CHICAGO – AccessDx Laboratory, a Houston-based CAP/CLIA diagnostic lab, and EMR integration specialist Jase Health seek to fill in a missing piece for healthcare providers looking to start or expand clinical pharmacogenomics programs: delivering clinical decision support based on patient genomic profiles directly to the point of care through electronic medical records.
AccessDx, which also has New York state certification, offers molecular services including COVID-19 testing, pharmacogenomic testing, cancer genomic screening, and respiratory pathogen panels. Jase Health, of Johnston, Iowa, integrates outside technologies into EMR products from Cerner, Meditech, Epic Systems, Athenahealth, Allscripts Healthcare Solutions, and others.
The firms said last month they would work together to embed lab processes into clinical workflows within major EMR systems.
As part of this partnership, Jase Health gives AccessDx an entry point to large healthcare systems by addressing what Houda Hachad, vice president of clinical operations at AccessDx, called the "last mile" of connectivity for bringing pharmacogenomics to the point of care.
"Pharmacogenomics is not a book, chapter, and verse diagnostic," explained Joe Spinelli, AccessDx senior vice president for product and strategy. "It has to be used correctly within a clinical world. It has to live within the medical records systems."
Spinelli said that it falls on vendors like AccessDx and Jase Health to manage data from multiple sources "to figure out how to elegantly deliver it to providers so that it's not just one more button, not one more alert, but truly provides [clinicians] the information that they need." He wants to avoid asking clinicians and case managers to go into the diagnostics folder of an EMR during every patient encounter to review a PDF of a genetic test while also having to remember if there might be any new relevant science.
With the AccessDx-Jase Health partnership, health systems no longer have to "reinvent the wheel" or do the "in-house heavy lifting" of writing software code and interfaces to achieve pharmacogenomic connectivity with their EMRs, Hachad said.
Hachad, a pharmacist by training, joined AccessDx in December. She said that she was attracted to the opportunity because she liked the idea of embedding molecular testing into clinical workflows to enable precision medicine.
These integrations bring in discrete data, not PDF files that computers can display but can't process. This data can be pliable. It's formatted and can be updated, and it can inform clinical decision support technology, Hachad said.
Making the partnership possible was the 2019 merger of AccessDx and clinical decision support software company MedTek21. While the two entities are technically under the same AccessDx corporate umbrella, they retain distinct brand identities.
Spinelli, former chief commercial officer of MedTek21, said that AccessDx and MedTek21 joined forces to focus on helping care providers implement pharmacogenomic programs.
Hachad said that the combination allowed the two sides to create a "data-driven company through technology" that lets AccessDx embed software into clinical workflows.
"Our goal from an overarching standpoint is to deliver a true end-to-end, diagnostics-based program to clients that we serve," Spinelli added.
Spinelli said that intelligence on drug-to-gene interactions is just as important as a medical history and drug-drug and drug-allergy interactions when choosing a therapeutic pathway. "The Holy Grail for us is to deliver it directly within the clinical workflow," Spinelli said.
AccessDx has a sequencing lab with Thermo Fisher Scientific Ion Torrent instrumentation, and performs genotyping on Thermo's OpenArray platform. The firm also has a toxicology lab for opioid testing.
The firm had been seeing most of its demand coming from pharmacogenomics until the COVID-19 pandemic came along. Because AccessDx performed RT-PCR and antibody testing, it was an easy decision to move into COVID-19 diagnostics, and Hachad said that the firm is currently looking into expanding into viral sequencing in order to detect COVID-19 variants.
"All of a sudden, a sliver of the functionality that our software had was adding a ton of value in terms of onboarding and coordinating all of the different PCR tests that were being required" by many of the company's clients, Spinelli said.
The pandemic acted as an "accelerant" for AccessDx proving the value of its diagnostic testing married with software to integrate medical knowledge into clinical workflows, Spinelli said.
"Now we're seeing a shift, going back to pharmacogenomics being of a lot of interest to different entities," Hachad added.
