CHICAGO – Electronic health records vendor Meditech is revamping its technology to increase support for genomics.
The Westwood, Massachusetts-based company expects to release new technology later this year focused on the "long-term management of genomics information," according to Meditech's genomics product manager, Jennifer Ford. The enhancements will cover the entire gamut of the EHR system, she said.
Notably, the vendor's laboratory information system will soon feature a new application base to manage the importation and communication of genetic test results and to assist in the building of patient genetic histories.
"Based on that foundation, we're working on bringing the data to the physician's fingertips, which is obviously one of the most important things we can do right now," Ford said.
This information will appear in the patient summaries that clinicians see in the system and it will inform clinical decision support. Meditech also will feed genomic research data to clinicians at the point of care to aid in the decision-making process.
"I think probably our biggest benefit with electronic health records is taking all of this data and all of this science and putting it in a format not only that our physicians can understand, but also putting it in front of them so they can make accurate decisions," said Executive Vice President Hoda Sayed-Friel, the company's resident genomics champion.
"Our job as an EHR vendors is to look at all that research, figure out what it's doing, where it's coming from, and then insert into the EHR, into the workflow so it helps both the providers and the patients."
Meditech has supported pharmacogenomics in its system since 2017. Meditech had convinced formulary services provider First Databank to add drug-gene interaction checking to its engine that powers clinical decision support for Meditech and other EHR vendors.
Two or three years ago, PGx was not on the minds of community health systems in particular.
"But now that a lot of new innovation has come out and more genomic testing is being done, then I think it's a little bit more in the mainstream than it was earlier," Sayed-Friel said. "Our clients and our customers weren't invested in genomics as much as they are right now, so I think it took a little momentum to get moving for them to even want it," Sayed-Friel said.
Meditech now counts Sioux Falls, South Dakota-based Avera Health and Willis-Knighton Health System in Shreveport, Louisiana, among its regular PGx users in nonacademic settings.
The company has been refining its genomics efforts of late to focus on interoperability with laboratories and making the information as accessible to physicians as possible.
The system already has areas in the chart for physicians to see patient genetic history. Meditech soon will link genetic testing with imaging and tumor samples as well.
"We're linking genetic testing that happens with, say, a surgical pathology specimen right in the chart," Ford said. "The addition of pathology gives us the tumor genomics [in the same workflow] as well, which is huge."
Meditech's oncology product already has features to help providers justify genetic tests and precision treatments to payors. Sayed-Friel said that insurance coverage and the rapidly falling cost of genetic tests has driven demand for genomics support in the EHR among community health centers.
Sayed-Friel likened the demand curve to uptake for telemedicine features.
"We've had virtual visits in our system for a long time," she said. But it was not until providers saw increasing demand and the possibility of being reimbursed for the service that they turned on the feature.
"I think once Medicare and the [commercial] payors actually see that there's a benefit in making sure that certain types of genomic tests are done and that they will actually pay and reimburse customers for it, then I do think that you will see a little bit more genomic testing being done," she said.
It also has become more attractive for community hospitals as the cost of testing has dropped.
"All of those things together, I think really show a different picture of what genomics is," Sayed-Friel said. "I also think that people talk about genomics in these generalities, but there's so many different slices of it that I think you have to look at each slice a little bit differently."
The product update will attempt to break down these pieces to allow users to manage each specific type of testing and to integrate with new technologies that might appear in the future, she said.
"As things change, the system is flexible enough to change with it in order to bring in the new information," Sayed-Friel said. "The way that we're building and the way that these results will get into the system, the patient's genetic history will be stored, as well as the types of data that can be stored with each specific gene."
The vendor initially built pharmacogenomics into the EHR in a way that the system could support other clinical genomics uses when providers were ready to move into those areas. The EHR connects to genomics labs via application programming interfaces for electronic ordering and results reporting.
"We've been able to grab that information and have re-engineered the electronic chart so that we can display the information to the clinician in a variety of formats that are understandable," Sayed-Friel said. "That's important because typically today they get these 10, 20, 30-page reports that are not synthesized for them."
Meditech does capture the full reports, but also is setting up the EHR to extract and display the most salient elements for clinical decision support. "We are presenting the information so they can track it, read it, and know what's gone on," Sayed-Friel said.
Users will have the option of storing test results and analyses outside of the EHR, as is common when dealing with large datasets, including whole genomes that might take up a terabyte of storage each. The EHR points to databases where patient information and relevant medical knowledge are stored.
"We can query them and say, 'Hey we have a CYP2C19 question. Do you have any markers for that, yes or no?'" in search of a suitable anticoagulant, Sayed-Friel said, as an example. If the clinical decision support system asks for more information about metabolomic-related liver enzyme functionality, the system can find it.
"What we've built is the ability to both store things and then being able to request information when we know where genetic information is being stored," Sayed-Friel said.
"It's all about taking the important pieces out of it and making sure that those are available for both clinical decision support in the background and available to the physicians when they need it," Ford added.
Meditech is bringing the PDF document from the lab to the doctor's view as well, also a common practice in the EHR world. "If they want to see any original data that's being sent back and they do want to comb through and take a look and deep-dive into it, they have that ability extremely easily right from their chart views," Ford said.
When Meditech grabs data, either temporarily or for permanent storage, it is adding the information to its relational database for business and clinical analytics purposes, Ford said.
"As we're looking at trends of different types of conditions, different types of markers, we'll have enough data there," Ford said.
"Potentially as we move a little bit farther into [artificial intelligence], that genomic information will be available alongside the EHR data as well as claims data. The aggregate of that combination of information is going to be truly powerful as we get more of it," added said.
Like competitor Epic Systems, Meditech is dealing with several different standards when working with genomics data. In the genomics module that Epic introduced last year, that company chose to follow version 2.5 of the Health Level Seven International (HL7) communications standard because HL7 did not finalize the more robust Fast Healthcare Interoperability Resources (FHIR) Genomics, a component of FHIR version 4.0.1 until later in 2019.
"We are working on utilizing HL7 standards that are currently out there, but we're also looking into FHIR standards and more API-based standards in the future so that we can do calls out and get information in at different times," Ford said.
She said that Meditech views genetic testing orders and data as more of a two-way stream than a point-to-point communication like a complete blood count. "Because of that, we're looking at new and more advanced technology and ways of communication so that we can continue communication back and forth on a single order as things are updated," Ford said.
That said, Meditech is primarily focusing on HL7 2.5 for that communication, though it is building FHIR Genomics interfaces for when clinicians and labs are ready for the latter standard.
Sayed-Friel noted that Meditech is using an earlier version of FHIR for its activities around the United States Core Data Interoperability (USCDI), a set of data classes and elements meant to help providers meet interoperability requirements specified in the 21st Century Cures Act.