is an area of increasing importance when it comes to determining effective treatments and working with more specialized medicines," Martin said. "Connecting Pathway Genomics to deliver results is just the first step but we are looking to expand our relationships with labs in the near future when we add lab ordering into the treatment workflow."

Practice Fusion's EMR is used by 150,000 medical professionals, who serve 60 million patients in the US. The San Francisco-based company, founded in 2005, claims it is the "largest and fastest growing online community of physicians and patients." Most of the medical professionals using Practice Fusion's services are independent doctors who work in small practices of nine or fewer doctors. Practice Fusion's EMR system is intended for doctors who "find the exorbitant costs of other EMR systems to be prohibitive … even [after] taking government incentives into account," Martin noted.

The collaboration between Pathway and Practice Fusion comes as the EMR services provider is becoming more interested in helping doctors deliver personalized care to patients. In February, Practice Fusion acquired 100Plus, a personalized health prediction startup that develops apps that can track how small behavior changes among patients impact their wellness.

"Increasingly, personalized medicine has become a bigger part of the healthcare equation," Martin said. "The genomic testing performed by labs such as Pathway is becoming a big factor for doctors as they seek the best treatments for their patients," Martin added.

In line with Practice Fusion's strategic direction, Pathway offers a test that analyzes 80 genetic markers associated with people's metabolism and dietary traits, as well as their response to exercise. This nutrigenetic test, called Pathway Fit, is typically ordered by physicians to help obese patients manage their weight, learn more about patients' metabolic syndromes, or provide patients with sports nutrition information.

Pathway is currently conducting a large prospective, randomized clinical trial with the Veterans Affairs San Diego Healthcare System to determine whether its nutrigenetic test can be used to help veterans make lifestyle changes that manage their weight. Although Pathway couldn't discuss the detail of the trial due to confidentiality agreements with the VA, Chief Medical Officer Michael Nova noted the trial will be ongoing for between six months to one year. Veterans enrolled in the study will be genotyped using the Fit test and followed for a number of endpoints, including direct weight loss, Nova said.

Previously, Pathway collaborated with the California Schools Voluntary Employee Benefits Association to study whether the Fit test helped 179 overweight California school employees lose weight. After six months, overweight employees in the trial who were genotyped through the Fit test had "significant weight loss" compared to those who tried to lose weight without genetic information as a motivator. Some study participants who received genetic testing lost up to 40 pounds, according to Pathway.

The latest partnership with Practice is part of Pathway's ongoing efforts to grow its visibility before physicians. Earlier this year, Pathway joined Blue Shield of California's Preferred Provider Network, which will give physicians who use the provider access to the company's tests, Johnson said. Blue Shield of California serves an HMO network of more than 34,000 physicians and 290 hospitals, and a PPO network of more than 60,000 physicians and 351 hospitals.

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