When is an app the difference between radiation and active surveillance?

Deciphering genomic data, simplifying critical conversations: the GenomeDx and Visible Health story

Medical apps must do two things especially in point-of-care use. 1. They must provide a very clear, specific function. “I’m going to show you your result, what it means and share it with you.” 2. They must be usable and fast. Time periods of direct interaction between physician and patient are painfully brief, as brief as eight minutes per visit. An app that crashes or isn’t intuitive simply won’t do.

Our colleagues at GenomeDx Biosciences offer a test called “Decipher®” a genomic test that uses the expression of 22 RNA biomarkers to calculate the probability of clinical metastasis within five years of radical prostatectomy surgery, and within three years of successive PSA rise (biochemical recurrence). It has been validated in over 1,500 patients.

The challenge: deliver genomic testing data based on Decipher in way that educates physicians on the value of the test to both their practice and their patients, then enables physicians to communicate test results quickly, clearly and securely and then chart personalized courses of therapies, improving outcomes.

Here’s how we’re getting it done, helping improve cancer treatment decisions for physicians, patients and advanced healthcare testing companies like GenomeDx.

The Problem:

Genetic testing is opening new windows of insight and altering treatment courses for healthcare providers and the patients they serve. According to a 2012 United Healthcare Study:

Around three-quarters of doctors surveyed say that genetic testing allows for more personalized medical decisions and more targeted choice of therapy. Around two-thirds (63%) say it gives them the ability to diagnose conditions that would otherwise be unknown. On average, physicians report having recommended genetic testing for 4% of their patients over the past year. However, about three-quarters of doctors also said that there are patients in their practices who would benefit from a genetic test but have not yet had one. Looking ahead five years, physicians on average said that they expect 14% of their patients will have had a genetic test.

But the data, and its value, is inherently difficult to communicate among the generators, the users and the patients. More than 2.5 million American men have prostate cancer. GenomeDx Biosciences offers a test called “Decipher®,” a genomic test that uses the expression of 22 RNA biomarkers to calculate the probability of clinical metastasis within five years of radical prostatectomy surgery, and within three years of successive PSA rise (biochemical recurrence). It has been validated in over 1,500 patients.

The challenge: deliver genomic testing data based on Decipher in way that educates physicians on the value of the test to both their practice and their patients, then enables physicians to communicate test results quickly, clearly and securely and then chart personalized courses of therapies, improving outcomes.

This is a new realm for physicians. Genomic test results are new pieces of information than can be counter-intuitive to traditional courses of treatment.

— Dr. Andy Katz, chief operating officer for GenomeDx

According to a study published by the National Center for Biotechnology Information on April 30, 2014, 31 percent of physician treatment recommendations changed with knowledge of genomic classifiers. Put another way, physicians would choose different courses of treatment for more than three out of 10 patients with Decipher data in hand. This is huge when treatment options commonly include radiation: truly life and death decisions.

The Solution:

Visible Health built Decipher Portal Professional, an app that provides oncologists insight into genomic test data in a way that makes communication easier. The app sits on top of Visible Health Connect, the backbone that enables swift, secure sharing of content, integration to 3rd party solutions, real-time content updates and full organization, user management and permission control.

The intent of the Decipher Portal Pro app is to have physicians new to Decipher experience those cases where their recommended course of treatment may differ, personally; to see patterns in their own patients and to become familiar with using genomic testing data in their treatment decision-making process in a safe environment.

The way information is presented is highly important to GenomeDx and both existing and potential providers using Decipher. The Decipher Portal Professional app provides secure ease of access to, and explanation of, test data. This education, access and ease of use is everything to both GenomeDx, our physician and clinician customers and ultimately patients.

How does this reflect the best in medical apps out there?

A medical app must do two things especially in point-of-care use. 1. It must provide a very clear, specific function. “I’m going to show you your result, what it means and share it with you.” 2. It must be usable and fast. Time periods of direct interaction between physician and patient are painfully brief, as brief as eight minutes per visit. An app that crashes or isn’t intuitive simply won’t do.

Again according to Katz, many labs have web-based portals into ordering and reporting tests: log in, place a test order, get the results. Basic functionality. Decipher Portal Pro differentiates itself in its analytic features. Among other functions, the app enables visibility into practice patterns, across physicians’ own patients in a clinical utility environment.

Compared to other types of healthcare apps designed for physicians like tertiary oncologists - this app has access to data sets generated by the physicians themselves and broader studies as well. Physicians can examine test cases, then add in nuances like individual test results and walk through treatment exercises to determine how decision-making is affected. Once this understanding is reached, the app reduces friction of order, then pings results returns and enables the physician to securely demonstrate the results and impact on courses of treatment.

For every app we develop, we work with the client to tease out what the real objectives are. Through a physician’s lens (inclusive of our co-founder physicians), our design team produces well thought out, usable, attractive, engaging apps, on top of a HIPAA compliant platform.

Results:

GenomeDx and Visible Health are in the process of measuring the uptake and effectiveness of Decipher Portal Professional and plan to announce preliminary findings in Q3 2014. As referenced by Robert Szczerba in a recent Forbes article, additional functionality is anticipated by Q4 2014. More broadly, Visible Health apps are in use by more than 40,000 physicians and clinicians worldwide. Our apps have also been downloaded more than 500,000 times.

http://genomedx.com/

http://www.visiblehealth.com/

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