November 2013

Computational Genomics: It’s in HIM’s DNA
By Julie Knudson
For The Record
Vol. 25 No. 15 P. 22

Expanded use of data analytics makes a genomics background an excellent fit for HIM professionals.

Computational genomics is receiving increased attention within the HIM realm for good reason. Only the growth rate of crab grass rivals that of health care data sets, and providers increasingly want to harvest useful information from all those ones and zeroes. However, tackling computational genomics can sound overwhelming (it doesn’t need to be), and the payoff from all that time and effort may seem like a long way off (it won’t be).

What’s Involved?
For HIM professionals interested in computational genomics, the focus typically can be narrowed to a handful of strategic issues and be incorporated into the education process earlier than ever before. Master’s-level programs have been teaching various aspects of computational genomics for a while, but Sue Biedermann, MSHP, RHIA, FAHIMA, an associate professor and the HIM department chair at Texas State University, says the trend is filtering down to the bachelor’s level. “We’re just now starting to get into it a little bit,” she says.

However, many of the elements may carry different labels. Rather than painting courses with the computational genomics brush, Biedermann says they may be lumped in with other data analysis offerings. “I think we’ve been taking baby steps for some of the foundational things,” she explains. “We’re still working with the data and building up where students have computer skills and data analysis skills. They can then move on into the computational genomics part.”

Melanie Brodnik, PhD, RHIA, FAHIMA, associate professor emeritus from the School of Health and Rehabilitation Sciences at Ohio State University, agrees that the majority of undergraduate programs don’t formally offer coursework in computational genomics, although there are classes that set the stage for students who want to pursue it later. At Ohio State, the formal genomics courses are part of the biomedical informatics program, a setup Brodnik says is echoed at other schools, particularly those engaged in genomic research. However, to help lay the foundation for more advanced courses, she says early-stage training could “perhaps define and expose students to the fact that [computational genomics] exists and how it is used.”

Leming Zhou, PhD, an assistant professor in the HIM department at the University of Pittsburgh, says biology and data analysis courses can provide senior-year undergraduates or graduate-level HIM students with a solid foundation for later education. Specific courses in computational genomics then can build on that fundamental knowledge. “The training in computational genomics for HIM professionals should focus on the basic concepts of genomics, the commonly used genomic data analysis tools and data analysis skills, and high-quality databases,” he says, adding that a thorough understanding of the genomic information housed within databases and EHRs can allow HIM professionals to manage, analyze, and mine those data stores.

Because data analysis requires technology, HIM professionals also should gain a better understanding of how HIT software fits into the picture as they learn computational genomics, says Rosann M. O’Dell, DHSc, MS, RHIA, CDIP, an assistant professor and the chair of the medical information and revenue management program at Johnson County Community College in Overland Park, Kansas. Software solutions are “increasingly capable of leveraging both a patient’s clinical data and genomic data,” she says.

With the mounting interest in using genomic information for personalized medicine, more HIM professionals are pursuing technology-related courses, O’Dell adds.

Who Can Benefit
HIM professionals who desire a more advanced understanding of the entire breadth of the sector, especially those with an interest in informatics, are ideal candidates for computational genomics pursuits, O’Dell says. Those who may work with genomic data stores also could find the extra education valuable. In addition, computational genomics is a natural fit for students considering positions with HIT vendors and HIM professionals interested in working in settings such as academic medicine, corporate health systems, and insurance companies, where data analysis plays a major role. “I think people in HIM who really consider themselves ‘data wonks’ haven’t ever appreciated how far they can take their interest and skills,” O’Dell says.

Zhou, who has taught genomics to students with only minimal college biology coursework, believes all HIM professionals should be capable of tackling the topic. “It’s not as challenging as many people believed, and students do not need to have any special training before a computational genomics class,” he says.

Advances such as those seen in high-throughput biotechnologies are helping to lower the cost and time required to obtain personal genomic information, a development Zhou says students should take into account when considering genomics courses. “Eventually, performing a whole-genome sequencing may be as simple as a blood test in a lab,” he says.

