AdventHealth’s Genomics Threat Evaluation for Most cancers and Early Detection (GRACE) program makes use of household and medical historical past in addition to digital mammography, AI and embedded algorithms to evaluate a affected person’s potential threat of growing breast most cancers. Wes Walker, M.D., vice chairman of genomics & precision well being at 55-hospital AdventHealth, spoke with Healthcare Innovation concerning the impression this system is having.
The Florida-headquartered well being system is embedding most cancers threat evaluation into major care and OB/GYN workflows. Walker has strategic and operational accountability for genomics initiatives in AdventHealth’s Central Florida division. However he additionally works to determine and develop pilots round genomics and precision well being that may be scaled system-wide. Walker mentioned well being methods are at an inflection level when it comes to with the ability to operationalize precision drugs at scale.
Healthcare Innovation: With the GRACE program, did you see a chance to determine larger threat sufferers earlier within the course of? And was age primarily how individuals had been stratified to be screened earlier than this?
Walker: Sure, we noticed within the tips and in additional superior medical practices, in addition to a few of the accreditation packages, that they had been in search of extra tailor-made, personalised, evidence-based threat evaluation methodologies different than simply age. After we checked out our group, we discovered there was a chance. We put collectively a multidisciplinary crew to develop a program on each the technical facet and the high-touch facet.
HCI: How is AI concerned and the way does a radiologist work with the chance evaluation instrument?
Walker: We work with an organization known as Lunit that has an AI module that gives predictions and suggestions for radiologists associated to breast density. Breast density is an important part of essentially the most superior threat evaluation fashions.
Right here is how this system works: Let’s say anyone schedules their mammogram. Two weeks earlier than they arrive in, they get a survey to assemble data that is not already in Epic that can be utilized in these threat evaluation modules. They arrive in and get their mammogram, and the Lunit module with the AI enablement supplies a suggestion. The radiologist can use that — and I’d say over 90% of the time they use that. A threat evaluation is calculated. That’s offered to the radiologist. All of that is occurring in Epic, and could be seen by all the healthcare crew. If the affected person is recognized as high-risk, that data routinely flows to the nurse navigator to allow them to achieve out and have a dialog round what that high-risk standing means.
This system has two parts. There’s high-touch after which high-tech. The tech is on the entrance finish, and high-touch is on the again finish when it comes to ensuring that this is not only a quantity or a radiology report that goes into the chart, however slightly there’s a human who has deep experience on this space. Our nurse navigators, on common, have 15 years of oncology nurse navigator expertise. They will present training but in addition present that emotional assist, as a result of discovering out you are high-risk for breast most cancers generally is a very demanding expertise.
HCI: I noticed you quoted as saying that roughly 20% of the ladies who are available to get a mammogram are literally at excessive threat. As you developed this system, did it’s a must to add extra nurse navigator positions?
Walker: Sure, we did rent a crew of nurse navigators, however we have additionally used the inhabitants well being instruments in Epic to automate the issues that may be automated and make them extremely environment friendly. The essential a part of that’s having our nurse navigator lead and her crew as part of the design course of to optimize the EMR in such a manner that it makes them extremely environment friendly. That is solely going to grow to be extra highly effective. There are extra automations out there. We’re going to be hiring extra nurse navigators as we scale this program. However due to the number of instruments we have now, they are going to grow to be more and more environment friendly and productive when it comes to the variety of sufferers they’re in a position to to handle and impression.
HCI: Is there a great way to symbolize the household well being historical past in Epic?
Walker: Sure, there may be the pedigree. However you even have to show that into discrete knowledge that rolls into Lunit’s threat pathway software program and is integrated into creating what we take into account essentially the most superior threat modeling out there.
Lunit’s threat pathways module takes the NCCN tips, that are actually the gold normal most cancers tips, and so they instantiate them into the software program. These tips are up to date, typically twice a 12 months, so there’s a variety of coding that has to go on behind the scenes to ensure that these tips are updated.
It serves two functions. One is to make use of the perfect evidence-based methodology to determine sufferers who’re high-risk, and two, if genetic testing is really helpful or extra imaging is really helpful, there’s going to be a pre-authorization course of, and that data helps with that pre-authorization course of.
HCI: Is there a task for genetic counselors typically, too?
Walker: There’s. We’ve some at AdventHealth, however there are simply not sufficient of them. They’re very laborious to rent, so we additionally companion with genetic testing firms which have genetic counselors on employees as nicely.
HCI: You’ve performed this spectacular work with mammography. Might this even be utilized to colorectal most cancers screening or in different areas?
Walker: NCCN tips additionally exist when it comes to hereditary threat evaluation for colon most cancers, and so they’ve simply up to date them as nicely. At the side of Lunit, we have up to date our modules. Now we’re breast, ovarian, colon, pancreatic, gastric, endometrial, and prostate.
We’re not solely going to develop the variety of cancers that we’re from a hereditary threat evaluation standpoint, we’re additionally within the strategy of increasing out to major care suppliers after which OB/GYN. In the end our imaginative and prescient is that this threat evaluation would be the normal of care for each grownup cared for by AdventHealth sooner or later within the not-too distant future.
HCI: Is it anticipated that following these high-risk sufferers extra carefully and dealing with them earlier will result in higher outcomes. Will there be a solution to measure that?
Walker: Sure. We’re within the strategy of measuring that, however it should take years. We’re already monitoring all of the downstream care that takes place, in addition to downstream outcomes, most cancers diagnoses, staging, and therapy. We’re already engaged on a number of manuscripts for publication.
HCI: If we appeared throughout the nation, what number of well being methods have packages like GRACE?
Walker: We’re not conscious of many who do. We have heard from Epic that we’re a frontrunner on this house. There are methods which might be doing good work. We’re not conscious of one other system that has performed all of the behind-the-scenes integration to combine the radiology and the PACS and all of the work it takes to to actually combine Lunit threat pathways into Epic, and couple that with the nurse navigator part.
HCI: Clearly, it is a variety of laborious work to do all that integration, as you say. However in one other sense, it looks as if a no brainer that you simply’d need to get forward of those diagnoses.
Walker: Sure, you’d. There are a pair the reason why maybe it hasn’t occurred. The rules weren’t mature sufficient. Additionally, for some time there was some pushback on genomic testing from payers, and it was nonetheless so new. However the price of genetic testing has additionally come down considerably, and can proceed to due to the event of recent applied sciences. I see this as an space that will likely be rising.
HCI: Has there been progress in pharmacogenomics, too?
Walker: There’s additionally been change there. Pharmacogenomics has been out there for nearly 15 years. With a few of the use instances round most cancers chemotherapy, and that getting integrated into tips, and with some Medicare’s reimbursement modifications, I feel you are additionally going to see a reasonably important uptick there.
HCI: Might you describe the rollout of GRACE? I learn it began in 2024.
Walker: Sure. We piloted it in two mammography facilities. We did a few iterative, enchancment cycles. You’ve bought to make your errors small so to get it to one thing that’s scalable. After which we scaled throughout our the remainder of our footprint in Central Florida.
HCI: And that’s 16 facilities, proper?
Walker: Sure, 16 facilities. Then Rocky Mountain went reside, and and now it is being applied throughout all mammography services within the AdventHealth nationwide footprint.
