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Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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UCLA Health to integrate genomic data into EHR in pilot

UCLA Health to integrate genomic data into EHR in pilot | EHR and Health IT Consulting | Scoop.it

UCLA Health will soon begin a pilot project with Seattle-based startup ActX that will integrate genomic patient data into its Epic EHR system, with the eventual intent of applying precision medicineto a large-scale patient base.

ActX, founded in 2012 and just out of stealth mode six months ago, collects a patient’s genetic information by way of a saliva sample, and then analyzes the information in real time. The data is integrated into an EHR – already, ActX is working with Allscripts and Greenway Health – and physicians will receive an alert about a medication and possible side effects, or warn of potentially serious risks for cancer.

Think of it as a 23andMe that is integrated into an EHR and available to the patient.

Molly Coye, chief innovation officer at UCLA Health, which operates four hospitals, said that’s precisely what intrigued the academic health system.

“Our goal is to try to bring precision medicine to a much larger proportion of patients,” she told MedCity News. “Right now it tends to be focused particularly on people with cancer, and even then on a low number of patients.”

She added that genomic data combined with an EHR could have “real clinical meaning for a larger number of patients than we could have known about five or 10 years ago.”

The pilot will begin in the coming weeks on 50 patients that the health system thinks will be a good fit, Coye said. Depending on initial success, it will be expanded to a greater number.

“If successful, and our physicians are enthusiastic about it, we’ll rapidly make it available more widely,” she said, adding that most UCLA Health pilots range from three-to-six months.

ActX co-founder and CEO Andrew Ury, a physician who has worked extensively in the EHR space, said up until now, few if any genomic data collectors have been integrated into an EHR. Dr. Ury previously worked for Practice Partner, which was acquired by McKesson in 2007.

As he sees it, EHR integration is the only way to harness genomic data on a large scale while at the same time providing the results for patient.

“We believe the way to do that is to build it into the everyday tool, the EHR,” he said. “The consumer factor is because we have to get the patient’s genomic data in order to make it work, so we offer access to affordable DNA sequencing. In order to that, we involve the patient.”

Given that UCLA Health uses an Epic system, which dominates the hospital market, Coye said the potential to reach a mass of patients is significant, and that such an EHR add-on could someday be a standard feature if it proves successful.

“They’re actually working with Epic, so decision support means a lot more if it pops up in the EHR,” Coye said. “This is going to be a game changer, I think. That’s the real promise that everyone recognizes about genetic testing,  that this will become a standard. It’s just a question of how you do it early on.”

Importantly, Coye cited the autonomous nature of ActX in how it’s available to both patient and physician.

Dr. Ury elaborated on the potential of precision medicine and EHR integration from a clinical standpoint.

“What this means is that if a patient’s genetic data is on file, because we’ve analyzed it, each time the physician writes a prescription in the EHR, it’s going to see if a drug is going to work, or if there’s an adverse reaction,” he said. “If there is an issue, the physician will get an alert.”

The data, and its use within an EHR, can also help physicians better determine if a patient is at higher risk of a genetic disease or a certain type of cancer. With that knowledge, more effective medications and treatments can be determined far earlier than before.

Coye said UCLA Health hopes the pilot can bring precision medicine to primary care and a further breadth of specialists “across a wide variety of clinical conditions.”

ActX is so far privately funded and has about 25 employees and independent contractors, including scientists, pharmacists, genetic counselors, physicians and software developers, according to Dr. Ury.

Dr. Ury noted that it’s “the dawn of precision medicine,” referring to the $235 million initiative championed by President Obama and overseen largely by the NIH.

“While genetics can’t predict everything, genetics can predict more and more and whether a patient has a side effect,” he said. “We think this is the future.”


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Top 10 EHR vendors in physician offices

Top 10 EHR vendors in physician offices | EHR and Health IT Consulting | Scoop.it

There's little question that Cerner and Epic are the giants in the EHR field. Epic is dominant not only in the scope of its market share but also in the depth of its client base. Mayo Clinic announced last month that it would be abandoning its three current EHR systems in favor of a new contract with Epic, which will now be the healthcare icon's sole EHR provider and strategic partner. Jilted in the deal were GE and Cerner, who were the providers of Mayo's current systemsalthough if you tallied the figures when Cerner acquired Siemens' EHR unit for $1.3 billion, it still had the largest US market share of any vendor, with 1,132 acute care hospitals. 

But a more granular look at market share amongst physician offices shows a slightly different market picture.



Epic is still on top, but only by a percentage point (eClinicalworks is close on its heels). And as you might expect, Epic's client base skews heavily towards larger practices, dominating the 41+ practice market at 54%. On the lower end of the scale (1 - 3), Epic, eClinicalworks, Allscripts and Practice Fusion are all within a percentage point or two of one another. 

Cerner, notably, is way down the list across the board in the physician practice world, taking just 3.5% of the overall market. So is athenahealth, at 3.3% overall and just 0.4% and 0.8% in the 26 to 40 and 41 and up segments. This tallies with the cloud-based vendor's ongoing investments in the inpatient market, however: In January, the cloud-based provider purchased start-up RazorInsights to move into the 50-bed and under sector, a niche that accounts for one-third of all hospitals in the US; and last week the company announced that it has purchased WebOMR, Beth Israel Deaconess' cloud-based, stage 2-certified EHR, for commercial development in the hospital setting.


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