Part 2: Crucial Factors in Making Genetic Counseling Available to All
In Part 1 of this series, we discussed the many advantages of the use of technology and automation in genetic counseling. Metis Genetics’ work with a particular client for their non-invasive prenatal screening (NIPS) program provides a concrete example of the benefits of automation. This large medical practice previously provided 100% of their test result disclosures for NIPS via a live genetic counselor. After the creation and initiation of video education sessions, 98% of these test result disclosures were conducted by an automated process, incorporating patient comprehension checks. Metis reported to the client how much of the educational video each patient watched, and what percentage of comprehension questions were answered correctly. The remaining 2% of test result disclosures were conducted by the client’s medical staff, as the test results indicated a finding with medical implications conferring higher risk for the patient.
Time/cost savings were estimated by determining the average time the appropriate personnel in each medical office (administrator, nurse, genetic counselor or other provider) typically spent to obtain and review the test result, contact the patient, explain the result, and note their actions in their electronic medical records (EMR) system. To calculate the estimated cost savings per patient, they averaged the salaries of each one of these personnel groups and found the cost savings per patient, based upon the time saved. To determine annual cost savings, they multiplied the per patient savings by the annual number of patients undergoing NIPS. This particular client saved approximately $88.5K per year based upon the high risk patient volume they received for NIPS testing. If this test and automated process were expanded to their low risk pregnant population as well, this savings would increase to approximately $354K per year.1 This savings was based on the utilization of this workflow for only one test type, and only one patient risk category. We can imagine the potential savings if this model was applied across all of the high volume genetic tests that a large medical practice performs.
In addition to the time/cost savings provided by this model, data has shown that patients prefer this type of genetic counseling. In the example discussed above, greater than 94% of patients said that they felt informed about their NIPS result after watching the educational video, and greater than 96% preferred downloading their negative test results at home, versus waiting for their next doctor’s appointment. Greater than 98% of patients demonstrated comprehension of the testing they underwent, based upon the results of their comprehension checks.1 In the traditional face to face model of genetic counseling, we rarely (if ever) have quantitative metrics to demonstrate patient comprehension. This is a great advantage of the automated model. The model also provides additional convenience, as patients can receive counseling and comprehension checks in their native (non-English) language, which is often not possible in the face to face setting. Patients are also able to watch videos and download results at times most convenient for them, such as after typical working hours, when face to face sessions are generally not available.
Genetic counseling is key to unlocking the advantages of personalized medicine. The healthcare system is at an acute juncture for making vital genetic counseling services available to all patients. A viable solution is the increased use of automation to support genetic counselors with the repetitive aspects of their caseloads. Resistance to automation may come from a fear that technology can, or will, replace humans. A great analogy to help quell this fear is the rise of automatic teller machines (ATMs) in the 1970s. This self-service option created concern among bank tellers about the longevity of their role. As the use of ATMs grew, banks recognized that they could not replace all the functions of a teller. In addition, banks increased the number of physical locations, making access to banking more convenient. This increased the need for bank tellers at each branch. Bank tellers were then enabled to focus their time on customer service, using their interpersonal and relationship management skills to gain new customers, versus complete repetitive tasks. Not only were teller jobs not eliminated, but the number of jobs available actually increased over this time period.2
New technology in genetic counseling must be utilized responsibly, with the involvement and under the direction of genetic counselors, to counterbalance this new service delivery model with consistent monitoring and a personal touch. Clinical support must remain available for complex cases and additional patient questions. The work of Metis Genetics and others has already shown that this service delivery model is successful. Technology and automation in genetic counseling holds the promise of increased access, patient comprehension, patient convenience, consistency, efficiency, scalability, and time/cost savings. It is incumbent upon those in the field to harness the power of these new service delivery models to make genetic counseling available to the many who desperately need it.
1. Kalejta CD, Higgins S, Kershberg H, et al. Evaluation of an automated process for disclosure of negative noninvasive prenatal test results. J Genet Couns. 2019;00:1–9. https://doi.org/10.1002/jgc4.1127
2. Gordon ES, Babu D, Laney DA. The future is now: Technology’s impact on the practice of genetic counseling. Am J Med Genet Part C Semin Med Genet. 2018;00:1–9. https://doi.org/10.1002/ajmg.c.31599
Kristina Habermann, MS, CGC, MBA
Kristina is a board-certified genetic counselor and a long-time enthusiast of the use of genetics to improve patients’ health and lives. She has practiced as a genetic counselor and worked in Sales and Marketing educating clinicians and patients about the risks and benefits of genetic testing; ranging from prenatal to cancer to pharmacogenetic testing in psychiatry. She particularly enjoys writing about genetics and genetic counseling and is currently the Assistant Program Director of the Genetic Counseling Graduate Program at LIU Post.