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Cerner uses employees’ DNA in pilot research; aims to use genetic info to improve health

After having their genome analyzed by a California company called 23andMe, Cerner employees Eric and Jennifer Geis volunteered to share those results with their company.
After having their genome analyzed by a California company called 23andMe, Cerner employees Eric and Jennifer Geis volunteered to share those results with their company. jtoyoshiba@kcstar.com

She was curious about her ancestry. He wondered if an allergy might be inherited by their twin girls.

So Jennifer and Eric Geis wanted to see if their DNA could answer those questions, and they sent saliva samples to 23andMe, a personal genetics testing company.

They then did something more unusual — and ended up as good-natured research subjects in a pilot program at their employer, Cerner Corp.

The couple became two of 82 Cerner employees who voluntarily turned over their entire DNA profile to their company. Sharing that chromosomal pattern — the very essence of who they are — is something many workers might not want to do.

But the Geises believe in the Cerner pilot program, a study that aims to help Cerner evolve away from being solely a health care technology company that builds systems to share data among patients, doctors and hospitals.

Cerner instead wants to be an actual health care company. The pilot program is a bet to show that early knowledge about somebody’s DNA will help reduce the effects of or even prevent illnesses in the long run and save money throughout the health care system.

“We fall into the ‘really want to know’ category,” Eric Geis said of his interest in baring his genome to scrutiny. “I wanted the data to know what to look for.”

Ditto, said Jennifer Geis, whose father died after a heart attack. “We did it for ourselves, but I now know more about the family history and risk factors.”

The DNA knowledge will mean “the person is at the center of health care,” said Cerner president Zane Burke.

“How do we use the power of all this health data and the tool sets we’ve built? How do we practically use it to help people live?” Burke said. “We’re now able to take vast amounts of data, upload that data, run programs against that data — diabetes protocol, care management protocol — and see how we identify people who need intervention. We need to understand the whole phone book, but get down to the personal level.”

Cerner was founded to provide computerized and, ultimately, shareable health care data on health conditions, procedures, treatment outcomes and billing. Cost reduction and elimination of duplicate services were big goals for the national health sector that counts for 17 percent of the U.S. economy.

But it’s become clear that cost control and best-practice care won’t happen unless and until people, individually and the population as a whole, take better care of their own health.

About 14,000 health care industry participants are in Kansas City this week at Cerner’s annual conference to discuss just such issues. Part of what they’ll hear is that while health care providers have collected massive amounts of data from the population as a whole, that’s not enough.

Personalizing data

“We know that large-scale analytics hit what works for everyone, but not for most people,” said Cary Pitman, a registered dietician at Cerner.

Pitman is credited with pushing the company to use the genomic testing from the Geises and other employees in individualized research. Such study gives individuals information that will help them make health-oriented decisions.

“The personal element is what we’re after,” said David Nill, chief medical officer in the Cerner Healthe Clinic, which operates on Cerner’s headquarters campus to serve Cerner employees. “Broad programs fail, but with genetic information we can tell people they’re built differently, so they may need to do something different.”

In the Cerner study, diet and health coaches will sit down with the Geises and others in the test program to see if they are more likely than the general population to suffer from four specific conditions — obesity, metabolic syndrome, osteoporosis and depression.

The participants’ DNA profile from their 23 pairs of chromosomes will have been run through complex algorithms created by Doug McNair, president of the Cerner Math division, and his colleagues.

“We know there are variations in genes that affect those conditions,” McNair said. “We know this from the research literature and from Cerner’s own prior genomics studies.”

The Geises, in their mid-30s, appear to be spectacularly healthy. They’re slim, exercise religiously and eat healthy diets. But the genomic test helped Jennifer Geis know whether she might or might not have a heightened link to family incidence of obesity, diabetes and depression. Eric Geis learned, in part, that he was vitamin D deficient.

The two meet periodically with Libby Even, their assigned health coach, in the Cerner clinic.

“We don’t make assumptions just by looking at them,” Even said. “We coach hundreds of Cerner people about healthy habits every day, but this test program is an added piece. We’re looking to see if we can drive personalization and motivation.”

For Eric Geis, being in the test program is a good thing. “It’s nice to talk proactively rather than reactively about your health,” he said.

Privacy concerns

Pitman, the dietician, knew there were long odds to create a test kitchen to advance the company’s population health research. For one thing, Cerner couldn’t ask its employees to submit to genetic testing.

A health privacy law, the Genetic Information Nondiscrimination Act, which went into effect in 2009, bans employers from requiring genetic testing or making any staffing decisions based on such results. Cerner, like many employers, takes pains to separate all employee health information from anything in their work-related personnel files.

So Cerner launched its test research by putting out a companywide call, seeking employees who already had voluntarily paid $199 for 23andMe’s Health + Ancestry Service to satisfy their own interests.

The California-based genetics company, founded in 2006, has genotyped more than 1 million customers worldwide. It turned out that 197 of Cerner’s 12,000 Kansas City area employees responded to Cerner’s initial call, offering up their 23andMe results.

Pitman said she had hoped to include 100 in the initial test program but ended up with 82 who met all qualifications to participate.

While in many companies, some employees are reluctant to let their employers know anything about their health — even to the point of refusing to sign up for company wellness incentive plans — access was more readily given at Cerner.

“We’ve drunk the Kool-Aid,” one worker joked. “They can know anything about me they want.”

The man, not involved in the test program, said he wasn’t empowered to speak publicly, so he asked that his name not be used. But he emphasized that Cerner’s mission is to improve health care delivery by making people healthier, and that starts with taking responsibility for one’s own health by having good information.

And that’s why Eric Geis started taking a vitamin D supplement after his personal analysis found a deficiency.

“The majority of people want that kind of intervention,” said Cerner president Burke. “We’re impacting the people who want to engage in their health. But some need incentives to engage. So we’re working with health providers and their plans … because the key is to engage before you have a problem.”

Cerner and other companies are in the early stages of “normalizing” the data, of using algorithms, probabilities and population health experience to help individuals learn about possible risks or likelihoods.

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Universities including Harvard, Stanford, Cambridge, MIT and Chicago are participating in 23and Me research, as are prime industry players such as Biogen, Genentech and Pfizer and nonprofit research institutes such as the National Parkinson Foundation and Lupus Research Institute.

Still others participate in the eMerge network, formed in 2007 to bring together genomics researchers, statisticians and clinical medical practitioners. The network exists to merge research and mountains of patient data with practical applications, at the same time minding privacy and ethical considerations.

The overarching goal remains: to catch little health issues from becoming big ones or keep them from developing at all.

“We’re in the business consumers really don’t want to use,” Burke said. “None of us wants to be sick. None of us wants to use the doctor. We want people to be healthy.”

Diane Stafford: 816-234-4359, @kcstarstafford

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