Dr. Marc Harrison: Hi, I'm Dr. Marc Harrison, CEO of Intermountain Healthcare. Today I'm with Dr. Lincoln Nadauld, who's our chief of precision health. He's joining me on the phone today. I think he's in the U.K. [United Kingdom]. Thanks for calling in, Lincoln. Can you tell us a little bit about yourself and what you do at Intermountain?

Lincoln Nadauld: Yes, my pleasure. Thanks for having me, Marc. As you mentioned, I'm the chief of precision health. I'm a trained medical oncologist, so in addition to taking care of cancer patients, I really spend my time focusing on our institutional mission, which is to help people live the healthiest lives possible. And I try to focus our teams' efforts in that direction by using precision medicine and precision health to help people live the healthiest lives possible.

Dr. Marc Harrison: Thanks, Lincoln. And you do a remarkable job of this. What are you doing in the U.K.?

Lincoln Nadauld: There's an international summit on population genomics that was held here, and I attended along with ministers of health and the leaders of population-level genomics efforts from all over the world, including places like France, England, Thailand, Singapore, Estonia, and Qatar. It was remarkable. It was a great conference.

Dr. Marc Harrison: That sounds terrific. So, for those of us who aren’t as expert as you are, what does population genomics actually mean?

Lincoln Nadauld: Well, a genome is really all of the DNA that we’ve inherited from our parents. A genome consists of the chromosomes and genes that our parents have passed on to us. So, genomics in general means studying the genes and DNA and chromosomes that we inherited, that tell our bodies how to function. And population genomics means studying the genomics of many people — of thousands, tens of thousands, or hundreds of thousands of people across an entire population.

Dr. Marc Harrison: So, Intermountain is beginning to work in this space, right?

Lincoln Nadauld: Intermountain announced in June our own population genomics efforts. So we are collecting and doing a whole genome map on 500,000 participants over the next five years. It's really an exciting effort.

Dr. Marc Harrison: So, is this unusual for big health systems to do this kind of work, Lincoln? Are we leading? Are we following? Are we ahead? Are we behind? What does this mean?

Lincoln Nadauld: Well, one of the things I learned at this international summit is that there's extraordinary interest in this, primarily because it offers the opportunity to understand populations better and to start to predict the health across entire populations. What that means is we could start to predict individuals in a population who might be at risk to get some forms of cancer or other individuals who might be at risk to have a heart attack or a stroke or to develop diabetes. And if we can predict that, then maybe we can work with those individuals to prevent some of those things from happening. What I also learned at this summit is that we are, I think, out in front. We're quite a ways out in front, fortunately. I think that has to do with some of the terrific leadership we have at Intermountain Healthcare, and it also has to do with our institutional commitment to patients. And, frankly, it has do with the populations we serve. This is a population of people who are health-minded. They're forward thinking. And as a result, we as an organization are out in front, and we're on the cutting edge in population genomics, and it feels good, and it's good for our patients.

Dr. Marc Harrison: Nice. Are we figuring out, Lincoln, how to fold this into the way we run the system and take care of patients on a day by day basis? Can you give a couple of examples of, if we're doing that work, how it actually happens for an individual person who we're privileged to care for?

Lincoln Nadauld: That was the exact talk that I gave yesterday. It was very well received. One of the big challenges that so many institutions have is they can do the genome mapping on individuals, even on patients under their care, but then how to turn around and put that information back into the care of the patient is where a lot of institutions are currently stuck. And we're all figuring it out together. The way we figured it out, and that others are now starting to mimic, is to implement it in specific “clinical programs,” as we call them at Intermountain healthcare.

One example is oncology. We can use genomics to understand a patient's tumor and identify personalized treatment options for that specific cancer patient. We've actually published data in the past that shows patients do better, and it actually costs less to take this kind of approach, and we call that approach precision medicine. We've also used this approach in our primary care and behavioral medicine clinics where any patient with a new diagnosis of depression or anxiety can have their genes mapped. That can help their provider better predict which medicine, which antidepressant or antianxiety medication, that patient would respond to. Our current approach, or the approach we've used for many decades, is something of a trial and error approach. And while that can be successful, we find that adding this genetics and genomics approach can even accelerate the road to improve health for those individuals.

And the third example, last example I'll give, is in our neonatal ICUs, that's where some of our sickest and most vulnerable patients are, our babies. And we have some patients, unfortunately, who will dwindle and linger there for a long time. And we found that if we can map the genomes of that select population of patients, we can often find a diagnosis that will change the management. It will change their care. It will inform their doctors. And it will often give answers to those families who are struggling to understand what's happened to their baby. And we're having a lot of success there. It's very satisfying. Those are three examples of how we're implementing genomics into everyday care and it's making a real difference.

