CHICAGO (GenomeWeb) – The next time you get a self-service biometric check-up at a local pharmacy, the results and recommendations might be based on your genome.
Higi, which has 11,000 health screening kiosks in US retail locations, last summer partnered with Interpreta, a San Diego-based company that collects and analyzes both genomic and clinical data to support precision medicine. That partnership is now just getting off the ground with some pilots to prove the link-up.
This week at the Healthcare Information and Management Systems Society annual conference in Las Vegas, Higi and Interpreta are showing a full integration of their technology, including genomics data, being analyzed in real time.
At HIMSS, Higi wants to demonstrate its progress around population health and how it "makes data actionable," said CEO Jeff Bennett, not just show off its kiosks and brag about its expansive network. Higi is positioning itself as a "population health enablement company," according to Bennett.
The idea behind the partnership with Interpreta is to support genomics-driven population health and close gaps in care by simplifying the process of collecting and communicating patient vital signs and environmental data to healthcare professionals, either through retail kiosks or with home-based medical devices that connect to a Higi mobile app.
"At Higi, we're all about making it easier to be your healthiest, from a consumer perspective," Bennett said in an interview last week at the company's riverfront headquarters in Chicago's Loop. "For healthcare organizations, it's how we connect their people with their patients to deliver better care."
Bennett frequently comes back to the breakdown of "determinants of health": 60 percent based on behavioral, social, and environmental factors, 30 percent related to genomics, and just 10 percent from actual healthcare.
"We looked at that and we started talking to Interpreta. We realized today, one of the problems in healthcare is that it's really hard to collect that information that's not collected in the hospital," Bennett said. Higi is working with Interpreta to get the information it collects to the doctors and health plans of the individuals it serves.
"From Higi's perspective, we're making it easier to reach people, easier to collect that data, and identify and connect that data back with the payor or provider by getting it to Interpreta, where they can interpret the data that we're giving them — which could include some of the behavioral, some of the social data — and mash that data together with their genomics data and with their Rx data and their claims data."
From its retail health stations — which have 510(k) clearance from the US Food and Drug Administration — Higi collects vitals and goes through personalized questionnaires to screen patients. "What we can enable is, now that you have someone in a 'health moment' who's going to be sitting and doing a screening, is [asking] what actions should be taken after that's completed," Bennett said.
Interpreta is helping Higi get data into the workflows of care managers at health plans and, to a lesser extent, accountable care organizations, which make up Interpreta's customer base.
Genes don't change. "But what does change is how knowledge of how your genes actually affect your health," Bennett noted. "Today, certain medications, we don't know whether those actually work with certain genes. I think part of the power of what we're working with Interpreta on is [that] they continually update their database."
Interpreta CEO and Cofounder Ahmed Ghouri, a board-certified anesthesiologist, said that his company's core competency is real-time interpretation of data from the clinical, administrative, and genomic realms.
"A physician really doesn't think exclusively in the domain of genomics," Ghouri said. They think about it in the context of laboratory values, potential drug interactions, family histories, and direct observation of patients.
"You think holistically about what's going on with the patient, and one component of that might be influenced by the genome, but it's really hard, in my opinion, to have separate analytics for each kind of clinical domain. It's too disjointed," Ghouri said.
He likened this to having one GPS device for navigating highways and a separate one for residential streets or rural roads. "It's not really useful," Ghouri said.
"We're trying to put clinical navigation into one single, real-time framework that includes the genome in the navigation," he explained. "We're trying to unify claims data, EMR data, the genome, and ambient data, which includes biosensor companies like Higi. We're trying to bring it all together in real time and interpret it in real time."
Interpreta and Higi have built a cloud-to-cloud interface so they can share data on a national level.
On the Interpreta side, the data itself comes from partnerships with health insurers, including lab data, pharmacy data, procedural data, diagnoses, and demographics. Ghouri called the interpretation engine his company's "secret sauce" when combined with diverse data sources, including patient-specific EMR, pharmacy, biometric, and genomic information.
"We have a network that can provide us full genome sequences. What we're doing, though, is bringing it all together in one instance in the cloud so that it can be interpreted in real time. As the data changes, it reinterprets the care path for the patient, no matter how fast it changes," Ghouri said, comparing it to a GPS recalculating a route after a driver misses a turn.
"We store the data and we reinterpret it daily, which is a big deal. Your medications don't change, your genome doesn't change, but the knowledge changes tomorrow," Ghouri said. "You can't just do genomic interpretation when you're prescribing. You have to do it even passively every day because there's new knowledge of the meaning of variants."
Interpreta is essentially providing clinical decision support by continuously recalibrating the care plan as new information comes in.
"Our system course-corrects in real time using all the available data. It's casting a forward-looking care plan, which is personalized to the [health plan] member," Ghouri said. "It's generating a future care path, but that is updated as new data comes in," Ghouri said.
For example, a Higi station could identify a new case of high hypertension. "Now in your care path is to make sure that the hypertension is being treated," Ghouri said. But certain medications put into the care plan might not be suitable for that patient because they interact with an asthma drug or won't be effective due to a specific allele in the genome.
"We're doing the treatment optimization prospectively," Ghouri said. "We're not recommending a single best treatment, but we're constraining the choices amongst things that are potentially going to be a problem. We're presenting the analysis in the care plan to the physician so they can make informed choices."
Having a genome sequence, though, is not adequate in isolation. "You have to holistically do the interpretation to be clinically correct," Ghouri said.
"If you were only using the genome in decision-making, you could have a lot of errors. Some of the choices, for example, are not appropriate if you're pregnant," he noted. "The clinical genome has to be interpreted in the clinical context."