FastTrack PGx Results: empowering timely tailored prescriptions and precision medicine
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This innovation envisions a near-future where every Veteran could benefit from Pharmacogenomics (PGx). PGx drives tailoring medications based on an individual's genetic profile. PGx can be leveraged to optimize drug effectiveness while limiting side effects. By utilizing PGx, clinicians can eliminate the trial-and-error and guesswork in prescribing: the RIGHT drug at the RIGHT dose for the RIGHT patient.
To set the stage in ensuring PGx thrives at the VA, we are developing agile solutions for the timely return of PGx results, making them readily accessible to the prescribing clinician. We are committed to
addressing the lack of interoperability and integration between the VA's electronic health records (CPRS) and the laboratory that provides the PGx results. This ambitious innovation boldly kicks it up a notch: the RIGHT drug at the RIGHT dose for the RIGHT patient at the RIGHT time (i.e. at the critical point-of-prescribing).
Origin:
March 2019, Durham VA Medical Center, Palo Alto VA Medical Center (Palo Alto, California)
Adoptions:
3 successful
Awards and Recognition:
(1) Senior Innovation Fellow, FY2024, (2) Director's Pick, Shark Tank Finalist, FY2025, (3) Selected project abstract for 2024 AMSUS Association of Military Surgeons of the United ... (1) Senior Innovation Fellow, FY2024, (2) Director's Pick, Shark Tank Finalist, FY2025, (3) Selected project abstract for 2024 AMSUS Association of Military Surgeons of the United States- The Society of Federal Health Professionals, National Harbor, MD, (4) Selected project abstract for 2024 Tri-Con Precision Medicine Conference, San Diego, CA, (5) Selected project abstract for 2024 AGBT Advances in Genome Biology and Technology, Aurora, CO, (6) Selected project abstract for 2024 Stanford Lean Academic Conference, Palo Alto, CA, (7) Selected project abstract for 2024 ASHG American Society of Human Genetics, Denver, CO, (8) This project was a featured article published by high-impact international Precision Medicine Journal, GenomeWeb, August 19, 2024 (VA Aims to Automate Input of Pharmacogenomic Data Into EHR, Studying Impact of Recommendations), (9) Impact of PGx in Mental Health, invited speaker for Sutter Healthcare Virtual Forum, July 2024, Sacramento, CA (sutterhealth.org), (10) The Healthcare Innovation Congress 2024, invited panelist for Federal Healthcare Innovations, Washington DC (www.thinc360.com) , (11) 2024 FORUM IMPACT Women in Leadership Award for this fellowship work (https://events.govforum.io/leading-for-impact-women-in-leadership/#winners)
Partners:
Innovation Ecosystem
Recent Updates
Overview
The problem
Main problem: the root cause is the lack of interoperability and integration between data systems (VA's electronic health records/CPRS and the reference laboratory).
Aim 1: The current state utilizes the ... The significant barriers to scaling PGx are (1) the turn-around time for the PGx results and (2) the access to PGx results at the point of prescribing.
Main problem: the root cause is the lack of interoperability and integration between data systems (VA's electronic health records/CPRS and the reference laboratory).
Aim 1: The current state utilizes the manual, error-prone uploading of PGx results into the CPRS. This innovation aims for end-to-end automation of pushing PGx results into the CPRS with rigorous failsafe system in place. Automation will significantly decrease the turn-around time/wait time of obtaining the PGx results.
Aim 2: The current state requires the prescribing clinician to log in to another resource to get the PGx results (search a heap of PDF files). This adds to burn-out and cuts away vital patient-clinician interactions. This innovation aims to make PGx results easily accessible. Without ever leaving the CPRS workflow, the clinician can check the PGx results and will be alerted as soon as they are pushed into the CPRS (alert set-up is scoped in this innovation schema).
Aim 3: The current state entails 5 FTE employees to manually enter the PGx results (PDF files). This innovation aims to ameliorate job dissatisfaction (from repetitive mundane task) through automation. Staff may be assigned to more meaningful patient-facing services. See more
Images
Above:
Current (trial-and-error) VS. PGx-guided (tailored) approach in prescribing
The solution
Files
- This innovation envisions a near-future where every Veteran could benefit from PGx. The Best Treatment is INDIVIDUALIZED Treatment
- Solution: process map of data transformation and transmission Integration of PGx results into CPRS
Links
- To get in contact with Dr. Relova, please visit this link. Rona Margaret Relova, MD - Contact Information
The results
DATA as of 8/2 ... Pharmacogenomics (PGx) is an evidence-based precision medicine approach that will transform the care we provide to our Veterans. PGx is a game-changer in individualizing care for every Veteran. This innovation (if supported to thrive) will move the needle in terms of our ability to integrate PGx into routine clinical care in near-real time.
