Dustin Brick, the system vice president of Innovation and research at Endeavor Health.

Justin, thank you so much for joining us today.

Thanks Jordan for having me.

For those who don't know, endeavor help, formerly known as North Shore, Edward Elmhurst Health is a health system based in Evanston, IL, just outside of Chicago.

It has 2000 hospital beds, 9 hospitals and is served by 10,000 primary and secondary providers.

So Justin, we have a variety of topics we're going to cover today.

I'd like to kick our conversation off with a discussion on genomics and personalized medicine.

Now I know that Endeavor Health has the largest genomics program based in primary care nationally, and you just launched a polygenic, a polygenic risk score.

This has been referred to as groundbreaking assessment testing with a look at lifetime genetic risk for cardiovascular, cardiometabolic, neurologic, oncologic, you're logic and other common diseases.

Can you tell us a little bit about what's groundbreaking here?

What polygenic risk scores are, and what has been both the genesis of this sort of program and what sort of kind of procedures have you gone to implement it?

So Genomics has been part of our DNA, unintended at Endeavor Health for over 3 decades.

It goes back to some of the pioneering efforts of gentleman to new candid car who had the vision to bring Henry Lynch of Lynch syndrome actually to our health system to be one of our first medical directors.

Fast forward, we have been very fortunate to continue to make investments in our Center for medical genetics and then ultimately launch something in 2010 that was called Genomic Health Initiative.

Today we have about 50,000 patients who have consented to be part of our Genomic health investigative, which is a big file repository.

But I think that wasn't good enough for uh for endeavor, because we really focus on translating kind of care from the research lab bench to the bedside.

And so soon after establishing the Genomic Health Initiative, we actually took that to primary care.

It did something that was pretty at avant garde.

At its time, we offered 10,000 patients complementary genetic testing and through that we saw DNA 10K.

Hmm.

We called it ultimately became a wild success, and we saw that there was a ton of excitement both from our clinicians who saw it as differentiating their practice, but also from our patients who really saw this as being the next kind of generation of medicine.

Yeah.

Umm.

So we've been very fortunate to now have grown that program.

We have over 200,000 patients who have completed our genomic our genetic Wellness assessment as part of routine primary care and in doing so have over 50,000 patients, nearly 50,000.

Yeah.

50.

I think we're maybe around 45,000 who have completed genetic testing as part of just standard of care.

For.

So it's really exciting to see what we've done.

The challenge is you think about genomics is that genetics typically only represents about 3 to 10% of risk depending on the gene.

That is.

And the reality is we're trying to understand what causes disease risk across the rest of that.

And so there's a very interesting way of thinking about this and it's kind of thinking about a beaker that has a line on it.

OK.

When you think about most genetic risk, you think about those big mutations like BRACA.

Braca is one of those mutations that essentially represents a big rock in that in that glass, the beaker that passes the line of risk.

And so you're at elevated risk.

Well, what we were finding out with polygenic risk score is there's these things called single nucleotide polymorphisms or snips.

Now I had to learn the word and ultimately those are like little pieces of sand that in culmination actually create that same level of risk.

Right.

And so you can actually move above what a bracket mutation would be or past that line by having all of these smaller mutations that in accumulation actually do create greater risk.

It.

We've been doing research on this clinical trials and ultimately as you alluded to launch a partnership with a great company called Genomic MD and the goal is to now bring polygenic risk scores to our population.

OK.

It's still on the kind of cutting edge of medicine, so it's not a covered benefit.

So patients do have to pay out of pocket, but we're finding a lot of uptake in this within the first month, over 100 patients have completed testing and specifically a lot of interest in cardiovascular disease.

And.

So when you're having a pay for these polygenic risk scores, I suppose one what's the value proposition you're saying to them?

Are you saying is a primary care physician having a routine physical and saying, hey, you know, you may want to pay for this sort of thing.

You may have a bunch of little genetic predispositions that in aggregate could pose a real risk to your health #2 what is the cost that you're kind of thinking?

You know.

I know 23andMe once had $99 testing.

How extensive is this testing?

How invasive is this testing?

And then if you do get an answer, you get that risk score.

What are the interventions that you can do in order to improve your health outcomes?

Yeah.

So genomics is both about prevention and therapeutics.

So at the onset, when you're thinking about genetics and preventative state, it's really about tailoring treatment strategies based on your DNA.

Like I look at the fact that I'm I'm one of my parents was adopted.

