Creating Proactive and Holistic Health Insights through Genomics at Population Scale

NorthShore – Edward-Elmhurst Health believes genomics represents the next frontier of medicine. It plays a key role in preventing disease through targeted screening, early identification of patient risk, and proactive intervention before disease develops. This results in more personalized and informed care and better outcomes for our patients.

NorthShore, which serves Chicago and neighboring suburbs, in 2019 launched the largest primary care-based genomics program in the U.S. The response was a strong indicator of patients’ and clinicians’ interest in understanding how genetic factors impact treatment and screening decisions. Today we have one of the nation's largest population-based genomics programs in primary care, involving more than 50,000 patients. At the Mark R. Neaman Center for Personalized Medicine, we are tailoring patient care through translational genomic testing and insights at the frontlines of care delivery.

Our experience and expertise in genomic medicine allows us to bring a greater level of understanding and awareness to our patients, supporting deeper relationships, better outcomes, and informed preventative recommendations for the individual and family. Not only do we offer specialized clinics for conditions such as Alzheimer's disease, cancer, and heart disease, but we also have one of the only pharmacogenomics clinics in the country that preemptively provides genetic testing to help predict how patients will respond to certain drugs.

Prioritizing Patient and Clinician Experiences

Our role goes beyond providing the latest clinical and technological advances. We know we need to make care more accessible, engaging, and valuable to the communities we serve. Our goal is to create meaningful value, as opposed to leading with a solution in search of a problem.

Today caregivers on average spend about 20 minutes with a patient during an office visit. We designed our genomics program with insights incorporated into existing clinical workflows in easy-to-understand snippets. This ensures a 20-minute interaction is focused on the most important dialogue between a doctor and patient, while also integrating the latest in medicine.

Patients hear about genomic testing as part of their annual physicals, because that is when they are naturally thinking, “What should I be doing to put myself in the best position to preserve my health?” We are having an impact — 87% of physicians participating in our genomics offerings report that clinical genomics have elevated their practice and provided meaningful value to their patients.

Experience goes beyond the actual administration of the test and the delivery of results. In one example, a patient with no family history of breast cancer learned she was genetically predisposed to the disease. In addition to sharing this information with her in a meaningful way, we supported the patient in meeting with a geneticist and cancer and surgical experts to understand the options for her own health journey. We also facilitated conversations with this patient’s daughter, who ultimately learned she had the same genetic predisposition. Providing meaningful impact includes partnering with our patients throughout their journey.

NorthShore – Edward-Elmhurst Health holds a fundamental belief that the best care is based on trust and relationships. Our community-connected network of providers, combined with an integrated system that provides actionable data about our patients’ health, sets the foundation for meaningfully improving the immediate and future health of the people we serve.

Addressing Patient Barriers

The cost of genomic testing has traditionally been a barrier – for health systems and
patients alike. Thanks to scientific and technological advancements, however, the cost of testing has decreased. We are focused on helping patients, doctors, and other health professionals understand the benefit of clinical genomics. We are also working with our philanthropic partners to offer financial assistance to those who need it and partnering to improve the health of our communities.

NorthShore has built predictive digital tools based on National Comprehensive Cancer Network and American College of Obstetricians and Gynecologists guidelines to help physicians identify when patients may need genomic testing. This approach has increased payor support for these diagnostics. In some cases, patients have no out-of-pocket expenses for guideline-based family history screening. If patients do not have a family history of disease, NorthShore offers appropriate testing starting at just $100.
A major component of NorthShore's primary care personalized medicine program is understanding and addressing cultural differences impacting adoption of genomic care. Through relationships with community leaders and investments in research, we are exposed to cultural perspectives about identity and family. All of this has played a critical role in the language we use and the processes we develop to build trust at every point of the process.

Scaling Clinical Genomics Systemwide

NorthShore’s patient outcomes demonstrate that integrating genomics into primary care is having a significant impact. One in every 10 individuals who receive a genetic test at NorthShore discover an insight, such as an inherited risk for disease, which is likely to impact their health decisions. The next steps are to continue to share the outcomes and benefits with clinicians, and to scale the existing infrastructure to serve more individuals.

Today, more than 95% of NorthShore primary care doctors are utilizing genomics in their practice to deliver meaningful impact to their patients. NorthShore’s recent merger with Edward-Elmhurst Health creates the opportunity to expand the benefits of clinical genomics across a larger population. Our new system services more than a million patients and has an opportunity to impact 4.2 million residents in the surrounding communities across Illinois. To be successful in scaling access across our communities, we continue to invest in a workforce culture that embraces genomics as a critical component of care. We are aligning the best minds, capabilities, and partners to help us realize big aspirations and deliver disruptive change.

Genomics data can be cumbersome and difficult to translate. Since our goal is not to turn our clinicians into geneticists, we had to create just-in-time electronic insights within already established clinical workflows that we know work for our primary care clinicians. These need to be as simple as a pop-up prompt when a PCP writes a prescription to suggest a different drug or alternative dosage based on that patient’s genetic insights. Given that 99% of patients receiving a genetic screening with us have a finding related to a drug interaction, this type of process is incredibly valuable.

The field of genomics is undergoing tremendous innovations and growth. The systems we create need to scale not just across people but across new insights. Ideally, every time a patient comes in for a physical, they can gain new understandings that will impact their longitudinal health. Our implementation approach is focused on ensuring we are not just getting patients to participate in the theoretical concept of genomics but that we’re continuing to give them practical new information that will have a meaningful impact on their health.

It Takes a Village

In an industry like healthcare, where there are numerous health gaps to address, it takes discipline and commitment to allocate the time and attention to explore what is possible in the future while solving the problems of today.
Like most transformational projects, success relies on effective partnerships between clinical, operational, financial and communications leaders who are committed to create meaningful value for patients, communities, and our own organization.
Any health system embarking on a clinical genomic journey should be confident in the opportunity to improve patient outcomes and experiences while aligning with the organization’s core values. For NorthShore — Edward-Elmhurst Health, the value proposition is clear.

As patients and clinicians are increasingly interested in understanding the relationship between genes and diseases, it is the role—and even the responsibility—of community-connected health systems to ensure their community members have access to rapidly evolving scientific and technological innovations. At NorthShore – Edward-Elmhurst Health, we believe those innovations are part of our commitment to providing the best care to our patients and communities.

About the author:
Kristen Murtos is the Chief Innovation Transformation Officer for NorthShore – Edward-Elmhurst Health and is responsible for driving innovation and growth to enable peak organizational performance and sustainable differentiation through systematic business and care transformation. Click here to learn more about her. To learn more about the system’s commitment to the advancement of personalized medicine through research at the Mark R. Neaman Center for Personalized Medicine, click here.