As these procedures become more commonplace and personal genomic data become more likely to be stored in EHRs (either as part of a larger database linked to a medical record or as a test result within a specific patient’s file), HIM professionals will be handling genomic information more frequently.

Why It’s Important Now
The ability to process genomic data may not yet be an everyday requirement, but those in HIM are being asked to apply skills in computational genomics more regularly. “Everything is about the data now,” Biedermann points out.
As advances in computer technology converge with massive (and growing) data sets, the wealth of health information becomes staggering, but it can’t be fully leveraged until it has been properly analyzed. That’s where the HIM crowd with computational genomic training can come to the rescue. “We understand the data and where it comes from,” Biedermann says. “We tie it in, and we get more involved with the analysis and quality improvement, looking for trends and doing some of the studies.”

A genomics background also may help HIM professionals navigate the myriad privacy issues and concerns facing health care. “I think HIM professionals are going to be able to offer important insight into policy and procedure creation when it relates to how we manage, sort, retain, and ultimately destroy that data that is yielded through computational genomics,” O’Dell says, adding that the Omnibus Rule brings even greater clarity to the need for HIM professionals to have a solid understanding of computational genomics and how it impacts the data privacy landscape. “When you start adding this more sensitive type of information into it, and knowing it’s also regulated in these other regards, I think the HIM professional is uniquely positioned to be a part of this area.”

Opportunities that leverage computational genomics already are available. “There are some DNA sequencing centers and labs, molecular diagnosis and pathology labs, some research labs, and large hospitals needing people to manage their large-scale genomic data sets,” Zhou says. Once genomic information is more widely applied in clinical practices, “Smaller hospitals and even individual physicians will need HIM professionals who can manage and process genomic data,” he adds.

Depending on how computational genomics coursework is structured and paired with other disciplines, the range of opportunities may become even wider. In Ohio State’s HIM baccalaureate program, students are exposed to database courses, PC applications with a heavy emphasis on spreadsheets, inferential statistics, and data analysis. “The tools are then applied in various courses related to finance, reimbursement/revenue cycle, compliance, quality improvement, and patient safety, to name a few,” Brodnik says, adding that this broader focus produces HIM professionals who can fill roles throughout the health care spectrum.

Many of these positions are on the horizon. O’Dell points to the enormous need for effective data analytics, particularly as the culture of Big Data continues to evolve. “With all of the data that will be garnered from computational genomics, I think if HIM professionals take their solid foundation in HIM and combine that with graduate work in informatics, there are going to be new career opportunities in clinical research organizations as well as academic health care settings,” she says.

In addition, many HIT vendors are expected to release computational genomics solutions. “Somebody with an HIM background and perspective can be an important member of those teams in regards to software development and then the training and implementation of these systems,” O’Dell says.

Because the HIM and HIT landscapes are changing, many roles still are in their early stages. Fortunately, HIM’s array of skills almost certainly will be an asset. “We’re in a support role for people in biomedical informatics and in computational genomics and anywhere they use data,” says Biedermann, who believes IT and statistical analysis will be two prime areas where HIM professionals can make their mark in addition to others that are less obvious.

For example, a large genomics study would need a well-qualified leader. Biedermann says an HIM professional with training in computational genomics would have the expertise to grasp not only the process but also the elements behind the project’s data and what they mean.

What Else Is There to Know?
Computational genomics isn’t the only academic area receiving attention in HIM circles; other disciplines outside of traditional HIM study areas also are making their mark. Project management is likely to be increasingly useful, according to Biedermann, who believes EHR implementations offer a perfect example. “Those are massive projects that require input from many different stakeholders who all have their own best interests,” she says. “It wasn’t always an HIM person taking the lead on that, but HIM should be fairly close to the top of heading up that group.”

Because HIM experts understand how data are used, including in patient care, quality improvement studies, risk management, and infection control, they bring added depth to project management and change management roles.
Zhou believes there are several other avenues open to HIM professionals who may want to explore “nontraditional” careers. Among the options are developing and implementing mobile health applications, applying robots in home care, and counseling patients on genetic test results. Each of these roles leverages data and technology, giving HIM professionals a wide range of expertise to leverage as the field continues to move away from traditional provider settings.

