Most healthcare leaders now see genomics as a significant leap forward in medicine. But now we’re starting to unpack what that means for our hospitals.
My personal ‘a-ha moment’ happened while I was Chief Medical Officer at The Royal Melbourne Hospital. At that time, I was on the Board of the Melbourne Genomics Health Alliance and had oversight of some fantastic projects.
I learned two things very quickly.
First, there’s real, substantial clinical benefit in genomic medicine. We were seeing reduced diagnostic odysseys, patients getting treatments they may never have received otherwise, and changes to drug regimens tailored to the individual needs of each patient. Not to mention the significant population and public health benefits from using genomics to track and control superbugs.
Second, clinicians were far ahead of their hospital leaders in being prepared and knowledgeable about this field of medicine. But those clinicians didn’t always have the system knowledge or context to scale and mainstream innovation.
We need the combined expertise of clinical champions and healthcare leaders to ensure that genomics is mainstreamed in a safe and effective way.
Hospitals really need a plan for genomics
We used to think of genomics as a test for rare diseases, but that’s changed now. It has utility for very common conditions in renal medicine, neurology, cardiology, haematology and other cancer care – not to mention pharmacogenomics, infectious diseases and the breadth of applications that exist there.
Hospital leaders have a responsibility to translate the fantastic benefits of genomics into safe and effective clinical care.
We use clinical governance frameworks to help answer questions like: Is the care safe? Is it timely? Is it efficient and effective? Is it equitable and person-centred?
While these frameworks are common, they’re not generally designed for a field as encompassing as genomics. And genomics has some unique and uncommon features that we need consider.
For example, we need to know that our workforce has the right skills and support to provide genomic medicine effectively. We need to prevent unwarranted variation in care, and we need to be sure that the care we’re providing has real value to the community.
Good quality care makes every health dollar go further
Every hospital leader has a thousand competing demands, but for me, there are very good reasons to put genomics high on the list.
The health budget is extremely tight, and every hospital is trying to find savings right now. But providing quality care is one of the best ways to ensure health dollars don’t go to waste.
Without the diagnostic insights from genomics, we’ll continue to see patients with an increased length of stay in hospitals, more adverse events, and more unnecessary interventions. All these are bad for patients and greatly increase the cost of care. So providing high-quality genomic medicine will help us avoid more of these events in the future.
Genomics should be embedded in all relevant specialties
What we’ve done in the past with genetic testing – funnelling every patient through a clinical genetics department – soon won’t work with genomics.
While referring all patients to a genetics department puts a level of control around the process, we know that it causes significant bottlenecks and pressure on clinical geneticists.
Increasingly, we’re moving towards a more holistic concept of genomic medicine as part of routine care.
Doctors from multiple specialities will need to be able to identify patients who need genomics, order a genomic test, and use the test result in patient care – saving only complex cases for clinical genetics.
Right now, genomics is being driven by clinicians who are at the cutting edge of their field. They’re committed to the patient in front of them, and to whatever potential treatments and interventions that patient might need. This is a common driver for evolution and innovation; and as hospital leaders, we have an obligation to nurture innovation and translate it into safe and effective care – as tricky as that can be when we have so many competing demands.
A toolkit for hospitals on their genomics journey
Hospital leaders said they could use some guidance in planning for genomics.
So we’ve been working with hospitals across Victoria to develop a toolkit that covers the foundations: from creating a genomics leadership group, to workforce planning, models of care and consumer engagement.
Something really interesting is happening in these hospitals. A shared space is being created for clinicians and hospital leaders to talk about genomics, and there's real value emerging from these conversations. For me, that’s a big step forward.
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