AdventHealth is providing personalized care for patients who are considered high-risk for developing breast cancer. In this article, originally published by our sister publication, Healthcare Innovation, David Raths discusses AdventHealth’s Genomics Risk Assessment for Cancer and Early Detection (GRACE) program with Dr. Wes Walker.

How AdventHealth embeds cancer risk assessment into workflows

AdventHealth’s Genomics Risk Assessment for Cancer and Early Detection (GRACE) program uses family and medical history as well as digital mammography, AI and embedded algorithms to assess a patient’s potential risk of developing breast cancer. Wes Walker, M.D., vice president of genomics & precision health at 55-hospital AdventHealth, spoke with Healthcare Innovation about the impact the program is having. 

The Florida-headquartered health system is embedding cancer risk assessment into primary care and OB/GYN workflows. Walker has strategic and operational responsibility for genomics initiatives in AdventHealth’s Central Florida division. But he also works to identify and develop pilots around genomics and precision health that can be scaled system-wide. Walker said health systems are at an inflection point in terms of being able to operationalize precision medicine at scale. 

Healthcare Innovation: With the GRACE program, did you see an opportunity to identify higher risk patients earlier in the process? And was age primarily how people were stratified to be screened before this?

Walker: Yes, we saw in the guidelines and in more advanced clinical practices, as well as some of the accreditation programs, that they were looking for more tailored, personalized, evidence-based risk assessment methodologies other than just age. When we looked at our organization, we found there was an opportunity. We put together a multidisciplinary team to develop a program on both the technical side and the high-touch side.

HCI: How is AI involved and how does a radiologist work with the risk analysis tool?

Walker: We work with a company called Lunit that has an AI module that provides predictions and recommendations for radiologists related to breast density. Breast density is a very important component of the most advanced risk assessment models. 

Here is how the program works: Let’s say somebody schedules their mammogram. Two weeks before they come in, they get a survey to gather information that's not already in Epic that can be used in these risk assessment modules. They come in and get their mammogram, and the Lunit module with the AI enablement provides a recommendation. The radiologist can use that — and I would say over 90% of the time they use that. A risk assessment is calculated. That is provided to the radiologist. All of this is occurring in Epic, and can be seen by the entire healthcare team. If the patient is identified as high-risk, that information automatically flows to the nurse navigator to enable them to reach out and have a conversation around what that high-risk status means. 

The program has two components. There's high-touch and then high-tech. The tech is on the front end, and high-touch is on the back end in terms of making sure that this isn't just a number or a radiology report that goes into the chart, but rather there is a human who has deep expertise in this area. Our nurse navigators, on average, have 15 years of oncology nurse navigator experience. They can provide education but also provide that emotional support, because finding out you're high-risk for breast cancer can be a very stressful experience.

HCI: I saw you quoted as saying that roughly 20% of the women who come in to get a mammogram are actually at high risk. As you developed the program, did you have to add more nurse navigator positions?

Walker: Yes, we did hire a team of nurse navigators, but we've also used the population health tools in Epic to automate the things that can be automated and make them incredibly efficient. The important part of that is having our nurse navigator lead and her team as a part of the design process to optimize the EMR in such a way that it makes them incredibly efficient. That's only going to become more powerful. There are additional automations available. We’re going to be hiring additional nurse navigators as we scale this program. But because of the variety of tools we have, they will become increasingly efficient and productive in terms of the number of patients they're able to to manage and impact.

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