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Transforming Medicine Through Personalized Health Care at Ohio State University Medical Center <br />Clay Marsh, MD<br />E...
Create the Future of Medicine to Improve People’s Lives Through Personalized Health Care<br />Harvard Business Review | Oc...
Creating a Tipping Point <br />What underlies successful epidemics is a belief that change is possible. Tipping Points are...
How Do We Create Change?<br />
Formula for Change<br />D x V x F &gt; R<br />D = Dissatisfaction with how things are now <br />V = Vision of what is poss...
Do We Need to Change?<br />
The Need for Transformation<br />Total health care spending was $2.5 trillion in 2008, representing ~17% of the GDP, like ...
Standard Health Care Today<br />Doctor- and Hospital-focused<br />Population-based and poorly coordinated<br />Therapeutic...
What is Our Vision at The Ohio State University?<br />
Improve Quality AND Lower Cost Transform Health Care from Reactive, Disease-Based Care of Today to Proactive, Wellness-Bas...
P4 Medicine<br /><ul><li>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 </li></ul>Wellness and Risk Management<br />
Alignment : One University<br />
The Structure of Our Plan<br />
Translate<br />Discover<br />Disseminate<br />Apply<br />
PLATFORM CREATION <br /><ul><li> Informatics Tools, Including Information Warehouse
-Omics, including microRNA
 Mathematical and Agent-Based Modeling
Systems Biology
 Imaging
Biobank Tagged to Deindentified Data Mart</li></ul>Discover<br />
Complex Relationships Determine Health and Disease<br />Complex interactions of genes and proteins explain differences bet...
Systems Biology<br /><ul><li>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</li></ul>www.sysbio.de/figs/sysbio8.gif<br />
The Institute for Systems Biology<br />
How Can We Simplify This Complexity?<br />
Network Hubs / Tipping Points<br />
“Our analysis showed that microRNAs preferentially regulate hub nodes, i.e., top 5% of the highly connected nodes in the n...
Using Systems Biology Tools to Understand IPFIdentify Networks and Key Regulatory Nodes Controlling Networks<br />http://m...
MicroRNA<br />Carlo Croce, MD<br />
PLATFORM TRANSLATION <br /><ul><li> Diagnostics
 Devices
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Transforming Medicine Through Personalized Health Care at Ohio State University Medical Center

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Dr. Clay Marsh presented "Transforming Medicine Through Personalized Health Care at Ohio State University Medical Center" at the 2009 Personalized Health Care National Conference.

Dr. Marsh is leading the Ohio State University Center for Personalized Health Care to create the future of medicine to improve people’s lives through personalized health care.

