Pharmacy Benefits Manager Genetic Data Integration
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Solution Overview
Problem
Current healthcare systems lack the ability to effectively integrate genetic information for determining medication efficacy, leading to ineffective treatments and unnecessary side effects due to the lack of genomic data in electronic medical records and the absence of routine genomics testing in healthcare provider routines.
Innovation Solution
A system and method for determining medication efficacy using genetic data, which involves reviewing patient information to identify relevant genetic markers, integrating genetic testing results into existing electronic health records, and automating laboratory-based authorization for genetic testing to streamline the ordering and eligibility process, preventing the coverage or fill of ineffective medications.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If genetic testing is integrated into electronic health records to determine medication efficacy, then treatment effectiveness is improved, but system complexity and implementation difficulty increase
Solution Approach 1:
The patent employs an intermediary system that acts as a bridge between genetic testing laboratories and existing electronic health record systems. This intermediary component translates and integrates genetic data into formats compatible with current EHR infrastructure, allowing genetic information to be incorporated without requiring complete system redesign. The intermediary handles data normalization, integration logic, and interface management, thereby reducing the complexity burden on both the genetic testing and EHR systems.
Solution Approach 2:
The integration process is divided into separate functional modules: genetic testing module, data transmission module, integration module, and display module. Each module operates independently with defined interfaces, allowing the system to be implemented incrementally and maintained separately. This segmentation enables hospitals to adopt genetic testing integration without overhauling their entire EHR system, reducing implementation complexity.
2Loss of energy
If genetic testing is performed routinely to prevent ineffective medication prescriptions, then resource waste is reduced, but testing costs and process time increase
Solution Approach 1:
Rather than performing comprehensive genetic testing for all patients on all medications, the system applies genetic testing selectively based on clinical guidelines and patient-specific factors. The integration system evaluates which gene-drug pairs require testing and only initiates testing when clinically indicated, avoiding unnecessary testing costs while still preventing ineffective prescriptions in high-risk scenarios.
Solution Approach 2:
The system performs genetic testing before medication prescription when possible, allowing proactive identification of ineffective treatments. By conducting testing in advance and integrating results into the EHR before prescribing, the system prevents resource waste from ineffective medications without requiring costly post-prescription trial-and-error adjustments.
3Loss of information
If genetic data is integrated into existing electronic medical records, then data availability is improved, but data security and privacy risks increase
Solution Approach 1:
The system implements differential security measures based on the sensitivity and type of genetic data. Different encryption levels, access controls, and security protocols are applied to different genetic information categories (e.g., pharmacogenomic data versus other health data). This localized security approach ensures adequate protection for sensitive genetic information while maintaining data availability for clinical use where appropriate.
Solution Approach 2:
An intermediary security layer is introduced between the genetic testing system and the EHR system. This intermediary handles data encryption, decryption, and access control, ensuring that genetic data is transmitted and stored securely while remaining accessible to authorized healthcare providers. The intermediary acts as a security buffer that protects the integrity and confidentiality of genetic information.
Data Source
AI summary
System and methods for preventing the coverage or fill of ineffective medications are provided. Genetic efficacy testing results are received at a pharmacy benefits manager (“PBM”) system from a laboratory information system. Medications reported as ineffective in the testing results are flagged as an allergy in an electronic patient record. Requests for coverage of medications are received at the PBM system from a dispensing pharmacy system and electronic notifications are issued to the dispensing pharmacy system where the medication is flagged as an allergy at the PBM system to prevent the flagged medication from being filled.