Advancing Patient Care with Precision Medicine
Amazon Web Services Fix This Podcast
CLS’ President and CEO, Scott Megill, was recently interviewed on Amazon Web Services’ Fix This podcast
In this episode, you’ll learn how Coriell Life Sciences uses research and genetic science to develop precision medical care specific to each individual.
Ray Rogers, AWS Fix This (00:05):
I’m Ray Rogers. You’re listening to Fix This, a podcast exploring tech ideas and solutions to some of today’s largest challenges. What makes us who we are? It’s a complex question of nature versus nurture, but there is no doubt that much of who we are as individuals is determined by our own unique genetic makeup. Coriell Life Sciences uses research and genetic science to develop precise medical care specific to each individual with GeneDose LIVETM, powered by Amazon Web Services. GeneDose LIVETM is a tool that allows healthcare providers to quickly test and identify which prescription is the best fit for a specific patient in real-time. With the overall goal to ensure patients are only taking medications that work for them, improve medication efficacy, and reduce potential toxicity. GeneDose LIVETM can change the way patients receive care and the way healthcare is administered. Precision medicine can ultimately yield better patient outcomes, lower healthcare costs, and enable faster clinical decision-making. In the U.S. alone, medication-related mistakes cost over $40 billion a year. And by some estimates are the cause of hundreds of thousands of deaths annually. To better understand how cloud-powered precision medicine is changing patient care, I talked to Scott McGill, president and chief executive officer at Coriell Life Sciences
Scott Megill, Coriell Life Sciences (01:25):
Coriell Life Sciences is a spinout from the Coriell Institute for Medical Research, which is a nonprofit research institute that’s been working in the field of genomics for the better part of 75 years. We created Coriell Life Sciences in 2013 to scale up and commercialize a particular area of genomics called pharmacogenomics, which really uses the information that we can glean from genetic testing to help steer appropriate medical care.
The field of genetics has seen such rapid growth in the last 20 years, especially. Today we have technology and the capability to understand at the patient level, their unique genetic makeup. Can you tell us how this advancement has changed the way medical doctors and researchers think about delivering effective care with precision medicine?
When we think about a doctor asking you if you have any family history of heart conditions or cancers, what they’re really asking is is there something in your genetics that would make you determined in some way to have more of a risk of these things than others? So, with the advent of now technologies that allow us to quantitatively measure the variation in human genome, we can start to use that in a much more precise and much more predictive way. Where we’re seeing that implemented most frequently today is in cancer genomics. So, we can look at the unique changes that happen in a cancer tumor versus the apparently healthy cells of that individual and help steer the course of treatment appropriate to that specific kind of cancer. We’re also seeing this in a very big way in medication management because so much of what happens in the body as it relates to how medications will actually react for that person is due to their own genetic makeup.
So, zooming out, how big of an issue is this? How often are patients prescribed medication that may not work as intended for them?
I think the FDA has actually said about half of the medications that individuals take on a regular basis are not effective for their care. Or they may be doing what we intend the medication to do. So think of a statin for reducing cholesterol. It may be doing a good job of reducing your cholesterol numbers, but at the same time it’s causing you harm in other ways. It could be causing joint pain or inflammation or unintended consequences that really are not the best suited medication for that person. And those are very often things that can be directed by genetic testing, helping us to understand the right statin to put that person on that would be both effective and safe. When we look at a typical self-insured employer, about 20% of their overall healthcare spend is on medications. The rest of that money is generally used for the additional healthcare services that are required, but of a huge portion of those additional services are related to those medications. So, people who have to go to the emergency room because they’re not receiving the appropriate treatment from their medications are largely treatable in this way if we can identify the differences in their genetics that would make one pill right for them and another one inappropriate.
I’m hoping that you can tell us a little bit more about some of the barriers that have traditionally blocked all of this research from being implemented in clinical settings and actually helping individual patients. So, how is the science catching up really to what we’re able to deliver today?
This is really a totally new paradigm. So, in the past, when we think about laboratory testing, we think about a particular vital of an individual being tested, being measured, and then an answer being immediately available. That’s not really how genetics work. With genetics, we’re looking at dozens, tens of dozens, potentially thousands of genes, that can all be different in different ways, person to person. And it’s not one answer that can be derived from one gene. So, it’s a really complex issue. And when we think about genetic testing as a whole, it’s become cost-effective to test large portions of the genome, as opposed to single genes, which means we can create a data asset for individuals that can be interpreted for today’s problem, but also reinterpreted it in the future. So, we’re not trying to do anything dramatically different. When we talk about the utilization of genetics, it’s the implementation of some new information alongside of what they already do. So, it’s really been the introduction of this in a non-disruptive way, and introducing it into the payment system such that it can be reimbursed and these services can actually be paid for.
Tell us about GeneDose LIVETM, which is a tool that Coriell Life Sciences has been developing. What exactly is it? Who’s using it and how is it helping to provide some of that information that doctors actually need to make those calls at the patient level?
