Post on 14-May-2015
description
“It is not the fittest of the species that survives, it is the most adaptable to
change”
Charles Darwin
bordalierinstitute.com
meta-activism.org
What is the Compelling Opportunity in Medicine?
Healthcare: The Need for Transformation
• Total health care spending was $2.5 trillion in 2009, representing ~17.6% of the GDP, likely to reach $4 trillion by 2016
• 75-90% were spent on managing and treating chronic illnesses that are preventable and effectively managed
• On a per-person basis, our health care costs are 50% higher than the second most costly nation.
• IOM reports that up to 98,000 preventable deaths occur per year and the research to practice gap is 17 years.
• The U.S. healthcare ranked by the WHO 37/191 countries in performance.
• Drugs prescribed for patients are effective in fewer than 60% of treated patients but costs of development is skyrocketed.
Blue Ocean Strategy
Value Innovation
Costs
Buyer Value
ValueInnovation
What is the External Landscape?
Francis Collins NIH Vision
• Large Biology Projects with High Throughput Technologies
• Translational Research
• Global Health
• Health Care Reform
• Sustaining Biomedical Research
Disruptive Innovation to Transform Health Care
• Create precision medicine (personalized care)
• Push care from more specialized to less specialized providers using rules-based approaches
• Decentralize medical care (push to community)
• Integrate medical information
• Incentivize health from integrated organizations that will benefit from health of its members (like Ohio State)
What Do Health, Disease and Nature Share in Common?
freelancingscience.comfreelancingscience.com
forums.treehugger.com
http://education.mit.edu/starlogo-tng/learn/flocking-activity
corpusoptima.com
corpusoptima.com
unreasonablydangerousonionrings.blogspot.comengineering.tufts.edu
They are Complex Adaptive Systems Made up of Networks
What Else Works in Networks?
clickonf5.org
NEJM 2007 (357): 406-07
Almost Everything
Medical Center Strategic Portfolio
Patient Care
Re
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Ca
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Cri
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He
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Ima
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Ne
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sc
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Tra
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pla
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Personalized Health Care
Key Research Programs
Human Genetics
Biomedical Informatics
Behavioral Medicine
Signature Programs
Edu
cation
Innovation and intellectual impact
Academic excellence and knowledge
Clinical Excellence and Service Delivery
Creating the future of medicine to
improve people’s lives
Personalized Health Care is P4/Systems Medicine
Resilience To Sustainability
Wellness from the Individual to the World
P4 MedicinePartnerships
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Predictive
Preventive
Personalized
Participatory
Using a person’s genetic makeup and family history to generate predictions about his or her health
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Diane Balster
• Genetic testing revealed BRCA2mutation
• Chose preventive procedures to minimize her risk
• Predictive care at Ohio State gives people the knowledge they need to make informed decisions
Predictive
Preventive
Personalized
Participatory
Using a person’s health-related information to prevent disease before it starts
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Medical Genetics at Ohio State
• Hereditary Heart Rhythm Disorders Clinic
• High Risk Family Heart Clinic
• Clinical Cancer Genetics Program
• Coriell Personalized Medicine Collaborative
• Heather Hampel, genetics counselor and ABGC president Heather Hampel, MS, CGC
Predictive
Preventive
Personalized
Participatory
Customizing medical care to the individual patient
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Janet Graves
• Routine test revealed hypertrophic cardiomyopathy
• Chose to treat condition with implantable cardiac defibrillator
• Extended family undergoing genetic testing
Predictive
Preventive
Personalized
Participatory
Encouraging patients to actively participate in their personal choices about illness and well-being
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Rita Brosie
• Chose Ohio State for her bariatric surgery
• Ohio State is a Bariatric Surgery Center of Excellence
• Rita’s participation in her own care plan is key to her continued success
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Your Plan for Health
• Faculty and staff wellness program at Ohio State
• Provides tools and programs that help faculty and staff and their families take a proactive approach to their health
• Incentivizes healthy behaviors
YP4H
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OSUMyChart
• Provides secure online access to patient information and health services
• IHIS: a single, electronic, personalized health record for the entire Medical Center
• Improves the quality, safety and efficiency of our care.
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P4 Medicine in Medical Curriculum
• Curriculum restructure prepares future doctors to practice P4 Medicine
• Greater focus on predictive medicine and preventive health care
• Use of mobile devices like iPod touch at the bedside promotes participatory medicine
• Clinical Skills Education and Assessment Center expansion helps prevent medical complications
Catherine Lucey, MD
P4 Medicine: Disease to Wellness
How Do We Define Wellness?
