A: Genomic medicine is poised to move quickly from the research realm into integration with healthcare delivery, but there is always a time lapse between technology advances and what we do with those advances.

A reference point I often use is from the technology industry. Moore’s Law, defined by Intel co-founder Gordon Moore in the mid-1960s, stated that computing power would increase by double roughly every two years. That held true for 40-50 years, along with a steady decrease in the cost to use the technology. Then around 2007 there was an explosion of cultural developments in the form of the sharing economy – for examples, the introduction of sharing services such as Uber, AirBnb, Hadoop and the iPod. It took decades for society to catch up with what cheap computing technology had to offer and to start deploying it in transformative ways.

In the field of genomics, the Carlson curve for DNA sequencing and cost is occurring significantly faster than Moore’s Law from the computing revolution. When you put the data points together of 1). The reams of genetic data we’re discovering in DNA and 2). The decreasing cost of sequencing, then what you have is faster sequencing and lots of data to work with in new and transformative ways for better health. Our ability to learn from and embed knowledge from genomics into medicine will continue to accelerate at a dramatic pace, and the corresponding explosion of cultural developments is occurring much sooner than we saw with the technology revolution.

A: As a healthcare provider that also does research and clinical trials, Providence St. Joseph Health has expertise in the cancer field.

If you look back 25 years ago, the cancer death rate was 210 out of 100,000. Today the rate is 160 per 100,000.

Through improved care for people diagnosed with cancer, including reducing risk factors, we’re helping save lives with personalized medicine and treatment. Along with many health systems, we’re changing the direction on cancer prognosis. We’re introducing hope for something that was once a life-ending scenario.

The drop in cancer death rate is a powerful example of changing population dynamics. It’s a sign something important is happening with precision medicine. The potential for all other health use cases is vast and is just starting to be tapped.

A: I see four areas for continued development when it comes to adoption of genomic medicine in clinical practice.

First, it’s going back to the Carlson curve and continuing to lower costs, especially for testing. We haven’t hit the right price point yet for clinical must-haves in testing for what I think of as “—omics,” which is not just the genome but also the proteins in blood and symbiotic organisms in our guts and skin that together form each patient’s genomic universe.

Second, we need to insure that insurance coverage mirrors the clinical necessity of testing.

Third, we need clear data ownership rights for individuals over their genomic information and data security for anyone privileged enough to access information about a human’s genome.

Fourth, our capacity to learn rapidly from information needs to expand. This will require clinicians and data scientists working side by side, computing power and algorithms that help us learn faster. At Providence St. Joseph Health, we’ve been integrating data scientists into our clinical leadership team for several years now, building a new muscle memory for our health system.

A: To me the three biggest and most immediate hurdles are around reimbursement, access to genetic counseling and integrating new genomic knowledge into medical practice.

Reimbursement for genomic testing needs to move to a less expensive price point, and we are looking to insurance companies to reimburse in more use cases. Right now it’s pretty limited to cancer instances. As we expand genomic testing beyond the cancer health scenario, we’ll need a mechanism in place to cover how testing will be reimbursed.

In general, new technology tends to be adopted by people with money. Over time the price comes down as the technology becomes a commodity, then more people have access to it. Today, genomic testing beyond cancer is still an early adopter or niche service for the “haves” in society.

Genetic counseling is an option for patients that was non-existent a few decades ago and it brings new territory to cover in the physician-patient relationship. It is important to understand what people want to know and to identify the potential of what can be done with information. Care teams will want to make sure testing only reveals what people want to know, similar to how we approach prenatal testing.

For example, in prenatal care, some expecting parents want to know the gender while others desire more insight on genetic risks like carrying genes for Alzheimer’s or Huntington’s disease. The clinical sector needs to work more with universities on identifying and articulating the risks and trade-offs of information, and how to communicate that to patients.

Finally, integrating genomic know-how into medical practice is daunting in some regards. The genome is unfathomably large, and expecting every physician to know every gene is not going to be realistic. We’ll need effective and simple systems to help doctors understand what genomic testing reveals.

A: As a clinician and health leader, the place I’d like to see the genomic community start focusing more is the treatment of disease. The power behind genomics is more about transformation in health and wellness. At Providence, we’re focused on what we call scientific wellness, which is identifying risk before a disease manifests and creating a personalized health plan that addresses behaviors that contribute to that disease. We could actually start preventing diseases from ever becoming manifest. To me, that is truly unlocking the power behind genomic testing.