DATA as of 8/29/2024:
Comparison of turn-around times of PGx results from proof-of-concept testing.
- Current state (manual data entry): 7-8 days
- Using this innovation: less than 2 minutes
#Veterans who can benefit from timely return of PGx results: average 5,877/ month
Veterans will take prescriptions with increased drug efficacy, and will experience less side effects.
#Prescribing clinicians who can tailor medications based on their patients' genetic profiles at point of prescribing due to easy access of PGx results: 8,418
#VA medical facilities that can be favorably impacted: 140 PGx testing sites
Cost mitigation 1: less ER visits or hospitalizations due to adverse drug effects (toxicity, etc.)
Cost mitigation 2: less waste of dispensed, unused medications that didn't work (discontinued prescriptions) due to the trial-and-error approach.
Cost mitigation 3: by leveraging automation tools, staff can save time, reduce manual errors, and focus on high-value activities such as Veteran engagement and relationship building. See more
Files
- Results of proof-of-concept: comparison of turn-around times Current State VS Near-Future State
Metrics
- #Veterans who agree to PGx testing = #Veterans who can benefit from timely return of PGx results. Tracking this metric monthly.
- #Prescribing clinicians who stay engaged (proxy measure: #PGx tests ordered). Clinicians will not order PGx tests if obtaining the PGx results is time-consuming and burdensome. Tracking this metric monthly.
- Prescriber's satisfaction survey.
- Veteran's (patient's) satisfaction survey.
- Cost analyses: amount of human labor costs (manual data entry).
- Time loss calculations: Time wasted on human-made errors or miscommunications.
- Operational bottlenecks: inability to connect to resource where PGx results are stored,
- Using CD-10-CM codes, track drug adverse effects or drug intolerance and investigate concordance with PGx results
Diffusion tracker
Does not include Clinical Resource Hubs (CRH)
Multimedia
Videos
Above:
Pharmacogenomics: When One Size Does NOT Fit All
Implementation
Timeline
-
Less than one week
Any site that has implemented PGx testing (currently there are #140 sites) may adopt this innovation for timely and easy-to-access PGx results. This project will utilize the Data Arch platform and the scope of work includes all the back-end technology and informatics for PGx results integration. The only requirement from the facility is to execute an MOU (partner site + Data Arch infrastructure).
Departments
- Medical Informatics
Core Resources
| Resource type | Resource description |
|---|---|
PEOPLE |
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PROCESSES |
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TOOLS |
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Support Resources
Files
- This is the value of end-to-end automation! Completed proof-of-concept testing in 3 pilot sites. NO COST TO SITES! NO STAFFING NEEDED! NO ADDITIONAL WORKLOAD!
Risks and mitigations
| Risk | Mitigation |
|---|---|
| As with any automation, potential errors in pushing PGx results to the wrong patient's records and/or alerting the wrong clinician could occur. | A rigorous validation process with audit reporting is being developed (live dashboard) and it will be updated in real time for prompt awareness of "unmatched" PGx results. |
About
Origin story
Original team
Dr. Rona Margaret Relova
Original Team Member, Senior Fellow for Innovation (VHA IE)
Dr. Cole Zanetti
Mentor/Lead Adviser (Medical Informatics)
Angela Gant-Curtis
Mentor/Lead Adviser (Technology)
Sweta Patel
Key Personnel
Annie Callahan
Key Personnel
Dr. Priya Joshi
Key Personnel
Jennifer Chapman
Key Personnel
Amber Goetschius
Partner
Kristopher Teague
Partner
Dr. Deepak Voora
Partner
Dr. Philip Tsao
Partner
Dr. Shriram Nallamshetty
Significant Contributor
Dr. Catherine Hong
Significant Contributor
Dr. Xiang (Becca) Li
Significant Contributor
Dr. Edrick Masangkay
Significant Contributor
Dr. Jennifer Lee
Significant Contributor
David Arreola
Significant Contributor
Colin McNerney
Significant Contributor
Paul Schmidt
Significant Contributor
Audrey Wong
Significant Contributor
Hong Nguyen
Significant Contributor
Laura Hutcheson
Significant Contributor
Michael Hill-Jackson
Significant Contributor
Dr. Jill Bates
Partner
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