The MedTek21 platform has helped AccessDx build a pharmacogenomics customer base among long-term care facilities across the US. In the process, the firm created connectivity with pharmacy and other IT systems popular in the LTC industry, which helps the firm deliver much-needed intelligence to "polymedicated" patients, according to Hachad, and to coordinate care between LTC, pharmacies, and external physicians.
The MedTek21 system also assists physicians in finding patients who might benefit from genetic testing, then facilitates test ordering and return and interpretation of results.
"We can really pinpoint the issues, not for the plethora of medications that could be on a pharmacogenomic report, but only for those that matter for that particular patient," Hachad said.
COVID-19 proved to AccessDx that the firm was able to connect myriad laboratory information systems with pharmacy information systems so physicians could order tests and receive results. The partnership with Jase Health builds on this, Hachad said, because it introduces this information into EMRs to inform broader clinical decisions.
"This allows us to get a better snapshot of the patient record because we can talk to these siloed [IT] systems that exist in these long-term care facilities or any other type of facility," Hachad said.
This is the second time Jase Health has struck a deal for integrating data from molecular laboratories. Jase has been working with 2bPrecise, a semi-independent precision medicine subsidiary of Allscripts.
Jase Health actually is moving faster with AccessDx than it is with 2bPrecise. John Orosco, Jase Health's founder and president, said that this is mostly due to internal prioritization at the companies.
While AccessDx was founded in 2016 and MedTek21 started in 2015, Jase Health traces its history back to 2007, when former Cerner employee Orosco started the integration company as a part-time project to help Cerner customers integrate their EMRs with ancillary systems.
Now, Jase Health has more than 20 integration consultations, and works with EMRs from Epic, Meditech, Athenahealth, and Allscripts. Orosco said that patient identifiers in the EMR do not necessarily match identifiers in ancillary systems, and almost definitely do not match external lab systems. Jase Health addresses this by creating "alias" ID numbers so clinicians can call up entire patient records with a single identifier.
"They don't care where it's coming from. They just want the information in front [of] them in a timely manner," Orosco said. "That's what our core focus is, helping groups like AccessDx and other folks to get this rich data information that they have" and present it to clinical users when they are treating patients, without adding extra clicks to the digital workflow.
"Having this deeply integrated into the workflow has a tremendous amount of upside in terms of patients' experience with medications that they know they can metabolize better than others," Orosco said. "It's less about a physician giving people some drugs and [seeing] how you react to this one. That's sort of barbaric."
Spinelli noted that despite federal monetary incentives and regulations promoting interoperability, EMRs do not always follow standards. "They have just an extraordinary amount of practical knowledge of the most elegant ways to work within some nonstandard and complex EMR environments," he said of Jase Health.
AccessDx-Jase Health work began with a Cerner site about two months ago. Spinelli said that AccessDx has several "production" clients who have begun integration with the help of Jase Health, but so far, the companies have only disclosed Broward Health in South Florida as a client of this new partnership.
Jase Health soon will be looking at a Meditech integration, Orosco said, and then move on to other ambulatory EHR vendors, including Greenway Health, though the schedule will largely depend on AccessDx customer needs.
"After Meditech, I think the conversation naturally goes to folks like Epic," he said, but mentioned a common problem: that vendor likes its clients to be purely Epic shops and work within Epic's own app store, called App Orchard.
"What do you do with Epic? Do you just do what they make available through App Orchard because there's really not a good mechanism in the Epic realm to do anything outside of App Orchard anyway?" Orosco said.
While Epic does have some application programming interfaces, Orosco said that they do not "satisfy the entire workflow," making it difficult to build custom interfaces.
AccessDx and Jase Health want to create common frameworks with various EMR vendors while still remaining flexible enough to address the unique needs of each user organization.
"Our goal is to have as many Swiss Army knives as possible to show our clients the different pathways that we can take," Spinelli said. "We always want to show the ways that we can work with your existing environment and get this up and running in the most efficient fashion."