Clinical OMICS

JAN-FEB 2017

Healthcare magazine for research scientists, labs, pathologists, hospitals, cancer centers, physicians and biopharma companies providing news articles, expert interviews and videos about molecular diagnostics in precision medicine

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www.clinicalomics.com January/February 2017 Clinical OMICs 11 I n recent years, the United Kingdom has made a major commitment to developing a large-scale population cohort study—the 100,000 Genomes Project—linking high-quality genomic sequence data to electronic health record information for the purposes of scientific discovery and clinical care improvement. The project is expected to yield valuable scientific insights on the molecular underpinnings of health and disease states. At the October 2016 meeting of the American Society of Human Genetics, leadership from the U.K.'s National Health Service (NHS) reported on the progress of the 100,000 Genomes Proj- ect and how to prepare the health sys- tem to make use of genomic medicine. From these presentations, it appears that scientific and health services lead- ership in the U.K. are well on their way to developing a robust national pro- gram that addresses long-term needs regarding data collection and interpre- tation as well as delivery of care. The model includes a distributed network of 13 regional Genomic Med- icine Centers staffed with individuals with scientific, clinical, and educational expertise that support the initiative. Further, the NHS has developed a comprehensive suite of approaches to education needs of the NHS over both the short and long term. Near-term approaches include extensive online and print resources targeting the pub- lic, front-line providers, and research- ers involved in the cohort project as well as those in the entire NHS popula- tion. Further, there are ongoing efforts to provide specific training and quality improvement programs for individu- als such as pathologists responsible for data and sample collection for the bio- bank associated with the cohort. Longer-term activities include development of relationships and com- mitments to improving genomics and precision health education by the national organizations in the U.K. responsible for training diverse provider types at all learning levels. Also, there is an already produc- tive effort to develop additional pipe- line capacity for health professional workforce development including new programs for genetic counselors, bioin- formatics specialists, and Ph.D.–level researchers that will be needed over the coming decades as the U.K. health system pivots towards a precision medicine-based approach. In all, the progress the U.K. has made in preparing its health system to embrace the 100,000 Genomes Proj- ect over a few short years seems quite remarkable. In fact, it seems that there is a commitment to make the project an organizing hub for overhauling their health system to lead in the 21st cen- tury in both genomics research produc- tivity, and precision medicine. How can we, in the United States, learn from the U.K. progress in imple- menting similar initiatives? While the U.K. effort is highly coordinated and centralized, the emerging picture in the United States is more complex. Here, many private and public cohorts are developing, each differing in pri- orities, pace, and approaches, which could lead to millions of genomes sequenced in the next few years. The U.S. Precision Medicine Initiative led by the NIH has made quick advances in less than two since launch. Progress has occurred in defining the scope of the initiative, framing its guiding prin- ciples and providing an initial bolus of resources to organizations and groups for recruiting research participants. National survey data suggest the pub- lic is excited and supportive about this initiative. But these are early days and it is dif- ficult to envision how a coordinated transformation of the U.S. health sys- tem will occur to deliver precision health. Perhaps the "many flowers blooming" approach will ultimately work well, and may be the only feasible approach given the realities of the U.S. health system. Nevertheless, all stake- holders including biomedical research, education, as well as the health ser- vices and public health communities should closely follow how successful cohorts and health systems are evolv- ing in the U.K. We might find that we have a thing or two to learn. Lessons for U.S. in U.K.'s 100,000 Genomes Project? OP-ED W. Gergory Feero, M.D., Faculty, Maine Dartmouth Family Medicine Residency

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