Precision health offers one of the clearest pathways to reducing waste and avoidable harm in modern healthcare systems, but it will require a concerted effort by governments, health systems, regulators, academia and the private sector, according to a report prepared by Beamtree’s Global Impact Committee (GIC).
The report “The Risk of Imprecision – why we must get precision health right” poses many of the “big questions” about precision health – from the cost of gene therapy to access and equity, workforce education, ethics and trust, regulatory systems and data foundations.
It says, “At a time of growing public distrust of scientific evidence and expert health advice, there needs to be open, transparent discussions with communities and patient groups about what precision health involves and how personal data will be protected.
“As precision health techniques such as genetic screening for cancer treatments become routine, securing and maintaining public trust will be vital.
“The other big challenge is ensuring access for all. Indigenous and First Nation communities risk exclusion through low levels of trust rooted in historic experience alongside under-representation in genetic databases.”
The report also predicts precision health could stall without significant workforce reform.
It says global demand for clinical geneticists already outstrips supply, with shortages reported across the US, UK, Australia and Europe. “With escalating demand for healthcare, a global shortage of doctors of all disciplines and rapid growth in genetic testing and research, there is no prospect of ramping up training of clinical geneticists to keep pace.”
Instead, most clinicians will require at least foundational genomic literacy, for example including knowing when to order tests, how to interpret results, and when to escalate to specialist advice.
Despite the challenges, the report concludes that “the prize is great”.
Precision health is here
“Precision health isn’t the future, it’s already here,” GIC member Professor Keith McNeil, a physician with over 40 years of experience told Pulse+IT.
But he says health systems are “stuck” at a plateau where incremental safety improvements are no longer enough.
“A safe, high quality, sustainable health system cannot be achieved unless we address the waste and harm our current systems inadvertently deliver,” Professor McNeil said.
Quoting the 60-30-10 Challenge that only around 60 per cent of healthcare is evidence-based, 30 per cent is wasteful and 10 per cent causes harm, he said precision health was essential to shifting that balance.
“We are engineering this unintentional waste and harm, both into and out of our systems through the digital healthcare agenda, and specifically via modern digital ecosystems and EMRs. Where we get it right, we do it very well. But we’re stuck now at a level, and we just don’t seem to be able to engineer any more safety into the system doing things the way we currently do them.”
Trial and error
The Beamtree report outlines how genomics, pharmacogenetics, AI and advanced data integration impact diagnosis and screening.
Professor McNeil said pharmacogenomics offered a potential way to avoid “trial-and-error” prescribing altogether.
“Because we don’t understand patients as well as we could, or should, we don’t get it right all the time and we don’t always get it right the first time,” he said.
One example, he says, is medication prescribing. “You might start someone off on a standard, evidenced-based treatment and say around 60 per cent of people will do well on it. But there will be a proportion that get side effects necessitating achange of the treatment. And there will be an additional proportion where the treatmentdoesn’t work as effectively as needed/intended, so you pick another option after a six week to three month “trial”.
“That’s waste. Unintended and sometimes based on the best evidence, but still waste. It’s a waste of resources and it’s a waste of the patient’s and clinicians’ time.
“As we understand patients at a more granular level however,– phenotypically and increasingly at a molecular level – which is what precision medicine is all about, we will be able to more accurately choose the right treatment, the most appropriate diagnostic modality, the operation that is most likely to benefit them the first time. So, we avoid that waste and minimise the chances of doing harm,” he said.
On cost of genomic testing
The Beamtree report says while the up-front costs of gene therapy will remain high for the foreseeable future, the net costs considered when deciding whether to provide a therapy should reflect savings elsewhere in the system, such as years of ongoing treatment and chronic care management. “While the costs are internalised to the healthcare system, a large portion of the benefits are externalised.”
Professor McNeil said the benefits are system-wide and societal. “Because keeping people healthy, making them better, getting them out of hospital early, giving them the right treatments gives you a societal benefit in terms of the general health and prosperity of the population, which in turn flows into generating more prosperity and avoiding other costs. But those benefits never flow directly back into the health equation.”
He said it was important not to think of precision health as being just about advanced sciences and genomics. Rather, it was about having the right information to make the best decision.
“The delivery of healthcare has always been done person-to-person, so it is ‘personalised’. What we are talking about is highly tailored, or targeted, therapy framed around an individual so it is personalised to them,” Professor McNeil said.
“Fundamentally, healthcare has always been about a clinician sitting down with a patient, asking questions and listening.
The whole reason we ‘digitise ’healthcare, is to generate data and actionable insights that can accurately inform that conversation and the resulting actions and interventions.
“If the clinician has the right information at their fingertips — and increasingly if the patient does too — then more often than not the right decisions about their treatment are made the first time.
“That’s how you embed sustainability. That’s how you eliminate waste. That’s how you reduce harm. It’s that simple.”
