Pharmacogenomics (PGx) at UCHealth, getting serious about Personalized Medicine (published article)

Thanks to Pharmacogenomics Journal at Future Medicine

https://www.futuremedicine.com/doi/10.2217/pgs-2020-0007

Thanks to Christine Aquilante, lead author and main force of nature behind our early experience with Pharmacogenomics. Pharmacogenomics is the specifc branch of Genomics and Personalized Medicine that deals purely with “drug-gene pairs” or how a patients genetic variants might affect their ability to process and metabolize medication. The upshot is: some patients don’t respond well to some medications. There are now several dozen drug-gene pairs well described in the literature, where patients won’t respond well to certain medications because of their genomic variant. However up until now, it has been difficult to get any knowledge of such variants in front of the patient and prescriber at the most important time: when deciding on a new prescription.

UCHealth has a Biobank where we have obtained research lab samples from over 100,000 patients (drawing an extra lab tube in the course of routine clinical care) and have been testing samples for pharmacogenomic markers. In a few cases, we have found clinically relevant genetic variants that we are beginning to deliver back into the Electronic Health Record in the form of test results for clinician, in the form of test results and notification to the patient in the patient portal, and finally and most importantly, to the prescriber of the affected drug AT THE TIME OF PRESCRIBING for any affected patient.

This is groundbreaking, and hard work on so many levels:

  • Have to educate providers about pharmacogenomics: something that most did not learn in school
  • Have to educate patients on complexities of homozygous, heterozygous, population risks and multiple gene variants, balancing transparency with unintended alarm
  • Have to figure out when/how to alert prescribers at just the right time, for exactly the right population so that we don’t overstep what the science tells us is true in the research. In other words, don’t alert ALL patients with the genetic risk and a particular prescription if 99% of them will NOT ultimately have a problem with that prescription.
  • Lots of other things to think through (we just spent an hour just starting the conversation on our next drug-gene pairing)

CMIO’s take? We are happy to be among the few organizations setting up, and scaling up our efforts on Biobanking: conducting research AND benefiting patients in clinical care with PGx. Here we are expanding the boundaries of medical knowledge, and turning around to translate this into better decision making for our providers and patients.

The EHR fights Hepatitis A outbreak!

From UChealth.org

https://www-uchealth-org.cdn.ampproject.org/c/s/www.uchealth.org/today/hepatitis-a-outbreak-colorado/?amp

Always excited to see awesome work from smart, altruistic colleagues. Our own Kelly Bookman, Senior Medical Director, Emergency Department and physician informaticist, helped develop and deploy a Clinical Decision Support alert in our Electronic Health Record, in conjunction with Michelle Barron, infectious disease specialist and Infection Control director, among other analysts and experts.

With a major outbreak across the country, including the regions we serve at UCHealth, the team built an alert for Emergency department docs, scouring patient charts for those who are at increased risk for Hep A, and reminding docs to prescribe the vaccine during the course of their ER visit, regardless of original reason for the visit. This resulted in hundreds of additional vaccinations to protect our most vulnerable patients.

When patients can’t afford it, UCHealth covers the cost.

Finally, our team shared our design and code with other hospital systems in our region, to protect more patients.

CMIO’s take? THIS is what the EHR does well. I’m grateful to awesome colleagues, and hopeful about our future.

Bowling Alone or Kicking in Groups? Wellness concerns…

I’m part of WellDOM, the Wellness initiative within the Department of Medicine at University of Colorado. As such, I continue to support the idea of Sprints, the way we boost physician and team efficiency and effectiveness using the Electronic Health Record. However, we know that a large part of physician burnout and wellness have to do with other components: a Culture of Wellness and Personal Resilience, in addition to Practice Efficiency.

In thinking more about these broader components, I’m reminded of the work of Robert Putnam’ Bowling Alone, a towering work, documenting the decline of civic virtue and engagement in this country, illustrated most profoundly by the fact that membership in bowling leagues has declined 40% from 1980 to 1993, while individual bowlers rose by 10%. There has been a dramatic drop in face-to-face social gatherings outside of work in the past few decades, and the thought is that this decline in the social fabric has led to isolation, loneliness, and a general decline in civility and personal resilience. See the recent Atlantic article “Kicking in Groups” on this, also.

We’re looking for objective measures that might allow us to survey for and detect burnout and resilience, that might get past ‘soft’ measures like “do you feel burned out” and perhaps measure “Do you have social groups that you meet with regularly at work” or “Do you have social groups that you meet with regularly outside of work”, and also “Do you meet regularly with a mentor or mentee?” We believe that measuring such behaviors MIGHT be a more objective way to determine who is more protected, and who is vulnerable, to burnout.

CMIO’s take? Physician/provider burnout is a real thing; difficult to address; and may be embedded in a larger change in the social fabric. Are you having success thinking about and intervening in this fraught area? Let me know.

Five healthcare schools on one campus! Innovation on the Anschutz Medical Campus.

img_1451
Weird spirochetal sculpture at Education Quadrangle, Anschutz Medical Campus

It is amazing that 5 major health schools are in shared buildings with shared resources on one campus: medical, dental, nursing, pharmacy, public health. I believe we may be the ONLY campus with such shared facilities and schools in one place! The cross-pollination of ideas between these schools, their faculty and students and projects is fertile and exciting. Add the CU Innovations unit that pulls in the healthy startup community in Colorado, and see what sprouts up! (Watch this space for some outcomes of this work.)

The history of Anschutz Medical Campus (named after Phil Anschutz, tycoon with history in oil, railroads, telecom) goes back to Fitzsimons Army Hospital from 1927, a World War I recuperation hospital. Back then Building 500 was the main hospital (see center of this interactive map).

We’ve come a long way from a square mile of military marching fields with a solo hospital in the midst, to being Eisenhower’s recuperation hospital in 1995, and now we are a square mile of a medical campus with over 30,000 employees and 3 major medical centers (UCHealth, Childrens Hospital Colorado, and Denver VA Medical Center).

Zoom! Powers of 10 IRL! How about a zoomable EHR?

From Science News

https://www.eso.org/public/images/eso1242a/zoomable/

Click the hyperlink (not the image) above. This is a ZOOMABLE 9 billion pixel image with 84 million stars (thanks to Seth Godin’s blog for the link). Thanks to the European Southern Observatory for hosting this image.

Makes you think about our relative place in the universe. I’ve been fascinated with the night sky and have followed our exploits in astronomy, the Hubble, etc. BUT! to have a single image where you can click and zoom in (or shift click to zoom out) gives you a sense of the truly massive scale of our universe.

This reminds me of the movie we watched in elementary school: “The Powers of 10” from 1977 (see it here). What I did NOT know is that Morgan Freeman narrates a NEW version of the Powers of 10 that includes more modern discoveries (here!).

CMIO’s take? Humbling to say the least. How often do we get our nose off the grindstone and look up? And then to have such a depth of data and an amazing tool to zoom in and out of our place in the universe? Would that our EHR could do that as well… Hmm….

Transition metal chalcogenides OR THE FUTURE IS 2D, via NYTimes

The future is 2D. Never thought I’d say that. Also, love the writing in this piece. In too much scientific writing, the concepts are dry and hard to follow. Excellent science writing, like this one, uses metaphors and analogies to liven up the discussion and make it much more digestible to lay audiences.

Dr. Urban compared the process to baking chocolate chip cookies, where magnesium is the chocolate chip — the key part — because it holds the hydrogen. “We want a chocolate chip cookie with as many chocolate chips as possible,” he said, and graphene nanoribbon makes excellent cookie dough. 

Hooray for story-telling scientists, and for excellent journalism.