Redefining Personalized Medicine

Dr. Scott Joy

October 16, 2013

Not Just for Specialists

Challenged by a presentation on how genetic factors are associated with the risk and progress of diabetes, Dr. Joy thought that he could bring more value to his patients using ‘personalized’ medicine.

Reference: Joy, Scott V., MD. Redefining Personalized

Medicine in the Primary Care Setting. Medscape. Oct 10, 2013. http://www.medscape.com/viewarticle/812376?nlid=35763_1521

Personalized Medicine 1.0

• Assess health status

• Focus on collecting biometric data

– Blood pressure

– Cholesterol

– Body mass index

– Allergies (food, medication)

– Family/social history

• Treat detected problems

• The ‘Platinum’ Edition

– Calculate 10-year risk for a cardiac event (Framingham Risk

Score)

– Calculate risk of developing diabetes (Diabetes Risk Test)

– Calculate risk for bone fracture due to osteoporosis (FRAX score)

Personalized Medicine 2.0

• Leverage technology and patient participation to provide a more efficient and better experience for both patient and provider

• Pre-visit, Patient uses secure portal to:– Schedule appointment

– Update medical, family, and social history

– Update medications and allergies

– Identify and Schedule needed lab tests

Personalized Medicine 2.0

• The day before the appointment, the patient gets a reminder email and uses secure portal to:– Verify insurance info

– Confirm labs have been completed

– Lists goal(s) for appointment

– Checks in online

• The provider can review all information prior to the appointment– Has biometric data in advance

– Knows exactly what the patient wants to get out of the visit

– Can focus on discussion of specific indicators and setting goals for improved wellness

Personalized Medicine 2.0

Summary

• Includes all of 1.0 ‘Platinum’• Patient portal• Bidirectional electronic

communication between patients, providers, and practices

• Integrated risk calculators into the EHR with prepopulation of relevant clinical data

• List of community resources

Personalized Medicine 3.0

Personalized Medicine 3.0• Pre-appointment genetic testing completed at home using a buccal

swab.

• Data are analyzed and the results are automatically uploaded into the EHR.

• Painless skin sensor monitors metabolic and activity levels

• Monthly summaries of these data are uploaded into the EHR and crosschecked with biometric data, family/social history, medication and allergy lists, and data from risk calculators.

• By the visit, the health information system has generated an enhanced health risk assessment that includes risk of developing chronic conditions based on genetic test results, biometric data, and medical/family/social history

• Recommendations to alter risks of developing these conditions are suggested to the provider, along with pharmacologic recommendations based on her pharmocogenomics profile.

• Community resources to help and support engagement in healthy behaviors that are available in the zip codes where the patient lives and works are identified and presented for consideration

The Challenge:

• Take our currently fragmented systems and integrate them into the clinical workflow of a primary care practice and the health information systems that support these practices.

• Build on the collection of data in a patient's EHR, introduce genetic testing results as a variable, and leverage HIT to synthesize these data to produce recommendations that will enhance the health andsafety of the patients we serve