So I don't know that part of my family history.

So when the doctor asked you your family history, I'm like, I don't know.

I can tell you what my father's history was, but my mother, I don't know.

Umm.

And I think that becomes really important.

And what genetics does is it actually creates something that is more of a quantifiable family history, because it's based on your genetics as opposed to, well, I think Grandma died of colon cancer.

But it maybe it was breast cancer and it had spread to her colon.

And again, these are real stories that we see and so through genetics, you're really able to identify those preventative screening therapies and figure out if you're somebody who's at higher risk, for example, you carry the Lynch syndrome gene and you need to have colonoscopies earlier to identify that cancer on the therapeutic side.

Umm.

Sure.

Now you're starting to see an explosion of gene therapies, and these are those million dollar drugs where you're seeing honestly, people were getting their sight and they're able to have one infusion of a drug therapy and all of a sudden this lifelong chronic condition is gone.

And and so when you start thinking about this, it really does have the ability to transform how we've managed care moving forward.

Huh. OK.

Honestly, a lot of it is just using your own body to repair itself and providing supercharged.

Kind of DNA that helps your body heal faster.

So is this targeting 100% of the patient population or more of those with chronic conditions or those at high risk or of different comorbidities?

Who's being targeted for this?

Well, if you take a look at guidelines today, guidelines actually are are moving along and and again you have to appreciate the fact that medicine moves slowly because it needs to in some regards to maintain safety and therapeutic efficacy.

Umm.

With genomics, they now actually, as part of the US Preventative Task Force Preventive Services Task Force are now recommending that you ask questions related to breast cancer history and actually recommend doing genetic testing even.

And so insurance companies are beginning to cover this because it's being shown to have the right types of quality adjusted life year outcomes are qualities and and that to me is really exciting because we now have this data to support that doing genetic testing may actually be as valuable as doing mammograms.

If you're somebody that has low risk and this is, this is really exciting for us to begin thinking about how you're using genetics to begin tailoring care to.

So suppose patient uh John Smith gets some genetic test testing at the recommendation of his primary care provider.

Next time John Smith comes in to see that PCP or any other provider is there, are these results incorporated into the general EHR workflow?

The end user clinician or how how, how do we incorporate the results of these tasks into their general standard of care?

Yep.

And so you're hitting on actually what has allowed us to grow our program and that's the fact that you have to appreciate that physicians, even today they spend more time in the autopsy lab than they do learning about genetics, even though most primary care doctors never see the inside of a human after they graduate medical school, right.

And I think this is where we've had to realize that you can't take our primary care doctors or even our specialists who haven't been trained in this and expect them to all of a sudden assume the role of the geneticist.

So we have actually done a lot of really innovative things and the space of, for example, pharmacogenomics, I'm not sure if you're familiar with that, but the idea of pharmacogenomics is basically your genes are really what helps you understand what you, what drugs you metabolize and even how quickly you metabolize those drugs.

We offer pharmacogenomics testing here at North Shore and in doing so we actually have best practice alerts that fire when a patient actually has a drug.

That's contraindicated based on their genetics, so for me, think about it very plain and simple.

Yeah.

I don't metabolize Plavix.

I have some sort of an allele variation that doesn't allow me to metabolize Plavix, but if I were to come in with a stroke or a heart attack, Plavix may be a first line of recommended therapy for me.

And again, as you think about that, it would be a failed therapy that potentially could result in death.

And so I now know and it's even actually in my my smartphone, I have it as one of the things that I don't metabolize planets.

And the reality is, is that extends beyond even, you know, cardiac conditions, you think about people who go on like coding or something like that.

Cool.

There was.

There was a situation happening many years ago in which there were babies that were dying after C-section and they couldn't figure out why they were dying and what they found.

After doing this analysis, is that oftentimes those mothers were on higher doses of codeine because they weren't actually getting any pain control.

So what did they do?

They gave them more coding, more coding, byproduct of coding.

I'm not a chemist, but essentially is morphine.

Morphine was entering the breast milk and the babies were dying.

Hmm.

And the reality is it's because they were rapid metabolizers of a drug.

So they needed more of that drug and then the byproduct of that drug was creating all these complications.

So I I think that's like a very tactical example.

And what's been really exciting for us is 99% of patients have at least one variant that would suggest they have a pharmacological drug change that they would need should they be ordered that specific drug.

Henderson.

And.

And so how are you ensuring?