Published in: Health & Medicine, Education

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

  1. 1. Transforming Medicine Through Personalized Health Care at Ohio State University Medical Center <br />Clay Marsh, MD<br />Executive Director<br />Center for Personalized Health Care<br />
  2. 2.
  3. 3. Create the Future of Medicine to Improve People’s Lives Through Personalized Health Care<br />Harvard Business Review | October 2007 | hbr.org<br />
  4. 4. Creating a Tipping Point <br />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. <br />Malcolm Gladwell, The Tipping Point <br />
  5. 5. How Do We Create Change?<br />
  6. 6. Formula for Change<br />D x V x F &gt; R<br />D = Dissatisfaction with how things are now <br />V = Vision of what is possible <br />F = Initial, concrete steps that can be taken towards the vision.<br />If the product of these three factors is greater than R = Resistance, then change is possible. <br />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.<br />
  7. 7. Do We Need to Change?<br />
  8. 8. The Need for Transformation<br />Total health care spending was $2.5 trillion in 2008, representing ~17% of the GDP, like to reach $4 trillion by 2016<br />75-90% were spent on managing and treating chronic illnesses that are preventable and effectively managed<br />On a per-person basis, our health care costs are 50% higher than the second most costly nation. <br />IOM reports that up to 98,000 preventable deaths occur per year and the research to practice gap is 17 years.<br />The U.S. healthcare ranked by the WHO 37/191 countries in performance.<br />Drugs prescribed for patients are effective in fewer than 60% of treated patients but costs of development is skyrocketed.<br />
  9. 9. Standard Health Care Today<br />Doctor- and Hospital-focused<br />Population-based and poorly coordinated<br />Therapeutics and procedures reimbursed best<br />Disease-oriented<br />Reactive, imprecise – 40% of medicine does not work as prescribed<br />
  10. 10. What is Our Vision at The Ohio State University?<br />
  11. 11. 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 <br />
  12. 12. P4 Medicine<br /><ul><li>Predictive:
  13. 13. New precision diagnostic tools
  14. 14. Personalized:
  15. 15. Through system medicine and genomic tools
  16. 16. Precise
  17. 17. Preventive:
  18. 18. Focused on wellness
  19. 19. Participatory
  20. 20. Patient empowered and participates in all phases of care
  21. 21. On demand and delivered at the patient’s place of choosing </li></ul>Wellness and Risk Management<br />
  22. 22. Alignment : One University<br />
  23. 23. The Structure of Our Plan<br />
  24. 24.
  25. 25. Translate<br />Discover<br />Disseminate<br />Apply<br />
  26. 26. PLATFORM CREATION <br /><ul><li> Informatics Tools, Including Information Warehouse
  27. 27. -Omics, including microRNA
  28. 28. Mathematical and Agent-Based Modeling
  29. 29. Systems Biology
  30. 30. Imaging
  31. 31. Biobank Tagged to Deindentified Data Mart</li></ul>Discover<br />
  32. 32. Complex Relationships Determine Health and Disease<br />Complex interactions of genes and proteins explain differences between people <br />1:1 interactions between 25,000 genes is 336,000,000 possibilities <br />What field has tools that we need to understand the organization of these complex interactions?<br />
  33. 33. Systems Biology<br /><ul><li>Emergent field that aims at systems understanding of biological systems.
  34. 34. Systems view focuses at understanding:
  35. 35. The complexity of the system
  36. 36. The networks activated in the system
  37. 37. The control methods of the system
  38. 38. Key nodes in the system</li></ul>www.sysbio.de/figs/sysbio8.gif<br />
  39. 39. The Institute for Systems Biology<br />
  40. 40. How Can We Simplify This Complexity?<br />
  41. 41. Network Hubs / Tipping Points<br />
  42. 42. “Our analysis showed that microRNAs preferentially regulate hub nodes, i.e., top 5% of the highly connected nodes in the network..”<br />The Open Systems Biology Journal, 2008, 1, 1-8<br />
  43. 43. Using Systems Biology Tools to Understand IPFIdentify Networks and Key Regulatory Nodes Controlling Networks<br />http://mcdb.colorado.edu/courses/3280/lectures/class16-2.html<br />
  44. 44. MicroRNA<br />Carlo Croce, MD<br />
  45. 45.
  46. 46.
  47. 47. PLATFORM TRANSLATION <br /><ul><li> Diagnostics
  48. 48. Devices
  49. 49. Targeted Therapeutics
  50. 50. Alignment Between Clinicians and Scientists
  51. 51. Wellness
  52. 52. Center for Clinical and Translational Science (CTSA) </li></ul>Translate<br />
  53. 53. CTSA is an outcome of the Roadmap for Research from NIH<br />
  54. 54. PLATFORM APPLICATION <br />Apply<br /><ul><li>Alignment with Managed Health System
  55. 55. Pilot Programs
  56. 56. Coriell Personalized Medicine Collaborative
  57. 57. Grid-enabled IT
  58. 58. Accountable Medical Care Organization, including Medical Home Teams
  59. 59. Tele-Health