O’Dell says disciplines relating to regulatory management and clinical data management also may entice enterprising HIM professionals. In addition, there will be an emphasis on patient education in the informatics era. “Statistically speaking, as a population, we don’t generally have adequate health literacy,” O’Dell says, adding that HIM professionals who supplement traditional training sectors with those that help educate patients may find themselves in great demand.

As new technologies gain a foothold in the industry, the HIM education landscape is undergoing a shift to keep pace, specifically in the genomic realm. Larger data sets are being generated, but the time and cost needed to make that happen is dropping. For example, a decade ago, the Human Genome Project was a multimillion-dollar project, but today’s technology has made similar initiatives a relative drop in the bucket. “Today, we only need to spend a few thousand dollars to get our own genome sequenced,” Zhou says. “Tens of thousands of individuals have already chosen to do so.”

Providers are beginning to use personal genomic data, researchers continue to make progress in finding genetic links to diseases, and personalized care rooted in genomics is inching its way toward reality. Without a wide knowledge base, HIM professionals may not be positioned to handle all these new data sets.

With this in mind, Ohio State’s baccalaureate program provides student access to database courses and other offerings to boost their skill sets. As the industry continues to evolve, Brodnik says there may be an opportunity to widen the window into computational genomics. “It is possible to design an assignment that would require students to access a genomic-related database similar to other assignments we have developed in the curriculum,” she says.

Brodnik believes the HIM body of knowledge will continue to grow as new tools for managing, processing, and analyzing data are added to the curriculum. “[HIM education] is changing as a result of our greater reliance on information analysis and technology,” she notes.

Within the health care ranks, it’s becoming more essential to pursue advanced education. The revolutionary effects of EHRs—coupled with the genomic health information that’s being added to those records—will continue to put pressure on HIM professionals to expand their knowledge base. O’Dell believes community colleges serve as sturdy stepping-stones on the path to higher education. “We view our program as sort of a pipeline to get people into the higher levels of HIM education,” she says. “We always tell them, ‘Don’t stop here.’”

Because she’s seeing a greater distinction between the educational components of two- and four-year degrees and there’s a growing need for HIM professionals with broader knowledge bases, O’Dell encourages students to continue their training. A strong science background coupled with technology expertise can lead to greater career heights. “That’s certainly the case with genomic-related informatics,” she says.

— Julie Knudson is a freelance business writer based in Seattle.

 

EHRs Key to Effective Use of Genetic Information
Marc S. Williams, MD, Geisinger Health System’s director of the Genomic Medicine Institute, believes that making a patient’s genetic test results available in the EHR is a win for patients and their physicians. But he also is clear that much work needs to be done before it’s a reality.

Insights of several research teams actively engaged in integrating genomic medicine into the EHR, including an editorial coauthored by Williams and Joseph Kannry, MD, of Mount Sinai Medical Center, are featured in the October issue of Genetics in Medicine.

In the editorial, the genomics researchers state that “successfully integrating genomics into clinical care requires a vision, a strategy that will achieve the vision, and an actionable implementation plan.”

The research, led by Williams, Kannry, and other members of the Electronic Medical Records and Genomics Network, explores various issues related to including genetic information in EHRs, including storage and representation of the information, education about the use of the information at the point of care, and solutions to concerns about privacy, confidentiality, access, and portability.

“If we believe that there is information in the genome that is going to lead to more effective and safer therapies, we need to solve these issues,” Williams says. “We are basically trying to build a bridge over a canyon, and you can’t leave out any of the key structural elements and expect the bridge to hold together. We really need to solve these problems if we want to move to what some people are calling precision medicine.”

Genetic tests now can tell whether patients are at increased risk of various cancers, heart or kidney disease, asthma, and numerous other conditions. Tests also can reveal how patients will respond to certain medicines or whether they’ll be harmed by side effects linked to their genetic code.

But harnessing that information to benefit individual patients and prevent illnesses in others will require that physicians have access to genomic information for each patient. As health records are converted to digital form, the most likely place to store and retrieve genomic information will be an EHR. But when and how that happens will depend on having good models to build on.

— Source: Geisinger Health System