How AdventHealth is moving to assess cancer risk earlier

At AdventHealth, “GRACE” is more than a reflection of the faith-based health system’s values.

It’s a new program that is designed to help identify patients at higher risk for cancer and to help them get screened more quickly. GRACE is an acronym: Genomics Risk Assessment for Cancer and Early detection.

AdventHealth is using AI to scour health records to see if patients may benefit from screening, even if they fall below age guidelines. The system has been rolling out the program with breast cancer patients, but is aiming to expand to patients with other cancers.

Dr. Wes Walker, vice president of genomics & precision health at AdventHealth, says the goal is to offer more personalized care for patients, and to ensure that if patients have cancer, then they are diagnosed at the earliest opportunity.

“GRACE really arose from the idea that increasingly healthcare is becoming more personalized in an evidence-based manner, and so you're seeing this across a variety of different areas, but certainly in the prevention, early detection, and screening realms,” Welker tells Chief Healthcare Executive®.

“We wanted a program that ultimately could scale across not only the mammography space and not only for breast cancer, but also to other hereditary cancers and ultimately to primary care and OB/GYN,” he says. “The long-term vision for GRACE is that it will be the foundation really for every adult who is seen at AdventHealth, and so that's kind of the vision.”

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Developing risk scores

So far, AdventHealth has deployed the program across the Central Florida region and across the Rocky Mountain region. AdventHealth operates 57 hospitals and more than 2,000 care locations in nine states.

Walker expects the program will be utilized in the mammography space across the entire system next year.

“It has now been established as an imperative and a standard for the company, and so now we're in the process of the rollout,” he says.

AdventHealth uses AI to help radiologists determine the breast density of patients. Women with dense breasts have a higher risk of developing breast cancer, according to the American Cancer Society.

In addition, AdventHealth is using AI to assess various factors that can lead to a patient having higher cancer risks, including their own medical history and also family members who have had cancer.

All of this information is integrated into AdventHealth’s electronic health record system, Epic, giving clinicians risk scores and insights on patients who may have greater risks.

“Everyone on the care team has clear visibility as to what has happened, what is happening, what risk scores are, and what the plan of care is,” Walker says.

AdventHealth is identifying more patients at higher risks of cancer, allowing for additional testing and earlier interventions, he says.

Guidance from nurse navigators

The GRACE program is both “high tech and high touch,” Walker says.

As patients come in for regular appointments and are identified as having an elevated cancer risk, nurse navigators will contact patients to offer support and discuss next steps, such as genetic testing or additional imaging, such as an MRI.

“We're not just providing a risk score or a radiology report,” Walker says. “But we're pairing that with a dedicated nurse navigator who has, on average, 15 years of experience in oncology.”

The nurse navigators help educate patients, offer emotional support and serve as a partner throughout the entire process, he says.

Importantly, Walker says the health system is moving to find cancers at the earliest stages, when patients have the greatest chance of survival and resuming a full, healthy life.

“There's no question that early detection and screening saves lives,” Walker says. “We ultimately want those that we care for to feel whole and live their best life, and if we can limit cancer to stage one, that's going to go a long way towards those goals.”

Walker also relishes the chance to give patients more care based on their own individual needs.

“It really is moving from a one-size-fits-all to truly personalized care, and I think that also kind of dovetails with our ‘whole person care’ philosophy,” Walker says. “We feel every person is unique. They're different in terms of their genetics, their family background, their past medical history, and so we want to create a care system that embodies that, and certainly make sure that we're doing it in an evidence-based way.”

Keys to success

The GRACE program was designed to mesh with workflows, with guidance from nursing leaders, Walker says.

He also cites the goal of making sure that primary care physicians aren’t overwhelmed, since they already have limited time with patients. Nurse navigators will reach out to primary care physicians to discuss planned outreach to patients and, in most cases, the nurse navigators will contact the patients.

AdventHealth is also seeing strong support from clinicians and patients, which he describes as “extraordinary.”

Walker also cites the strong backing of AdventHealth leaders in making the program successful, since it involves work across several departments, including information technology.

“We have that excellent executive support,” Walker says. “There is an upfront build that is required to do all the behind-the-scenes digital plumbing.

“There are an extraordinary number of demands and requests to IT, and so prioritization for large organizations is a really big deal,” he adds.