GeneDose LIVETM is a clinical decision support tool. What that means is it’s technology. It’s an application that clinicians – whether they be pharmacists or physicians – can use to create the appropriate medication plan for a patient, bringing together all of these different facets of risk. Not just the genetics, but all of those other things as well. What conditions does this person suffer? What do they eat? What do they drink? What do they smoke? What potential challenges might they have because of their stage of life? When someone is older, certain medications can’t be tolerated as much as when you’re younger, if you’re too young, if you’re a juvenile, some medications are also inappropriate. If you’re pregnant. Things like that. All of that is an awful lot that needs to be accounted for all at the same time, along with the genetics and that’s generally something that a physician or a pharmacist, frankly, doesn’t have time to do that kind of due diligence on a particular patient. So, we need tools to do that. And that’s what GeneDose LIVETM is. It’s a real time modeling system that takes into account all of those various risks and helps those physicians and pharmacists see the alternatives in real-time that are better suited for their patient. So, it could be that it’s a pharmacy team that’s doing reviews for a particular population. It could be a doctor who sees only their patients. The system has been designed such that it’s role managed. You can see your patients. Each one of them, you would consider like a case. So, you can open that case. You can see the risks associated with their current treatment plan, genetic and non-genetic, and then you have an ability to action that by creating alternative regimen trials. So, you can try out different drugs and it will test each of them against every one of those variables. So, very graphically represented, it’s is a reduction or increase in risk across many, many different vectors, including genetic and non-genetic. So, it gives them a quick and easy way to bring together what would otherwise be an awful lot of research they would have to do to understand what those risks actually are.
What is the process like for the patient?
In most cases, patients are identified by their healthcare provider as being someone who is appropriate for this kind of testing in this process. Generally, that means they are someone who’s being treated for a chronic condition. It may be someone who has had previous medication failures. In the case of someone who is identified for this service, they would be educated through some outreach and some enrollment process to go ahead and sign up. We either do in-home collection through spit tests through what looks like an Ancestry.com or 23andMe kit. But a tube arrives in the mail, they spit in the tube, and that goes off to one of our laboratories for processing. From there they are then contacted to say, your results are in, we’d like you to schedule an appointment with one of our pharmacists, and that pharmacist will then assess, using GeneDose LIVETM, the results of the test and all the other risk factors for that patient. The process then ends with that medication action plan, which is really the recommendation of the pharmacist back to their own physician. Very easy for the patient to then get engaged with their doctor, because their doctor has been briefed by the pharmacist on what those changes should be. The really good news on all of this is it works. We have a tremendous amount of feedback that we get from our patients. We generally survey some of those individuals. We talked a bit about mood disorders and mental health. One of the anecdotes that I have here from one of our patients recently was, “I had previously been taking a different antidepressant med for 15 years for severe depression and hospitalization. Once I received my results, my med changed from SNRI (serotonin and norepinephrine reuptake inhibitor) to SSRI (selective serotonin reuptake inhibitor) meds, and I’ve never felt better. My family, friends, and neighbors have been over to with the change.” That’s pretty typical for someone when we are able to identify that root cause being either genetic or non-genetic for medication failure, the results are pretty dramatic. So, we love getting that feedback. It certainly is what gets us up in the morning and it’s what gives us the reason to continue to push this further and further into the health care environment.
GeneDose LIVETM runs on AWS. Why build on the cloud?
If this were a tool that needed to be installed locally in every hospital system or only available within certain clinics, it would be far less useful. This really needs to be available on mobile devices. It needs to be available from a geographic perspective everywhere that clinicians are doing their work. This very much lends to a hosted environment where we can really leverage the core technologies that are brought to bear by AWS. And that includes database security, everything that we do from a redundancy and scalability perspective, without us having to manage a data center. Without us having to bring in lots of different, best-of-breed technologies and try to cobble together something that’s very specific for each use case. Instead, we can develop more of a hub and spoke model that allows all of those potential endpoint users to reach into a central, constantly evolving system, without us having to push updates to all of these specific endpoints. So, this really, quite frankly, couldn’t be developed in anything but the cloud because of how fast all of this information changes and evolves.
How do you see GeneDose LIVETM fitting into today’s medical landscape and how will building on the cloud help Coriell Life Sciences deliver?
For a patient that’s seeking treatment for something that, in their life, is affecting them to the point where they needed medication, it’s often a six-to-eight-week journey per medication per dose. If we can immediately avoid certain medications because we know their body’s not going to tolerate them or they’re not going to be effective for them, we can shortcut that whole process, get people to treatment faster, and certainly reduce all of those downstream economic costs that come along with an untreated mood disorder. So, in this space GeneDose LIVETM really fits this bill very well because, as we see more and more individuals that are being diagnosed with mood disorder and mental health conditions, GeneDose LIVETM and this whole process of genetic plus non-genetic factors can really get you there faster. And that’s really what this is about. Let’s avoid all of the missteps. Let’s shortcut this journey and get people to treatment much faster than they might otherwise.
Scott Megill LinkedIn: https://www.linkedin.com/in/scottmegill/
Coriell Life Sciences’ Medication Safety Program: https://corielldev.local/resources/corigen-at-a-glance/
Amazon Web Services Fix This podcast: https://aws.amazon.com/solutions/case-studies/fix-this/