So I heard that the best practice advisory, which is an epic.

The alert real time alert.

I I know that that's one way that you can incorporate the data into the workflow for the providers.

UM, I guess.

Uh what?

Uh, you know when?

How how would you address a patient?

Question which is what changes in my DNA may be important to my health?

How do you proactively help?

You spoke about how providers can address genomics.

How do you tailor a digital front door genomic results to a digital front door to address patient questions needs?

Yeah.

So as we started out the program we we really started with looking at family history and using family history as a guide to figure out if somebody would meet criteria to have genetic testing.

Umm.

But that that only addressed the subset of the population that had a known family history.

As I alluded to, we then started to offer patients the ability to select into having what we're calling a population genomic screen, which is getting to that idea of it's all comers.

Umm.

Anybody that wants to have genomic information or genetic information about themselves can have access to that.

Umm.

And what's been really unique about genetics is you think about this, all it requires is a blood draw or a cheek swab.

And so we have been looking at how you can actually provide genetic medicine virtually almost 100% virtually because you and I could establish a provider patient relationship.

If I was a physician, I drop a kit in the mail and have the ability to get insights back to you that ultimately could help me as I'm thinking about creating a tailored screening for you.

Got it.

Now I kind of want to segue into your own personal history for a minute on, but related to this topic, in a way I know you've spent some time at Kameda Medical Center in Kamigawa City in Japan.

I'd like to ask if there have been any innovations and other nations or industries that you've applied to your work at endeavor.

For example, what's happening with genomics and other parts of the world?

Many hospitals use lean segment or 6 Sigma to do workflow efficiency within the hospital, which is an error action program that comes from the automotive industry in Japan with Toyota.

Any other lessons learned from other industries or nations that may be applicable to genomics or other programs you're working on?

Yeah, it's an awesome question.

And I think we need to do more to understand how other countries are approaching healthcare, something that was very interesting at the time when I was in Japan.

It was a very homogeneous population, and so when you're putting out again, getting a little bit into the genetics, when you have a very homogeneous population, you have the ability to roll out guidelines that are going to be more applicable, contrast that with the United States where we have wide diversity.

And the idea of what makes sense for a Caucasian male, North American or historian, northern European versus having someone that's maybe from Africa versus someone that may be of Asian descent, you start to see that there are different ways that you're going to have to manage those patients.

Umm.

And.

And if you don't take into account there uniqueness and their ethnicity, you're going to miss that and you're going to treat them like in one of many as opposed to an end of 1.

And so that to me, I think was very interesting to see that the other thing is, I mean, call it for what it is, the payment models are very different and in in other parts of the world and as a result, the incentive to think about prevention as opposed to out and and prevention and following the long term outcomes of the patient's are weighed much more heavily than in the US I'm.

Umm.

Umm.

I'm.

I'm beating the dead horse here with genomics, but that's that's part of the reason to get involved in genetics is it has lifetime value test once and you're done.

So.

So your title that endeavor is SVP Innovation and research and well on this topic of innovation with genomics, many health systems and many of our listeners may be working at health systems that are beginning to develop their own health tech startup accelerators and incubators.

So I understand that endeavor has engaged in a partnership with M Hub and MENTEC accelerator.

There's support, innovation and invest in the future of healthcare at endeavor.

What would you say to one of your peers at another organization that's going down a similar path and considering whether they should financially invest in an accelerator and incubator and get involved in promoting innovation with startups?

I I mean, I think it comes down to is it a priority as I take a look at endeavor, we're in a very complicated and competitive marketplace with academic medical centers.

And the question is always ask, why would a patient choose to come to a community based hospital as opposed to driving downtown?

And I think at the end of the day, it's true.

If you have research that's associated with expertise and the thing that I think becomes really important for us is we want to have the ability to differentiate ourselves for innovation research.

So our patients don't drive past us, they can get that same cutting edge medicine plus even some differentiated medicine and their own backyard.

And so I think for those individuals who are in a health system that is more competitive, you have to ask yourself how can you differentiate yourself?

One of the benefits of being a community based health system is our community.

We take care of patients.

It's not an episode where they come to me because they need a specific specialty.

You know, thing that they think only a large academic player can provide.

The reality is these are patients who stay with us for a long period of time, and in doing so we have the benefit of getting to know them better.

And so as you think about innovation and some of the new technologies that are out there, they're not built around necessarily these small episodes of care.

It's about care enablement across a large period of time and through different life phases that patients have.