Your Environment Regulates DNA Activity
Behavior Environment Gene
Physical
Defining and Quantifying Health
Behavior
Environment
Genetics
Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. -- WHO, 1948
Health is the ever-changing process of achieving individual potential in the physical, emotional, social, mental, spiritual, and environmental dimensions.-- Bridget Melton, 2010
Physical
Dimensions for Measuring Health
Behavior
Environment
Genetics
• Optimism• Faith/Spiritual• Relationship: family and
social network• Empathy• Social functioning• Lifestyles
Physical
Dimensions for Measuring Health
Behavior
Environment
Genetics
• Diet / Nutrition• Sleep / biorhythm• Micro-biomes• Geo-locations• Employment / workplace• Culture
Physical
Dimensions for Measuring Health
Behavior
Environment
Genetics
• Family health history• Genetic test (SNPs)• Pharmacogenomics test• DNA sequences and epigenetics• Transcriptomics• Targeted genetic screening• Network analysis (systems and
computational biology)
Physical
Dimensions for Measuring Health
Behavior
Environment
Genetics • Biometrics• Autonomic nervous system• Grip /core strengths• Balance• Endurance• Cognitive functioning• Bio markers
Program at OSUMC
Two Main Pilot Projects: Wellness and Care Coordination in Chronic Disease
wellness.ucsd.edu/WhatisWellness.shtmlkardiol.com/?tag=heart-failure
P4 Approach to Wellness
Longitudinal PHA/Biomarker data leads to Care Team review and
recommendations
Your Strategic Plan For Health
Customer visit medical home team and/or family physician to review and finalize plan:
• Current strengths and weaknesses
• Opportunities for improvement
• Health and wellness targets for next 2, 5, and 10 years
• Action Plan: recommendations
Optional special and/or virtual clinics that meet individual needs
Molecular Diagnostics Genetic Counseling
Behavioral Health
Nutrition
Exercise & performance
• Biomarker and Genetic risk factor awareness and education
• Behavioral risk factor awareness and mitigation strategies; happiness, optimism
• Evidence-based recommendations
• Nutrition and diet changes that meet each person’s unique needs
• Exercise and physical performance routines designed for individual needs
Sleep Medicine & Circadian Rhythm
• Sleep medicine and circadian rhythm analysis
• Assist individuals for best rest to promote health
Chronic Disease
Stratify Identify
www.indezine.com/.../peopleanimation_02.jpgacl.com
Prevent/Treat
www.socialsecurityinsider.com/wp-content/uplo
Principles of Transforming Health Care
• Reduce variability and deliver evidence-based medicine (Personalize)
• Stratify patients to create smaller, precise groups (Predict, Prevent, Personalize)
• Analyze data to create knowledge (Predict, Prevent, Personalize)
• Activate patients (Participation)
Reduce Variability to Decrease Cost and Increase Quality
Stratify Populations
Single Nucleotide Polymorphisms in Clinical Medicine: Pharmacogenomics
science.marshall.edu
Pharmacogenomics
pharmainfo.net
Analyze Data to Create Knowledge
http://www.sys-bio.org/contentimages/WhyWeNeedComputer.png
Hubs are Strong Links in Networks
Group Working on Complex Adaptive Systems and Networks in Health Care
Identify Networks and Key Regulatory Nodes Controlling Networks
http://mcdb.colorado.edu/courses/3280/lectures/class16-2.html
Engage Consumers
Participatory Medicine
ama-assn.org
The Power of Networks
• 500 M users– 50% on line at any
one time
• 700 B minutes a month
• 177 M tweets/day
• 572K new accts/day
jeichert.wordpress.com
You Tube is the 2nd Most Used Search Engine on the Internet
1 in 75 People on the Planet is Playing Farmville
www.slideshare.net/avantgame/born-to-play-games-a-talk-by-
jane-mcgonigal-about-human-destiny-circa-2020-ad
Networks, Participation, the Power of Games and Crowdsourcing
Jane McGonigal and Games
Finding the Red Balloon
techcrunch.com
What Are Health Applications?
bryankorourke.com
Social Media and Smoking Cessation
www.health.com/.../0,,20209135,00.htmlhttp://www.euroclinix.net/health-news/smoking-cessation/facebook-helping-people-to-kick-the-habit-231.html
Personalized Medicine Home
Dedicated PCP or NP
Assigned Care
Coordinator
Patient tracking
and registry functions
Patient self-management
support
Visits, Lab-Test, and Referral tracking
Telemed tools
Be the Change That You Want to See in the World
Mahatma Gandhi