UPMC report: precision medicine's next bottleneck is execution, not science

PITTSBURGH —

A new report from UPMC’s Center for Connected Medicine finds that the next phase of precision medicine will be decided in operations rooms, not labs. The survey, covering U.S. health systems with established precision-medicine programs, identifies three recurring blockers to scale: inconsistent payer coverage, fragile EHR integration, and weak patient enrollment.

About 35% of surveyed systems have run a precision-medicine program for five or more years, and roughly 60% have appointed a dedicated leader — a precision-medicine director, chief genomics officer, or similar. Reimbursement is well-established in oncology, with broad coverage for Foundation Medicine’s FoundationOne CDx and Natera’s Signatera. Coverage for population genomic screening and non-oncology pharmacogenomics, by contrast, remains narrow.

The report names three implementations as references:

• Vanderbilt University Medical Center, in partnership with Epic, has built a genomics module that lets clinicians order genetic tests directly from the EHR.
• Endeavor Health has embedded genomic data into more than 50,000 patient records to support pharmacogenomic prescribing.
• Geisinger’s MyCode initiative has consented over 370,000 patients and sequenced roughly 230,000 — one of the largest health-system-linked biobanks in the world.

Even where the clinical pathway is mature, the gap between capability and use is wide. Only about 35% of lung-cancer patients ultimately receive treatment matched to their tumour’s molecular profile.

The implication for hospital systems weighing investment, the report argues, is that the next dollar should fund operations infrastructure — billing integration, EHR ordering UX, patient-enrollment staff — rather than additional sequencing capacity. For most established indications, the bench science is already there.

Source: UPMC Center for Connected Medicine, “Precision Medicine 2026” report.