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2bPrecise Sees PGx Demand From Independent Providers

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CHICAGO (GenomeWeb) – Precision medicine platform developer 2bPrecise has seen an increased interest in pharmacogenomics from small and midsize medical practices and hospitals since late last year.

According to Joel Diamond, the company's chief medical officer, while some academic medical centers have been developing broad precision medicine strategies, smaller providers have decided to "leapfrog" the big organizations by going with the low-hanging fruit of precision medicine, PGx. "They're very, very hungry to start this process right now, particularly in the area of prescribing, but many of them just don't know where to start," he said.

"People are starting to see this as a competitive advantage, that they're able to offer this exciting new science to people and improve medication safety," Diamond noted. Other providers are trying to get a leg up on risk-based payor contracts by turning to genomics to stratify patient populations, he added.

Diamond did not disclose who any of 2bPrecise's smaller customers are but said that Cancer Treatment Centers of America and University Hospitals in Cleveland have come online in recent months as users of 2bPrecise.

Pressure is coming from patients bringing in results from direct-to-consumer genetic tests such as 23andMe. "Consumers are demanding this and we've continued to practice at least prescribing in this sort of blindfolded way," without genetic information, Diamond said.

"Pharmacogenomics, I would say it's the gateway for most organizations to get into precision medicine, but it probably represents a very small part of its overall impact," he said. "I think pharmacogenomics seems to be the area [from which] people are starting to glom onto the other areas like inherited risk and cancer risk."

2bPrecise, a wholly-owned subsidiary of Chicago-based electronic medical records vendor Allscripts Healthcare Solutions, does not aspire to serve just pharmacogenomics or just inherited cancer risk, though. Diamond noted that the "darling" of precision medicine has been cancer, particularly with immunotherapy becoming the standard of care of so many cancers, but there is so much more to precision medicine.

"I think people are very, very interested in [pharmacogenomics results], but the bulk of the rest of the germline data, and understanding stratifying risk and population health, is yet to come," Diamond said. "We believe strongly that if you segment the market into those individual spaces, you will not be able to reuse this data across the enterprise."

In the mid-2000s, Allscripts grabbed headlines by offering a standalone electronic prescribing portal for free for those medical practices that had not yet adopted EMRs. That succeeded in increasing the rate of e-prescribing usage before federal incentives and market pressures caused physicians nationwide to ditch their prescription pads for digital technology in the early part of this decade, but prescription orders from the free module rarely made it into EMRs.

Now, integration is the expectation.

Allscripts launched 2bPrecise in 2015 as kind of an evolutionary step from the company's 2013 acquisition of DBMotion, an Israeli clinical integration and population health management platform.

DBMotion cofounder Assaf Halevy created 2bPrecise after he joined Allscripts and continues to serve as CEO of the subsidiary. Diamond also was a developer at DBMotion and later chief medical officer for population health at Allscripts before helping Halevy start 2bPrecise.

Allscripts has decided to keep 2bPrecise as a separately operated entity in order to remain "agnostic" toward whatever EMR a customer chooses. EMR vendors have been hewing to this strategy ever since Cerner bought clinical decision support content provider Zynx Health from Cedars-Sinai Health System in 2002. That company sold Zynx off to media conglomerate Hearst two years later, in part because providers using non-Cerner EMRs were reluctant to work with Zynx.

Diamond said that 2bPrecise is live with several Cerner users now and expects to come online in the next few months with customers of Epic Systems, Meditech, and other EMR vendors. Ideally, the EMR would be the hub of integration of data from many sources, with components like the 2bPrecise platform presented as tabs within the main system.

"Our main tool is a little floating icon that looks like another icon within the EMR. Everything that we do we believe should be a single click," Diamond said.

"If you're looking at a med list in your EMR, you want to be able to see those meds applied toward some pharmacogenomics knowledgebase to help you do your prescribing at the point of care without clicking out, having to look somewhere else."

The National Institutes of Health has used 2bPrecise since 2016. Clinicians at the NIH Clinical Center in Bethesda, Maryland, which has an Allscripts Sunrise EMR system, click on a tab to pull up a specific patient's genetic test results, just as they can for medication lists, radiology reports, and laboratory results, according to Diamond.

In the same spirit as the free Allscripts e-prescribing portal of years past, 2bPrecise is teaming with Translational Software and PWN Health to offer free pharmacogenomic testing to all US-based Allscripts employees.

"It's about putting your money where your mouth is," Diamond said. "We want those patients to be empowered with that information so they know what variants have been tested and they know what variants they have."

Eventually, the company wants to integrate those results with EMRs, no matter where each employee is treated. That, Diamond said, will have to come from consumer demand and broader adoption of data interoperability standards.

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