Minn. — It has been 1.5 years since Mayo Clinic opened the
world’s first integrated multidisciplinary genomics service,
the Individualized Medicine Clinic, which uses genomics and
next-generation sequencing technologies to personalize
treatments for patients with advanced cancer and complex
diagnoses. In a special issue of the American Journal of
Medical Genetics Part C, “Implementation of Genomic
Medicine,” developers of the Individualized Medicine Clinic
report the clinic’s structure and share lessons learned in
everything from efficacy of genomics in patient care to
struggles with insurance reimbursement and ethical dilemmas.
Lazaridis, M.D., a Mayo Clinic hepatologist and director of
the Individualized Medicine Clinic, says the clinic is a
natural extension of Mayo’s commitment to putting the needs
of the patient first and that leaders in the Mayo Clinic
Center for Individualized Medicine saw this opportunity as an
imperative. Since opening the clinic, more than 30 percent of
patients on a diagnostic odyssey have received answers through
“We now have
the capability to understand cancer and diagnostic odyssey
cases at their most fundamental level,” says Dr. Lazaridis.
“And while we had many hurdles to overcome in designing and
launching this clinic, we continue to improve our services,
and that’s what matters to people who need our help.”
Individualized Medicine Clinic accepts patients on a
case-by-case basis and admits those deemed most likely to
benefit from next-generation sequencing technologies.
— Within the
healthcare administrative framework, a new clinic without
departmental affiliation affords greater patient access and
provider flexibility in meeting patient needs.
— Setting up
an Individualized Medicine Clinic shares many similarities
with launching a new clinical department, including
considerable investment in information technology and
undergoing whole exome or whole genome sequencing usually want
educational materials well before the procedure to give them
time to think through the many complex decisions they will
have to make about their genomic information. Even
well-informed patients deserve and benefit from thoughtful
conversations with certified genetic counselors.
— About half
of Individualized Medicine Clinic patients receive at least
partial insurance reimbursement, despite attempts by Mayo
Clinic providers to secure prior authorization. And,
estimation of out-of-pocket expenses for patients remains a
challenge. The landscape of insurance coding and reimbursement
has not yet caught up with medical capabilities.
requires meaningful interaction and collaboration with
different departments throughout an institution.
access to genomics services is possible through both tele-consultation
and disparate healthcare providers who use a unified ordering
system and electronic health record.