KLAS: Providers See EHR Vendors Playing Limited Role in Precision Medicine

By | November 23, 2018

Many healthcare organizations are moving forward with precision medicine programs, but, so far, there is no single vendor solution covering all areas of precision medicine. With regard to precision medicine technology, many healthcare organization leaders are focused on niche vendors who have the experience and capabilities needed to address the specific challenges inherent in precision medicine and most do not see electronic health record (EHR) vendors playing a leadership role in precision medicine.

In short, precision medicine is too complex for EHR vendors, according to a recent KLAS report.

The transformative promise of precision medicine is often cited by healthcare industry leaders, both providers and vendors, as the driving reason why healthcare organizations need to begin their own clinical genomics programs. But with high barriers to entry, questions remain about whether precision medicine technology has reached a point where pioneering provider organizations have been able to realize a return on their investments, KLAS researchers wrote.

In a recent KLAS Precision Medicine Provider Validations report, KLAS researchers spoke with provider organizations about their approaches to precision medicine, applying genomics to patient care and the vendors they use. KLAS aggregated the results as a measure of overall performance in the precision medicine market. 

In a previous report on precision medicine, vendors weighed in on the functionalities they offer. KLAS researchers noted that while many vendors interviewed by KLAS previously stated that they provide services in multiple areas, the researchers found it difficult to verify that all of these technologies/modalities are actually in use by healthcare organizations today—even when speaking to reference sites provided by vendors.

Looking at the health IT vendor solutions being used, KLAS researchers found that healthcare provider organizations are extremely skeptical of the role of electronic medical records (EMRs) in precision medicine. Nearly three-quarters of providers interviewed (72 percent) do not believe that the EMR will play a primary role in the future of precision medicine, with several citing inherent deficiencies within EMRs as root causes. When asked what role their EMR vendor will play in precision medicine, 28 percent cited a limited role or “none”; 44 percent of providers see their EMR vendor playing a peripheral or supportive role; 20 percent said their EMR vendor would play a central, but non-leadership role and only 8 percent expect their EMR vendor to play a leadership role.

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Sixty percent of respondents use either Epic or Cerner for their electronic health record systems. Nine percent use Allscripts, nine percent use Flatiron and 17 percent did not identify their EMR vendor.

“Many respondents were not shy in expressing their feelings about EMR vendors’ roles, stating that the EMR in its current state is a hinderance to the advancement of the field and going so far as to call their vendor ‘a major issue,’ ‘not capable,’ or ‘not viable’ and state that precision medicine is ’too complex’ for EMR vendors to handle,” report author Kody Hansen wrote.

One healthcare executive interviewed said Cerner and Epic were both taking “baby steps” in the direction of genomic medicine but the EHR vendors face stiff competition from young biotech companies. “I don’t expect Cerner and Epic to play big roles once the big companies make the right plays,” the executive said, according to the report. “We have seen IBM Watson Health come to market too early and not become a profitable product. I am pretty certain that companies like Google, Amazon, Microsoft, and Apple will be very big players in precision medicine. It will be difficult for Cerner and Epic to compete. IBM built a platform only for adult cancers, so it wasn’t of use to us. It wasn’t built to meet our needs. We had discussions with IBM, but those discussions weren’t going to solve the problem. Certainly, cancer is one of two or three big areas that will grow within genomic medicine.”

Another healthcare executive said, “I don’t think that EHR vendors are motivated to take their systems from being records systems to being information systems….EHRs have the potential to dramatically help our understanding of future steps in patient care and patient liability, but the real question is whether users could actually extract the information in a useful way.”

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Overall, respondents feel that their peers looking to begin a journey into precision medicine should focus on niche vendors who have the experience and capabilities needed to address the specific challenges inherent in precision medicine.

The two respondents who feel that the EMR will play a leadership role are using specialty oncology EMR solutions, according to the KLAS report.

Fifty-nine percent of respondents believe that a precision medicine program does provide a positive return on investment. KLAS found that while a few have had some trouble personally realizing that return within their own organizations, most of these trust that the business case is quickly approaching.

“Currently successful organizations feel that having a precision medicine program allows them to treat patients holistically, which in turn leads to much greater patient satisfaction and retention. Among those pursuing a value-based care model, some have found that precision medicine successfully lowered their costs by helping determine patients’ genetic risk factors and engaging them in successful treatments that help keep them out of the hospital,” Hansen wrote.

Other organizations have also seen value in offering patients treatments utilizing genetic testing for infectious diseases, tumors, and rare diseases, and in offering pharmacogenetic testing to determine the best treatment for patients, leading to better outcomes and an increased number of patients seeking out these healthcare organizations for treatment, according to the report.

While providers may be skeptical of their EHR vendors’ capabilities for precision medicine, nearly nine in ten early precision medicine adopters are satisfied with their vendor(s), KLAS found, and, regardless of the solution in use, most of these organizations offer very similar opinions of their vendors.

“Many, even among those few who are currently dissatisfied, are confident that their vendors will continue to make improvements to the products over the next year, and this will, in turn, drive respondents’ overall satisfaction even higher,” KLAS reported. “Many interviewed organizations state

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they are currently working directly with their vendors as development partners and thus are the recipients of much more vendor communication and support than is typical across most segments measured by KLAS.”

Those few respondents who are less satisfied than the majority feel the technology offered by their vendors has not advanced to the level they initially were led to expect, with gaps remaining in integration, data display, and reporting capabilities and functionality limitations within the various systems, according to the report.

Nearly one in five respondents feel their vendor has not kept all promises that were made, leading to various levels of dissatisfaction and/or frustration with the products and vendors, the KLAS researchers report.

Although precision medicine is most often associated with oncology settings, provider organizations of many types have found utility in adopting precision medicine technologies to increase the quality of care that they are able to deliver, according to the report.

With no single vendor solution covering all areas of precision medicine, providers must align their needs with those vendors who are most adept in meeting those needs. KLAS researchers found that healthcare providers who have been successful in working with their vendors often use a number of best practices. These organizations define their organizational precision medicine objective—target a specific area or expand their solutions holistically and also determine whether they have a transactional relationship with vendors or strategic partnerships.

Organizations that have made headway in this area also invest in a decisive way, looking to specialty vendors to fill the organization’s needs. Don’t expect a one-size-fits-all solution, KLAS researchers note.

Other best practices includes design, validate and continually optimize the precision medicine solution and consider data storage needs beyond terabytes—expect to need petabytes of storage space.

Organizations should also venture outside standard testing practices because precision medicine is always changing, the KLAS researchers note.

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