Presented at the Personalized Medicine World Conference 2010

1. Integra(ng
Genomic
Medicine
into
Pa(ent
Care
Presenter:
Trisha
Brown,
MS,
CGC

2. DNA
Direct
Overview
Our Mission:
To bring the power of personalized medicine to patients,
providers, and payors – reducing health risks, preventing
disease, and better targeting therapies

3. Agenda
• Personalized
Medicine
– What
is
it?
– Barriers
• Integra=ng
Genomic
Medicine
– DNA
Direct’s
Solu=ons
– Physician/Pa=ent
Educa=on
&
Decision
Support
– Payors,
Humana
– Hospitals,
El
Camino
Genomic
Medicine
Ins=tute
– Pa=ent
Compliance
Programs

4. Personalized
Medicine

5. Barriers
to
Personalized
Medicine
• Lack
of
healthcare
provider
knowledge
– 90%
of
MDs
surveyed
want
to
use
gene5cs,
but
only
40%
are
comfortable
ordering
a
gene5c
test,
and
63%
have
limited
or
no
access
to
experts
• Lack
of
Experts
– Gene5c
Counselors:
MS,
cer5fied
professionals
who
assess
risk
and
educate,
<2,400
– Clinical
Gene5cs:
MDs,
provide
gene5c
diagnos5c
and
therapeu5c
management,
<500
Trinidad, et al 2008, Sources: Washington G-2 Reports Advisory Services’ 2008 Molecular
Diagnostics Survey, internal analysis, LabCorp study

6. There
are
only
a
liPle
over
500
gene=cists
and
2400
gene=c
counselors
who
see
pa=ents
in
the
U.S.
Ratio of geneticists to population by state
As a result,
0 geneticists who see patients (4) genetics is pushed
1M - 3M per geneticist (11) to the PCP, who is
often not prepared
500K - 1M per geneticist (22)
for genetics
<500K per geneticist (14)
6 Source: ACMG, 2007 & NSGC 2009

7. Barriers
to
Personalized
Medicine
• No
evidence
yet
that
PM
has
a
significant
impact
on
common,
chronic
disease
– Affects
>50%
of
the
US
popula5on,
and
accounts
for
~75%
of
the
total
healthcare
spend
• Adop=on
of
standards
into
clinical
prac=ce
can
lag
by
over
a
decade
– In
one
study,
only
32%
of
eligible
women
had
her2
neu
tes5ng
– Across
studies,
only
30-­‐55%
of
eligible
pa5ents
are
prescribed
warfarin
Balas & Boren, (2000) Yearbook of Medical Informatics pp 65-70
Phillips, K (2008) JAMA 300(21):2542-44, Partington, et all (2007) Thrombosis Research 120, 663–669

8. Barriers
to
Personalized
Medicine
• Pa=ent
non-­‐compliance
– Only
20-­‐30%
of
people
recommended
to
have
colon
cancer
screening
do
it
– 30%
of
people
with
adenomatous
polyps
do
not
return
for
follow
up
colonoscopy
– By
6
months
of
therapy
ini5a5on,
up
to
55%
of
people
stop
taking
their
cholesterol
medica5ons
Siddiqui et al Alimentary Pharmacology & Therapeutics. 2006;24(11):16 23-1630, Inadomi Journal of Gastroenterology and Hepatology 23
(2008) Suppl. 2; S198–S204, JPMorgan MedCo 2010, presentation http://phx.corporate-ir.net/External.File?
item=UGFyZW50SUQ9MjYzNDR8Q2hpbGRJRD0tMXxUeXBlPTM=&t=1

9. Integrating Genomic Medicine
• “In order for personalized medicine to progress
as many US researchers want it to, it will require
a more focused commitment from better
informed federal agencies, smarter
collaborations across public and private
sectors, bigger studies and bolder science, and
intelligent changes in the healthcare system
overall”
-Francis Collins, January 2009

10. DNA Direct Solutions
Proprietary
Technology National Call Center
Architecture Unique + of Genetic Experts
to Genetics
Guidance & Decision Support for Genomic Medicine
10

11. Access
to
Experts

12. Physician
Educa=on
Secure portal to
access
comprehensive tools
and resources
Preauthorization
wizard
Latest news and
updates on tests
and technology
CME sessions and
forum for physicians

13. Pa=ent
Educa=on
Genomics 101
developed for
consumer audience
Clinical Decision
support tools to help
understand test
appropriateness
Multimedia videos
and testimonials as
a learning tool
Immediate access to
genetic experts

14. Pa=ent
Decision
Support
Customizes content
based on family and
medical history
Integrates video to
share patient stories
and perspectives
Enables exploration
of various decision
options
Explains possible
next steps based on
test results

15. Gene=c
Guidance
Programs
Payors
-­‐
Humana
Prior-authorization
system & call center
for molecular
diagnostics
Helps physicians
find the right test for
their patient at the
right lab
Genetic counselors
available to
physicians and
patients to answer
questions about
tests

16. Genomic
Medicine
Ins=tute
Physicians
–
El
Camino
Hospital
Refer patients to
genetic counseling
Web-based clinical
decision support and
tools
Key specialty area
overviews and
guidance for testing
CME education and
Training

17. Genomic
Medicine
Ins=tute
Physicians
–
El
Camino
Hospital
Test
Appropriateness
Questionnaire
Test background
and use
Clinical guidelines
and evidence
Controversies and
references

18. Genomic
Medicine
Ins=tute
Pa5ents
-­‐
El
Camino
Hospital
Literacy level
appropriate
Comprehensive
content to inform the
lay person
Call to action:
contact physician or
learn about genetic
counseling

19. Genomic
Medicine
Ins=tute
Pa5ents
–
El
Camino
Hospital
Easy-to-understand
result interpretation
Next steps and
actions
Personalized
message from
physician
Letter for family and
support physicians

20. Tes=monials
“Just wanted to let you know that I really enjoyed
this great experience in learning about such
breakthrough technology, and was amazed how
it can help human beings' fundamental but also
complex health issues be answered”
-El Camino Patient
“Instead of referring my patient to another center
and making them wait weeks to get in, I can get
the information I need and refer patients to DNA
Direct for immediate help.”
-El Camino Physician

21. Decision
Support
Tools
Payors,
Providers,
Medical
Centers,
Labs
Over 600 users in a small pilot in 40 practices, patients and
physicians very satisfied.

22. Pa=ent
Compliance
Programs
Payors,
Employers,
Medical
Centers,
Labs
• Stool
DNA
Colon
Cancer
Screening
Program
– Large
US
employer
distributed
kits
to
50+
year
old
employees
at
health
fair
– DNA
Direct
provided
educa5on
as
needed,
and
followed
up
with
employees
to
help
them
return
kits
– Return
rate
increased
by
40%

23. Integra=ng
Genomic
Medicine
Into
Pa=ent
Care
Pre / Post Test Phone
Decision Support Counseling
Physician
Consultation

24. Thank
You!
trish@dnadirect.com