We are entering an era in which DNA sequencing will become a routine laboratory test for a high percentage of patients. Geisinger, always a leader in innovation, is beginning the validation of this diagnostic approach (see: Geisinger to perform DNA sequencing as routine care). The key question, of course, is what actions hospital personnel will take based on this DNA information. This question is partly answered in the excerpt from the article below:
Geisinger will soon roll out DNA sequencing as part of its preventive care for patients....Over the next six months, the Danville, Pa.-based system will enroll 1,000 patients in a pilot program recommending DNA sequencing as part of routine clinical care. Eventually, Geisinger said will provide clinical DNA sequencing across its Pennsylvania and New Jersey footprint....."This forecasting will allow us to provide truly anticipatory healthcare instead of the responsive sick care that has long been the industry default across the nation [according to the Geisinger CEO]." The health system said in a release DNA sequencing would become a "routine screening" like mammograms, colonoscopies and cholesterol checks for its patients. Physicians will work with their patients to respond to any genomic risk factors found. The pilot will build off of Geisinger's research-focused genomic initiative, known as MyCode Community Health Initiative, that started in 2013 [Should Hospitals Recruit Patients for Drug Company Research Projects?]. So far, Geisinger has alerted more than 500 patients that they have a genomic variant that increases their risk of developing early cancer or heart disease. That amounts to 3% of the more than 200,000 patients enrolled in the DNA sequencing program. But Geisinger executive vice president and chief scientific officer...believes 10% to 15% of patients could benefit from the expanded program as they find more genomic variants. "
So. some key facts now emerge about how routine broad DNA screening may be deployed in the future for patient managment at Geisinger: (1) 1,000 patients will be enrolled in a pilot program for such testing; (2) emphasis will be placed on early warning for cancer and heart disease; and (3) Geisinger personnel predict that perhaps 10-15% of patients could benefit from such DNA screening as the program matures. Obviously, the devil is in the details for such a program but I am confident that Geisinger will get it largely right. All of this boils down to several questions. What genetic abnormalities should a hospital screen for in such a program, how and when should hospitals notify patients of significant DNA results, and what actions should hospital personnel take after a patients has been identified as having one of the key abnormalities being screened for.
One question pops up in my mind immediately, perhaps because of the litigious nature of our healthcare system. Let's assume that a genetic error is detected for Patient X in this process. What is the health system's obligation legally to that patient in the future? What if he or she changes health systems or drops out of a particular health plan? In short, what obligation is assumed by the hospital detecting a DNA abnormality as opposed to the responsibility of the patient. The answer to these questions and more will soon be understood at least, in part, through this pilot study.