Progress toward Health System Readiness for Genome-Based Testing in Canada

Don Husereau¹, Eva Villalba², Vivek Muthu³, Michael Mengel⁴, Craig Ivany⁵, Lotte Steuten^{6

7}, Daryl S Spinner⁸, Brandon Sheffield⁹, Stephen Yip¹⁰, Philip Jacobs¹¹, Terrence Sullivan^{12

13}, Larry Arshoff¹⁴

Affiliations

¹ School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada.
² Coalition Priorité Cancer au Québec, Saint-Lambert, QC J4P 2J7, Canada.
³ Marivek Healthcare Consulting, Epsom KT18 7PF, UK.
⁴ Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, AB T6G 2S2, Canada.
⁵ Provincial Health Services Authority, Vancouver, British Columbia, Vancouver, BC V5Z 1G1, Canada.
⁶ Office of Health Economics, London SE1 2HB, UK.
⁷ City University of London, London EC1V 0HB, UK.
⁸ Menarini Silicon Biosystems Inc., Huntingdon Valley, PA 19006, USA.
⁹ William Osler Health System, Brampton, ON L6R 3J7, Canada.
¹⁰ Department of Pathology & Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z7, Canada.
¹¹ Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada.
¹² Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada.
¹³ Gerald Bronfman Department of Oncology, McGill University, Montreal, QC H4A 3T2, Canada.
¹⁴ Diagnosis, Solutions & Results Inc., Thornhill, ON L4J 7N5, Canada.

PMID: 37366891
PMCID: PMC10296918
DOI: 10.3390/curroncol30060408

Review

Progress toward Health System Readiness for Genome-Based Testing in Canada

Don Husereau et al. Curr Oncol. 2023.

. 2023 Jun 1;30(6):5379-5394.

doi: 10.3390/curroncol30060408.

Authors

Affiliations

¹ School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada.
² Coalition Priorité Cancer au Québec, Saint-Lambert, QC J4P 2J7, Canada.
³ Marivek Healthcare Consulting, Epsom KT18 7PF, UK.
⁴ Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, AB T6G 2S2, Canada.
⁵ Provincial Health Services Authority, Vancouver, British Columbia, Vancouver, BC V5Z 1G1, Canada.
⁶ Office of Health Economics, London SE1 2HB, UK.
⁷ City University of London, London EC1V 0HB, UK.
⁸ Menarini Silicon Biosystems Inc., Huntingdon Valley, PA 19006, USA.
⁹ William Osler Health System, Brampton, ON L6R 3J7, Canada.
¹⁰ Department of Pathology & Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z7, Canada.
¹¹ Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada.
¹² Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada.
¹³ Gerald Bronfman Department of Oncology, McGill University, Montreal, QC H4A 3T2, Canada.
¹⁴ Diagnosis, Solutions & Results Inc., Thornhill, ON L4J 7N5, Canada.

PMID: 37366891
PMCID: PMC10296918
DOI: 10.3390/curroncol30060408

Abstract

(1) Background: Genomic medicine harbors the real potential to improve the health and healthcare journey of patients, care provider experiences, and improve the health system efficiency-even reducing healthcare costs. There is expected to be an exponential growth in medically necessary new genome-based tests and test approaches in the coming years. Testing can also create scientific research and commercial opportunities beyond healthcare decision making. The purpose of this research is to generate a better understanding of Canada's state of readiness for genomic medicine, and to provide some insights for other healthcare systems. (2) Methods: A mixed-methods approach of a review of the literature and key informant interviews with a purposive sample of experts was used. The health system readiness was assessed using a previously published set of conditions. (3) Results: Canada has created some of the established conditions, but further action needs to be taken to improve the state of readiness for genome-based medicine. The important gaps to be filled are the need for linked information systems and data integration; evaluative processes that are timely and transparent; navigational tools for care providers; dedicated funding to facilitate rapid onboarding and support test development and proficiency testing; and broader engagement with innovation stakeholders beyond care providers and patients. These findings highlight the role of the organizational context, social influence, and other factors that are known to affect the diffusion of innovation within health systems.

Keywords: biomedical; clinical governance; diagnostic molecular pathology; diagnostic services; financial support; genetic services; genetic testing; health technology; healthcare innovation; technology assessment.

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Conflict of interest statement

The authors declare the following conflicts of interest. D.H. and L.S. report funding, outside the submitted work, from various pharmaceutical companies with an interest in genome-based testing and precision medicine. D.S.S. is a salaried employee of Menarini Silicon Biosystems, Inc. (Huntingdon Valley, PA, USA) which is a commercial diagnostic manufacturer/clinical laboratory. V.M. advises a range of companies, including those with products and services related to the subject of this paper. V.M. holds, and has held shares in health data, health services, healthcare consultancy, and biotech companies, and serves or has served in paid non-executive director roles and paid advisory roles in such companies. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

**Figure 1**
Number of necessary conditions for health system readiness for genome-based medicine established by province. Lightest shade indicates the condition does not exist or needs significant improvement (‘needs improvement’). Intermediate shade indicates some aspects of the condition were established (‘partially established’), while the darkest colour indicates most or all aspects of the necessary condition were established (‘established’).

See this image and copyright information in PMC

References

1. Sikka R., Morath J.M., Leape L. The Quadruple Aim: Care, Health, Cost and Meaning in Work. BMJ Qual. Saf. 2015;24:608–610. doi: 10.1136/bmjqs-2015-004160. - DOI - PubMed
1. Ginsburg G.S. Realizing the Opportunities of Genomics in Health Care. JAMA. 2013;309:1463–1464. doi: 10.1001/jama.2013.1465. - DOI - PubMed
1. Sperber N.R., Carpenter J.S., Cavallari L.H., Damschroder L.J., Cooper-DeHoff R.M., Denny J.C., Ginsburg G.S., Guan Y., Horowitz C.R., Levy K.D., et al. Challenges and Strategies for Implementing Genomic Services in Diverse Settings: Experiences from the Implementing GeNomics In PracTicE (IGNITE) Network. BMC Med. Genom. 2017;10:35. doi: 10.1186/s12920-017-0273-2. - DOI - PMC - PubMed
1. Skivington K., Matthews L., Simpson S.A., Craig P., Baird J., Blazeby J.M., Boyd K.A., Craig N., French D.P., McIntosh E., et al. A New Framework for Developing and Evaluating Complex Interventions: Update of Medical Research Council Guidance. BMJ. 2021;374:n2061. doi: 10.1136/bmj.n2061. - DOI - PMC - PubMed
1. Husereau D., Steuten L., Muthu V., Thomas D.M., Spinner D.S., Ivany C., Mengel M., Sheffield B., Yip S., Jacobs P., et al. Effective and Efficient Delivery of Genome-Based Testing-What Conditions Are Necessary for Health System Readiness? Healthcare. 2022;10:2086. doi: 10.3390/healthcare10102086. - DOI - PMC - PubMed

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Progress toward Health System Readiness for Genome-Based Testing in Canada

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Progress toward Health System Readiness for Genome-Based Testing in Canada

Authors

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Abstract

Conflict of interest statement

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