Survey Says Many Hospitals Are Reluctant to Adopt Precision

A new survey by the organization Healthcare Catalyst suggests that many hospital executives are on the fence regarding using precision medicine within their walls.

The findings come on the one-year anniversary of an Obama administration initiative that provided more than $200 million in funding to push precision medicine. At that time, the White House had declared that "translating initial successes to a larger scale will require a coordinated and sustained national effort."

The results of the Healthcare Catalyst survey tend to bear that out. Of the 61 hospital executives surveyed—mostly chief information officers with a smattering of clinical leaders and no lab managers—only 25 said precision medicine would play a significant role at their institutions in the next five years. That's just 41 percent. Factor out academic medical centers—which tend to embrace research and technological initiatives much more earnestly than community hospitals—and the numbers drop to 32 percent.

Those surveyed at academic medical centers have a vastly different view. Seventy-one percent said precision medicine would play a significant role in the near term, while 64 percent said they planned to fold genomic data into the electronic health records of their patients.

"The disconnect between the recognition that genomics holds great promise and yet the lack of preparation for precision medicine may reflect the fact that technology adoption is often driven by research efforts at major academic medical centers, with others following in their footsteps," said David Crockett, Health Catalyst's senior director of research and predictive analytics. Crockett did note that the survey confined its focus to next generation sequencing, gene panels and exome genetic work, and not specifically molecular testing.

That lag could spell trouble for some esoteric laboratories, which have been developing tests intended specifically for use in the hospital setting and to more quickly respond to serious issues such as hospital-acquired infections like sepsis. The mortality rate of such infections can be cut dramatically with a quick diagnosis, which molecular testing can deliver.

Crockett, who was formerly a senior manager at ARUP Laboratories and was a professor of pathology at the University of Utah, believes that hospital managers may have other issues on their minds.

"I think it is a combined pressure of both the dollar amount that would need to be invested and the financial return on (precision medicine), while avoiding penalties for readmission and other clinical benchmarks," he said. "I think genomics just gets pushed to the back burner. It is not ready to be prime time."

Crockett suggested that the mindset might be changed as the current government reimbursement system moves away from fee-for-service and more toward bundled payments. However, even private payers do not focus on the long-term. "They are typically focused on near-term risks across all plans," he said.

Takeaway: Despite a push for precision medicine, many hospitals are not expected to wholly embrace its use for many more years.