  60. 60. Comparative Effectiveness </li></li></ul><li>What Are Being Done at the OSUMC?Molecular Diagnostic and Prognostic Markers<br />
  61. 61. What Are Being Done at the OSUMC?Targeted Therapy/Treatment Selection<br />
  62. 62. Crops to Clinic<br /> “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,” <br />Mark Failla, PhD, professor and chair of the Department of Human Nutrition in the College of Human Ecology. <br />“According to scientific estimates, there are 20,000 chemicals and 50 to 60 essential nutrients in the human diet,” <br />Steven Schwartz, PhD, professor of food science and technology in the College of Food, Agricultural and Environmental Sciences.<br />
  63. 63. Coriell Personalized Health Care Collaborative <br />Michael Christman, Ph.D., CEO Coriell Institute<br />
  64. 64. Overview of OSUMC/OSU Managed Health Care Personalized Health Care Demonstration Projects<br />
  65. 65. Baseline Assessment<br />Web-based risk assessment tool to include:<br /><ul><li>Individual health history
  66. 66. Family health history
  67. 67. Life style / exercise
  68. 68. Behavioral / stress
  69. 69. Nutrition / environment</li></ul>Comprehensive health risk <br />assessment<br />Informed<br />Consent<br /><ul><li>Genetic test kit is sent directly to customer’s home
  70. 70. Customer provides sample and send sample to lab via mail
  71. 71. Lab runs genetic test and post test results to customer web portal
  72. 72. Customer authorize release of test results to care team</li></ul>Genetic<br />Tests<br />Customers<br />Physical Examination<br /><ul><li>Receive form in the mail or email.
  73. 73. Send in signed consent form or bring the form to meeting with physician.
  74. 74. Care team (Prime care physician, exercise physiologist) perform physical exam of customer</li></ul>Confidential and privileged. Do not copy or distribute. © OSU Medical Center, 2009<br />
  75. 75. Information Warehouse<br />
  76. 76. Transforming Medicine:Disruptive Innovation<br />
  77. 77. Disruptive Innovation to Create Value and Reduce Costs<br />Create precision medicine (personalized care)<br />Push care from more to less specialized providers using rules-based approaches<br />Decentralize medical care<br />Integrate medical information<br />Incentivize health from integrated organizations that benefit from health of its members (like Ohio State)<br />
  78. 78. Wellness<br />
  79. 79. Your Strategic Plan for Health<br />Care Team to include:<br /><ul><li>Physician
  80. 80. Genetic counselor
  81. 81. Psychologist
  82. 82. Exercise physiologist
  83. 83. Bio-nutrition counselor
  84. 84. Nurse
  85. 85. Pharmacist</li></ul>Comprehensive health risk <br />assessment<br />Data and Analysis:<br /><ul><li>Genetic risk profile
  86. 86. Major health risk factors
  87. 87. Current state of physical health
  88. 88. Current state of emotional health
  89. 89. Current state of life style and environments</li></ul>Genetic<br />Tests<br />Care Team review, conference, and recommendations<br />Physical Examination<br />Your Strategic Plan For Health<br />Customer visit care team to review and finalize plan:<br /><ul><li>Current strengths and weaknesses
  90. 90. Opportunities for improvement
  91. 91. Health and wellness targets for next 2, 5, and 10 years
  92. 92. Action Plan: recommendations</li></ul>Confidential and privileged. Do not copy or distribute. © OSU Medical Center, 2009<br />
  93. 93. Specialized Personalized Health Clinics<br />Care Team review, conference, and recommendations<br />Optional special clinics that meet individual needs<br />Genomics/ Molecular Diagnostics<br /><ul><li>Genetic risk factor awareness and education
  94. 94. Molecular wellness tools</li></ul>Your Strategic Plan For Health<br /><ul><li>Behavioral risk factor awareness and mitigation strategies
  95. 95. Focus on resilience </li></ul>Behavioral health<br />Customer visit care team to review and finalize plan:<br /><ul><li>Current strengths and weaknesses
  96. 96. Opportunities for improvement
  97. 97. Health and wellness targets for next 2, 5, and 10 years
  98. 98. Action Plan: recommendations
  99. 99. Evidence-based recommendations
  100. 100. Nutrition and diet with analysis of epigenetic / molecular signature effects </li></ul>Bio-nutrition & dietary<br />Exercise & performance<br /><ul><li>Exercise and physical performance routines designed for individual needs</li></ul>Confidential and privileged. Do not copy or distribute. © OSU Medical Center, 2009<br />
  101. 101. Chronic Disease<br />
  102. 102.
  103. 103. Disseminate<br />PLATFORM DISSEMINATION<br /><ul><li> Process Creation
  104. 104. P4 Medicine Medical School Curriculum
  105. 105. Social Networking and Media
  106. 106. Information Support Tools </li></li></ul><li>iPOD Touch Program <br />
  107. 107. The Power of Process<br />N Engl J Med 1999;340: 286-92<br />
  108. 108. Improving people’s lives through personalized health care<br />

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