Dr. Marc Harrison: Lincoln, I like all of the examples, but as a pediatrician, particularly as a pediatric ICU doctor, I have very strong memories of families who just were ... They were scared, and they were sad, and they were confused, and they just didn't understand what was going on with their very sick newborn. And we didn't either, to be quite honest. And that's a long, painful road. I just love the fact that we're able to ... Even if we can't 100 percent fix those kids, we can give answers and a sense of direction. That's actually quite a step forward for those folks.

Can you talk a little bit about ... We all are familiar with things like 23andMe and Ancestry.com, and you and I both know the leadership of both of those organizations and have a lot of respect for them. They're great folks. How does the work that they do differ from our population genomics work with HerediGene?

Lincoln Nadauld: A big difference is that ... In the past I've classified that as more along the lines of interesting genomics or recreational genomics. And it has a place. And I will say that many of those entities have begun to offer some component of health into their tests. The biggest difference with what we're doing in our HerediGene population study is that we're mapping an entire genome. To put that into perspective, a genome has three billion individual letters that make it up, and we're mapping all three billion of those in every single person. These companies that you mentioned and that we've all seen grow up, they look at about 800,000 spots. So, we're looking at more than a thousand times the information that they're looking at.

And the other big difference, not only just in terms of total information, but maybe the biggest difference, is how we're using that information. We're turning around and really helping patients with their healthcare. If we find a gene, for example, that tells us they might develop breast cancer or colon cancer, we'll tell the patient that, and we'll work with them to implement the right interventions. So, I think the two biggest differences are in the overall scope and scale of information we're generating. And then the second one is how we're using that really to impact and improve an individual's health.

Dr. Marc Harrison: If I wanted to sign up for HerediGene, how would I do it?

Lincoln Nadauld: Right now people can walk into any one of about a dozen clinics that we have open across Intermountain Healthcare up and down the state. No order is required. It's free to any participant. Anybody over the age of 18 is eligible, and individuals will be asked to sign a consent form. And they can choose whether they want to receive results or not. It's totally up to them. By the end of this year, we'll have 25 different sites open. The best way that people can find a site open for them is by visiting our website, which is IntermountainHealthcare.org/HerediGene. It's spelled H-E-R-E-D-I G-E-N-E.

Dr. Marc Harrison: Nice. How do we manage the privacy concerns that a potential HerediGene participant might have?

Lincoln Nadauld: It's a common question. It's a great question. Privacy is our number one concern as well. We are absolutely committed to the privacy of our patients, and we believe that patients own their own data. Along those lines in HerediGene, as soon as a patient enrolls on HerediGene and a sample is collected, it's immediately de-identified. It's given a unique number that is totally anonymous. Any identifiers for that patient are removed from the sample so that this is a completely private and anonymous research study, really. So that, I think, is just a reflection of our commitment to a patient's own privacy. And then if at any time an individual wanted to be taken out of the study, they could inform us, and we would remove all of their information from this study.

Dr. Marc Harrison: Great. So, I know people worry about things like, "What if we find something and then later in life I'm applying for health insurance?" Given what you've described, that shouldn't be an issue.

Lincoln Nadauld: Yes, that's right. We don't share any of this information with anyone else, including a patient's insurance company. In fact, there isn't any mechanism by which an insurance company could find out this information about one of our patients. They're completely protected in that regard.

Dr. Marc Harrison: That's fantastic. We're very fortunate at Intermountain that we're now serving beyond some of our historical boundaries. For instance, we now are working in Las Vegas with a terrific group who's joined us called HealthCare Partners Nevada. Does HerediGene have any implications across the mountain west and beyond, more broadly?

Lincoln Nadauld: It does. In fact, we're excited to enroll patients from our partners in Nevada. And we anticipate doing that in the coming years. And there are really no constraints on who could participate in something like HerediGene. More deeply, findings and discoveries that come out of this HerediGene project will be applicable to individuals everywhere. We're committed to publishing our discoveries and findings. And anything that we find that will improve healthcare for individuals, we will disseminate that information. We'll make it available to other doctors and other health systems. Our commitment to help people live the healthiest lives possible knows no boundaries. It knows no borders, and we'll pursue that and make our efforts available and open to the public.

Dr. Marc Harrison: Thanks, Lincoln. I just want to say how much I appreciate your leadership and how much I enjoy working with you. It makes me realize every time I talk with you that I should've paid more attention in ninth grade biology class. But apart from that, it's been absolutely fantastic. And I wish you safe travels. Is there anything you'd like to add as you wrap up, and before you get to Heathrow [airport in London]?

Lincoln Nadauld: I just appreciate the opportunity. I think there's nothing more exciting happening in medicine right now than efforts in precision medicine and precision health. And it's a thrill to be at an organization like Intermountain Healthcare where the leadership, led by you, Marc, understands that it fulfills our mission to patients. And that by being cutting edge and innovative, we're really improving health for everyone. So, it's a pleasure to be a part of it. I find fulfillment every day. I love serving our patients. I love our patients and I really believe we're fulfilling our mission to help people live the healthiest lives possible.

Dr. Marc Harrison: Thanks, Lincoln. Take care, and I'll see you soon.