Transforming Medicine Through Personalized Health Care at Ohio State University Medical Center

Transforming Medicine Through Personalized Health Care at Ohio State University Medical Center
Clay Marsh, MD
Executive Director
Center for Personalized Health Care

Create the Future of Medicine to Improve People’s Lives Through Personalized Health Care
Harvard Business Review | October 2007 | hbr.org

Creating a Tipping Point
What underlies successful epidemics is a belief that change is possible. Tipping Points are a reaffirmation of the potential for change and the power of intelligent action. Look at the world around you. It may seem like an immovable, implacable place. It is not. With the slightest push; just in the right place; it can be tipped.
Malcolm Gladwell, The Tipping Point

How Do We Create Change?

Formula for Change
D x V x F > R
D = Dissatisfaction with how things are now
V = Vision of what is possible
F = Initial, concrete steps that can be taken towards the vision.
If the product of these three factors is greater than R = Resistance, then change is possible.
Because of the multiplication of D, V and F, if any one is absent or low, then the product will be low and therefore not capable of overcoming the resistance.

Do We Need to Change?

The Need for Transformation
Total health care spending was $2.5 trillion in 2008, representing ~17% of the GDP, like 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.

Standard Health Care Today
Doctor- and Hospital-focused
Population-based and poorly coordinated
Therapeutics and procedures reimbursed best
Disease-oriented
Reactive, imprecise – 40% of medicine does not work as prescribed

What is Our Vision at The Ohio State University?

Improve Quality AND Lower Cost Transform Health Care from Reactive, Disease-Based Care of Today to Proactive, Wellness-Based Care of the Future Through Systems Biology/Medicine Tools Create Tools to Build a Health System Without Walls

P4 Medicine

Predictive:
New precision diagnostic tools
Personalized:
Through system medicine and genomic tools
Precise
Preventive:
Focused on wellness
Participatory
Patient empowered and participates in all phases of care
On demand and delivered at the patient’s place of choosing

Wellness and Risk Management

Alignment : One University

The Structure of Our Plan

Translate
Discover
Disseminate
Apply

PLATFORM CREATION

Informatics Tools, Including Information Warehouse
-Omics, including microRNA
Mathematical and Agent-Based Modeling
Systems Biology
Imaging
Biobank Tagged to Deindentified Data Mart

Discover

Complex Relationships Determine Health and Disease
Complex interactions of genes and proteins explain differences between people
1:1 interactions between 25,000 genes is 336,000,000 possibilities
What field has tools that we need to understand the organization of these complex interactions?

Systems Biology

Emergent field that aims at systems understanding of biological systems.
Systems view focuses at understanding:
The complexity of the system
The networks activated in the system
The control methods of the system
Key nodes in the system

www.sysbio.de/figs/sysbio8.gif

The Institute for Systems Biology

How Can We Simplify This Complexity?

Network Hubs / Tipping Points

“Our analysis showed that microRNAs preferentially regulate hub nodes, i.e., top 5% of the highly connected nodes in the network..”
The Open Systems Biology Journal, 2008, 1, 1-8

Using Systems Biology Tools to Understand IPFIdentify Networks and Key Regulatory Nodes Controlling Networks
http://mcdb.colorado.edu/courses/3280/lectures/class16-2.html

MicroRNA
Carlo Croce, MD

PLATFORM TRANSLATION

Diagnostics
Devices
Targeted Therapeutics
Alignment Between Clinicians and Scientists
Wellness
Center for Clinical and Translational Science (CTSA)

Translate

CTSA is an outcome of the Roadmap for Research from NIH

PLATFORM APPLICATION
Apply

Alignment with Managed Health System
Pilot Programs
Coriell Personalized Medicine Collaborative
Grid-enabled IT
Accountable Medical Care Organization, including Medical Home Teams
Tele-Health
Comparative Effectiveness

What Are Being Done at the OSUMC?Molecular Diagnostic and Prognostic Markers

What Are Being Done at the OSUMC?Targeted Therapy/Treatment Selection

Crops to Clinic
“Nutrients and bioactive chemicals in foods represent important factors in the prevention and treatment of disease. They are Mother Nature’s drugs, and we are trying to understand how they interact once they are ingested,”
Mark Failla, PhD, professor and chair of the Department of Human Nutrition in the College of Human Ecology.
“According to scientific estimates, there are 20,000 chemicals and 50 to 60 essential nutrients in the human diet,”
Steven Schwartz, PhD, professor of food science and technology in the College of Food, Agricultural and Environmental Sciences.

Coriell Personalized Health Care Collaborative
Michael Christman, Ph.D., CEO Coriell Institute

Overview of OSUMC/OSU Managed Health Care Personalized Health Care Demonstration Projects

Baseline Assessment
Web-based risk assessment tool to include:

Individual health history
Family health history
Life style / exercise
Behavioral / stress
Nutrition / environment

Comprehensive health risk
assessment
Informed
Consent

Genetic test kit is sent directly to customer’s home
Customer provides sample and send sample to lab via mail
Lab runs genetic test and post test results to customer web portal
Customer authorize release of test results to care team

Genetic
Tests
Customers
Physical Examination

Receive form in the mail or email.
Send in signed consent form or bring the form to meeting with physician.
Care team (Prime care physician, exercise physiologist) perform physical exam of customer

Confidential and privileged. Do not copy or distribute. © OSU Medical Center, 2009

Information Warehouse

Transforming Medicine:Disruptive Innovation

Disruptive Innovation to Create Value and Reduce Costs
Create precision medicine (personalized care)
Push care from more to less specialized providers using rules-based approaches
Decentralize medical care
Integrate medical information
Incentivize health from integrated organizations that benefit from health of its members (like Ohio State)

Wellness

Your Strategic Plan for Health
Care Team to include:

Physician
Genetic counselor
Psychologist
Exercise physiologist
Bio-nutrition counselor
Nurse
Pharmacist

Comprehensive health risk
assessment
Data and Analysis:

Genetic risk profile
Major health risk factors
Current state of physical health
Current state of emotional health
Current state of life style and environments

Genetic
Tests
Care Team review, conference, and recommendations
Physical Examination
Your Strategic Plan For Health
Customer visit care team 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

Specialized Personalized Health Clinics
Care Team review, conference, and recommendations
Optional special clinics that meet individual needs
Genomics/ Molecular Diagnostics