So again, I think in the space of innovation and research, if you're a community based hospital, you really need to be asking yourself, do you have something that's unique that would actually allow you to be attractive as a partner of choice or potentially a space where you could offer some new innovative things like clinical trials in order to keep your patients in your own backyard?

So on the topic of innovation, but also keeping in mind that the title of this podcast is Healthy Data podcast.

I'd like to speak to you about your program called data advantage and how you leverage data to create new insights with external collaborators.

Yep.

For example, you've partnered with IQVIA and you've won a prestigious best AI based solution for healthcare for artificial intelligence breakthrough.

Can you talk to me about that partnership?

I know there's a lot of joint ventures that many of our listeners are going or entering into across the nation.

You know, how did you decide to enter into this partnership and kind of what was your metric metric for success?

And then what are what are the implications of incorporating Gen AI into into endeavor?

But so this is the elephant in the room, I think, is what is AI?

What are large language models?

Natural language processing and what do they mean for healthcare?

I have to give a huge shout out to my colleague Chad Konchak and Nirav Shah, doctor Nirav Shah, who have really been instrumental in the relationship with QIA and and what's been really exciting as we've taken a look at that relationship is we were trying to solve for real problems and I think that's why that was awarded and a best innovation in that example, what we did is we looked at how many patients are actually coming into the emergency room and don't have the ability to have someone who's doing a deep dive to understand what are.

Their social determinants of health.

A lot of that information isn't captured discreetly.

It's embedded in notes, and those notes may be across multiple years.

So what they did is they partnered up and created a model that allows them to actually surface insight.

That may be buried in the text in order to help those patients get associated with care managers, care navigators, social workers at the point of care and real time.

You would never be able to actually read through an entire EMR and determine someone's potential determinants of health.

If you did leverage that technology, so data advantage to us is really saying how do we take advantage of the fact that we have one of the longest longitudinal data sets going back to twenty 03 when we went live with Epic and and because of that, we have all of this information that we now need to coal into insights.

Umm.

Umm.

That's just the first of many.

We are also working on clinical analytics predictive engine, our Cape model and deterioration in the hospital as well as thinking about how we can position our data, whether it is genomics or it's EMR data to identify what patients might benefit from clinical trials.

1st.

If we know more about them, we could maybe short time shorten the time frame for them to get access to a clinical trial.

So we are approaching the end of this podcast episode and as we do, I'd like to pose a final kind of reflective question that's based upon the past 20 minutes of our conversation just now.

We've spoken about extracting real time data from the EHR using Gen AI over a longitudinal unified record earlier we spoke about.

Uh.

Having a genetic the genetic data of 50,000 patients in a fire repository, my question is kind of from a technical perspective, how do you kind of add, aggregate and integrate all the data from all different data sources and all the different data types and make it accessible at the right time to the right user at the right place and real time?

What?

You know, how are you driving that fire repo?

How are you driving your OMOP?

Yeah.

You know OMOP to fire calls.

Yep.

You know, how are you technologically enabling your platform to make sure that the right data is available to clinicians when they need it?

I so I at amazing question that you're asking and I think one that we had to confront head on when we started taking a look at what we were doing in genetics.

I so I E.

But I mean, interoperability is an issue that you have across the board.

As alluded to, we've been growing as a health system now bringing 9 hospitals together that we're on the spirit.

EMR is even getting to a standardized nomenclature and data definitions.

Is is a challenge?

I can share just a very tactical example.

When we were looking in the space of genetics again, we didn't have a system that could actually standardize variance in order to push those into epic.

Yeah.

So we built it ourselves.

We built a product called Flight FYE and Flight is our bioinformatics tool that helps us actually bring in data from various labs.

You can have a commercial lab.

You could have it in house lab.

You could have patients who are bringing data from other sources.

We bring that all together, harmonize it, and that becomes then the quality control that allows us to ensure that we have the right standards before we push those into the medical record.

Well.

Admittedly, we've had to build some of that in order to do it, because those products haven't existed.

I see.

Well, thank you.

I I think this has been quite a conversation from building your own enterprise data warehouse to building your own pharmacogenomics data set from scratch to creating innovative partnerships in order to leverage the benefits of Gen AI.

This has been an interesting conversation.

So for our listeners, like your mind you, this has been adjusting brick, the SVP of innovation and research and endeavor health.

Justin, thank you so much for joining us today.

Jordan, appreciate the time.