The Next Frontier in Medicine: Videha Sharma Discusses Personalised Medicine and Pharmacogenomics

In this interview, we had the pleasure of speaking with HETT Steering Committee member, Videha Sharma. As a lecturer in Health Informatics, at The University of Manchester, he discusses the future of personalised medicine and pharmacogenetics with us.

What's the most compelling evidence of personalised medicine and its importance for the health and care sector now and in the future?

The most compelling evidence for personalised medicine is around the testing for changes in people's DNA that affect how they respond to medicines. This is being implemented in the NHS and in healthcare systems worldwide, but only for specific uses.

For example, patients receiving treatment for cancer might have a test that looks at their response to certain chemotherapy (anti-cancer medicines) and then get and then they get a personalised treatment that’s based on their individual response. That means that their treatment is more likely to be effective and therefore improve their cancer outcome.

However, scientific research shows that these genetic changes, which affect how we respond to medications, are much more common and apply to many everyday medicines prescribed in the NHS. In fact, the prescribing of medicines is the most common therapeutic intervention in healthcare, but we treat everybody in the same way. This ‘trial-and-error approach’ means that medicines work well for some people, but for some they don't have an effect or even have harmful side effects.

Testing for genetic changes that affect how people respond to medicines could enable more personalised treatment, presenting a significant opportunity for healthcare systems. However, the main challenge lies not in genetics or science but in implementation.

As all HETT attendees know, any healthcare intervention today is underpinned by digital and data. The biggest challenge in pharmacogenetics is around making test results from specialist labs accessible and understandable to GPs and pharmacists at the time or prescribing. The final point is how we can make that information available to patients themselves so they can be aware of what best treatments are right for them.

So, we think that personalised medicine is going to be playing an increasing role, but the gap is really around the digital health and implementation challenge.

How can genomics and pharmacogenetics become part of NHS clinical pathways and decision-making and how can some of the existing barriers be mitigated?

The biggest part of the challenge is this digital health challenge of how you move that data around. If you think about an end-to-end service that allows people to have a pharmacogenetic test that will then ultimately lead them to have a personalised prescription, they are probably 3 main components.

Firstly, there is a testing process, someone needs to be able to order a test, receive one, and give a sample that then needs to end up in a genetic lab. Secondly, you've got the laboratory process, and that's something that the NHS is usually good at as it has well-established genetic laboratories that do lots of genetic testing every day. However, if we shift towards pharmacogenetics and personalised prescribing, it will require a larger scale of testing than we've ever seen before.

Then the final piece of the puzzle is to make that stored information available in the different parts of the healthcare system. Making that information available across the different care settings and organisational boundaries is a huge interoperability challenge.

However, one of the realisations that we've had is that genomics and pharmacogenetics has got a unique opportunity in that we haven't already got 20-30 years of electronic systems that have been storing this data. So, can we be interoperable by design, and can we recognise the fact that this information is going to be used in lots of different places, so design solutions that are interoperable from the outset? We know this information is going to be used in primary care and social care and pharmacies and hospitals, so let's not put it into a single system. Let's make a solution that’s standalone that separates that data from the different applications that's going to be used at from the outset.

How do factors like patient safety, patient experience and patient engagement factor into pharmacogenomics?

My background in digital health is user-centered design, so we've applied those principles from the start, staying close to end users to guide our design. Pharmacogenetics is not going to be delivered by specialist geneticists who have got deep knowledge in this area, but it's going to be used by people that prescribe every day on the clinical frontline who know little about genetics or are under extreme pressures already.

To ease the transition, we've engaged extensively with these clinicians, running workshops and co-designing user interfaces for practical use. A lot of them have said they would love to have this personalised treatment for their patients, but they don't have the time and capacity to log into another system and find this information and try to interpret complex languages.

To overcome this, we've collaborated with professionals from other industries, including a service designer and brand strategist, to effectively communicate ideas and value propositions. We've integrated our solutions into existing IT systems, using language and alerts that fit seamlessly into healthcare professionals' workflows, avoiding disruption and additional burden while enhancing their ability to deliver care.

From the perspective of patients, it’s positive because many patients report negative experiences with medications, so would gladly take a test to determine which medicines are right for them.

There is a concern about data privacy and the potential for using genetic information in ways that could identify individuals. Therefore, alongside our innovation efforts, there's a significant task ahead to educate people about genetic testing. It's important to clarify that genetic testing only examines genes related to medication response. And that those four genes we check for are never going to be able to identify an individual.

The other thing that people will often talk to us about is the impact it could have on their insurance. However, The Association of British Insurers have signed a charter with the government that they will never ask for genetic information to guide how they set their premiums. However, from an insurer's standpoint, if they know your genetic makeup regarding medication response, they can predict which medicines work for you and which ones don't. This means you can receive more effective treatment from the beginning, which may benefit both you and your insurer.

What's the value of interdisciplinary and cross-sector working to the pursuit of personalised medicine within the NHS?

Though we try to innovate in healthcare, there is a lot we can learn from other industries. We are very good at that basic research and trying to answer why certain things happen or why the body reacts in a certain way or why some people get diseases. We're also starting to get better at translating that into policy documents or guidelines etc. The bit that we're not good at is the ‘how’, and I feel like that is a big gap that we should try to bridge.

Lots of people have great innovations within the NHS and in the entrepreneurial space, but you often see them get stuck in the pilot phase where they may do a pilot in one hospital, maybe generate some data, maybe raise a little bit of money. But then how do they go to having a product that's scalable across geographies that's having an impact for patients across populations.

We often struggle with the "how" question, and I believe we can learn from other industries by incorporating skills such as prototyping, user testing, and product development. Embracing more design-led approaches driven by user needs and requirements is crucial, and it's an area where we currently fall short.

What's your advice for inspiring medical professionals to explore careers and benefits in healthcare innovation and technology?

As a medical professional, this is a super exciting space. You can add immense value by channeling your clinical experience into a curious mindset, questioning how things can be improved based on your experiences in patient care and collaboration.

If you're passionate about this, consider formal or informal training in health technology or healthcare innovation. There are great courses around the country, postgraduate certificates, master's or more formal academic opportunities like PHD's. There is significant value in gaining some training and expertise in this space; you need some training because the skills are different from those of being a doctor. My journey has dramatically changed how I think about, and approach problems and solutions compared to when I was just a doctor and now, I'm a doctor and a digital health person.

Attending events like HETT also offers a great opportunity to learn from and network with experienced professionals. If you're interested, definitely consider attending.

Find out more at HETT Show

Discover more about personalised medicine at this year’s HETT Show on 24-25^th September at ExCeL London.