Nest Genomics creates EHR-integrated clinical decision support for genetics-based care

NEW YORK – After selling his latest company for millions of dollars, software and life sciences entrepreneur Moran Snir is ready for his next adventure – trying to make it easier for doctors to create care plans based on genetic results of patients.

Snir in 2019 sold Clear Genetics, a company she co-founded in 2016, to medical genetics company Invitae for an estimated $50 million. Clear Genetics had developed chatbot software to guide patients through the process and results of genetic testing, and had been adopted by health systems like Geisinger Health.

Now she’s turning her attention to bringing genetic information to patient care as CEO of Nest Genomics, a New York-based company she co-founded in January to develop decision support software. genetics-based clinic that connects to providers’ existing electronic health record (EHR) systems.

In April, Nest raised $8.5 million in seed funding and earlier this year participated in Y Combinator – a startup accelerator known for providing a launchpad for successful startups like Airbnb, DoorDash and Dropbox.

While access to genetic testing has become better — and cheaper — in recent years, “there is now a huge gap in the implementation of genetics in clinical practice,” Snir said.

Nest’s software will integrate a patient’s genetic, demographic and other data from the EHR to create care management plans for patients. The product bases care plans on clinical guidelines from the American College of Medical Genetics and Genomics (ACMG) and other specialty societies, and so far has care plans for hereditary cancers, cardiovascular genetics, and conditions included in the CGPA Secondary Outcome List. Healthcare systems and Nest customer clinics will be able to adapt care plans within their own organization if their processes differ from other guidelines.

Snir said the platform could be used by genetic counselors and other genetic specialists, or by primary care physicians and specialists managing their patients’ genetic results.

The system also includes a patient companion tool – a web-based application that contains educational information about genetic results and reminders to encourage adherence to care plans, such as screenings for various conditions. Patients can use the app to view and share their genetic results with other doctors.

There is a need for tools that help providers and patients navigate genetic results, said David Ledbetter, clinical and research director at the Unified Patient Network, a subsidiary of bioinformatics company Seven Bridges Genomics, and advisor to Nest. He previously served as Chief Scientific Officer at Geisinger, based in Danville, Pennsylvania, who had used the Clear Genetics chatbotcalled Gia.

This need will only increase as whole genome sequencing (WGS) becomes more widely used, as patients will gain tons of data beyond a typical gene panel, including data that could be useful for further testing later in life, Ledbetter said. He quoted a recent pre-publication study who found a lower rate of inconclusive test results and higher diagnostic yield with genomic sequencing tests compared to multigene panel tests.

But for such a system to succeed, it will need to work within existing vendor workflows, including with the EHR. Physicians “really don’t like getting out of this unique EHR environment,” Ledbetter said. It’s inconvenient for a doctor to have to open other programs and switch between them and the EHR, he said.

The Nest team is building integrations with various EHR systems, starting with Epic Systems, Oracle Cerner and Athenahealth, according to Snir.

Snir said she envisions a future where, as the price of WGS continues to drop, patients can be sequenced once and have that information reinterpreted later as new standards of care for genetic variants emerge. DNA sequencing holders and startups compete on the sequencing of the human genome at the lowest cost.

Managing genetic results can be complicated, in part because guidelines, patient information and classifications can change over time, Snir said. By updating the software based on new information, Nest can help providers create care management plans based on the latest available evidence.

Nest proposes to “incorporate findings that are actionable today, and then, as new information becomes available, provide those updates to patients and providers,” Snir said. The company only provides care plans at the request of a clinician.

Nest does not plan to seek US Food and Drug Administration clearance for its rules-based clinical decision support tools. The company will continue to assess regulatory needs based on final guidelines that the FDA has released in September, which outlined the agency’s approach to regulating clinical decision support software. Nest will follow FDA guidelines and develop solutions accordingly, Snir said.

The company performed a soft launch in August and has signed deals with a handful of health systems and two labs to roll out the product, according to Snir. Nest is planning a full retail launch in November.

As organizations roll out the platform, Nest will assess whether it affects patient adherence to care plans and influences their long-term outcomes.

Nest is trying to solve a “last mile problem” in genetic sequencing, linking available evidence on what to do with genetic results with tools to suggest such steps to doctors and patients, said Philip Payne, founding director of the Institute of Computer Science and chief data scientist at Washington University School of Medicine in St. Louis.

The university is in talks with Nest Genomics about possible co-development work, such as creating tools for cancer, neurodegenerative diseases and rare genetic diseases in children. He said the “best case scenario” would be to create systems that could one day be deployed with WUSTL physicians, as well as shared with other organizations.

“We have this deep expertise in terms of sequencing and interpreting sequencing data for both research and clinical purposes,” Payne said, citing the school’s McDonnell Genome Institute. “But like many organizations, we are challenged to bridge this gap between sequencing and clinical decision-making.”

Ideally, he hopes tools like those offered by Nest will help frontline clinicians create care plans and manage patient genetic outcomes, especially as the industry grapples with a labor shortage. work in clinical genetics.

“It’s not something that can only be done by specialists,” Payne said. Of course, genetic counseling will be needed for complex results, he added.

Huma Rana, clinical director of the division of genetics and cancer prevention at the Dana-Farber Cancer Institute in Boston, said she is preparing to test Nest Genomics with high-risk patients, i.e. patients with genetic predispositions to hereditary cancers and who need specialized monitoring, as part of a research project.

This will initially involve talking to patients to get feedback on the system, before deploying it in a clinical trial.

Dana-Farber has worked with Nest to co-develop and customize tools that clinicians can use to help track patients undergoing various screenings and other preventative care. Rana said she also wants to see how patients interact with the patient-facing component and if it changes their adherence to screenings.

The patient app is “largely an educational tool, but also a way to keep track of their ‘to do’ list — what they’re due and when they’re due,” Rana said. “Those are really, for us, exciting things.”

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