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P4 Medicine Town Meeting

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Clay Marsh, MD, discusses how OSUMC is putting P4 medicine to work.

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P4 Medicine Town Meeting

  1. 1. “It is not the fittest of the species that survives, it is the most adaptable to change” Charles Darwin
  2. 2. bordalierinstitute.com
  3. 3. meta-activism.org
  4. 4. What is the Compelling Opportunity in Medicine?
  5. 5. 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.
  6. 6. Blue Ocean Strategy Value Innovation Costs Value Innovation Buyer Value
  7. 7. What is the External Landscape?
  8. 8. Francis Collins NIH Vision• Large Biology Projects with High Throughput Technologies• Translational Research• Global Health• Health Care Reform• Sustaining Biomedical Research
  9. 9. 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)
  10. 10. What Do Health, Disease and Nature Share in Common?
  11. 11. freelancingscience.comfreelancingscience.com
  12. 12. forums.treehugger.com
  13. 13. http://education.mit.edu/starlogo-tng/learn/flocking-activity
  14. 14. www.bioteams.com/images/swarm_behavior.jpg
  15. 15. corpusoptima.com corpusoptima.com
  16. 16. engineering.tufts.eduunreasonablydangerousonionrings.blogspot.com
  17. 17. They are Complex Adaptive Systems Made up of Networks
  18. 18. What Else Works in Networks?
  19. 19. clickonf5.org
  20. 20. The Tipping Point and Social Networks www.flickr.com
  21. 21. NEJM 2007 (357): 406-07
  22. 22. Almost Everything
  23. 23. Medical Center Strategic Portfolio Personalized Health Care Education Signature Programs Research Innovation and Academic excellence Transplantation Neurosciences Critical Careintellectual impact and knowledge Imaging Cancer Heart Key Research Programs Human Genetics Creating the future Biomedical Informatics of medicine to Behavioral Medicine improve people’s Patient Care lives Clinical Excellence and Service Delivery
  24. 24. Personalized Health Care is P4/Systems Medicine
  25. 25. Wellness from the Individual to the World Resilience To Sustainability
  26. 26. P4 Medicine Partnerships28
  27. 27. Predictive Using a person’s genetic makeup and family history to Preventive generate predictions about his or her health Personalized Participatory29
  28. 28. Diane Balster• Genetic testing revealed BRCA2 mutation• Chose preventive procedures to minimize her risk• Predictive care at Ohio State gives people the knowledge they need to make informed decisions 30
  29. 29. Predictive Using a person’s health- related information to Preventive prevent disease before it starts Personalized Participatory31
  30. 30. 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 32
  31. 31. Predictive Customizing medical care to the individual patient Preventive Personalized Participatory33
  32. 32. Janet Graves• Routine test revealed hypertrophic cardiomyopathy• Chose to treat condition with implantable cardiac defibrillator• Extended family undergoing genetic testing 34
  33. 33. Predictive Encouraging patients to actively participate in their Preventive personal choices about illness and well-being Personalized Participatory35
  34. 34. 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 36
  35. 35. Your Plan for Health • Faculty and staff YP4H 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 37
  36. 36. 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. 38
  37. 37. 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 Catherine Lucey, MD expansion helps prevent medical complications 39
  38. 38. P4 Medicine: Disease to Wellness How Do We Define Wellness?
  39. 39. Your Environment Regulates DNA Activity
  40. 40. Behavior Environment Gene
  41. 41. Defining and Quantifying HealthHealth is a state of complete physical,mental, and social well-being and not Behaviormerely the absence of disease orinfirmity.-- WHO, 1948 EnvironmentHealth is the ever-changing process ofachieving individual potential in thephysical, emotional, social, mental, Geneticsspiritual, and environmentaldimensions.-- Bridget Melton, 2010 Physical
  42. 42. Dimensions for Measuring Health • Optimism • Faith/Spiritual • Relationship: family and Behavior social network • Empathy • Social functioning Environment • Lifestyles Genetics Physical
  43. 43. Dimensions for Measuring Health Behavior • Diet / Nutrition • Sleep / biorhythm • Micro-biomes Environment • Geo-locations • Employment / workplace • Culture Genetics Physical
  44. 44. Dimensions for Measuring Health Behavior Environment • Family health history • Genetic test (SNPs) • Pharmacogenomics test Genetics • DNA sequences and epigenetics • Transcriptomics • Targeted genetic screening • Network analysis (systems and Physical computational biology)
  45. 45. Dimensions for Measuring Health Behavior Environment Genetics • Biometrics • Autonomic nervous system • Grip /core strengths • Balance Physical • Endurance • Cognitive functioning • Bio markers
  46. 46. Program at OSUMC
  47. 47. Two Main Pilot Projects: Wellness andCare Coordination in Chronic Disease wellness.ucsd.edu/WhatisWellness.shtml kardiol.com/?tag=heart-failure
  48. 48. P4 Approach to Wellness Longitudinal Optional special and/or virtual clinics that meet individual needs PHA/Biomarker data leads to Care Team review and Molecular Diagnostics • Biomarker and Genetic risk factor recommendations Genetic Counseling awareness and education • Behavioral risk factor awareness and mitigation strategies; Your Strategic Plan For Behavioral Health happiness, optimism Health • Sleep medicine and circadian Sleep Medicine & rhythm analysis Circadian Rhythm • Assist individuals for best rest toCustomer visit medical home promote health team and/or family physician to review and finalize plan: • Evidence-based• Current strengths and Nutrition recommendations weaknesses • Nutrition and diet changes that• Opportunities for meet each person’s unique needs improvement• Health and wellness targets for • Exercise and physical next 2, 5, and 10 years Exercise & performance performance routines designed• Action Plan: recommendations for individual needs
  49. 49. Chronic DiseaseIdentify Stratify Prevent/Treatacl.com www.indezine.com/.../peopleanimation_02.jpg www.socialsecurityinsider.com/wp-content/uplo
  50. 50. 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)
  51. 51. Reduce Variability to Decrease Cost and Increase Quality
  52. 52. Stratify Populations
  53. 53. Single Nucleotide Polymorphisms in Clinical Medicine: Pharmacogenomics Pharmacogenomicsscience.marshall.edu pharmainfo.net
  54. 54. Analyze Data to Create Knowledge
  55. 55. http://www.sys-bio.org/contentimages/WhyWeNeedComputer.png
  56. 56. Hubs are Strong Links in Networks
  57. 57. Group Working on Complex AdaptiveSystems and Networks in Health Care
  58. 58. Identify Networks and Key Regulatory Nodes Controlling Networks http://mcdb.colorado.edu/courses/3280/lectures/class16-2.html
  59. 59. Engage Consumers
  60. 60. Participatory Medicineama-assn.org
  61. 61. 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
  62. 62. You Tube is the 2nd Most Used Search Engine on the Internet
  63. 63. 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
  64. 64. Networks, Participation, the Power of Games and Crowdsourcing
  65. 65. Jane McGonigal and Games
  66. 66. Finding the Red Balloon techcrunch.com
  67. 67. What Are Health Applications?
  68. 68. bryankorourke.com
  69. 69. Social Media and Smoking Cessation http://www.euroclinix.net/health-news/smoking- www.health.com/.../0,,20209135,00.html cessation/facebook-helping-people-to-kick-the-habit-231.html
  70. 70. Personalized Medicine Home Dedicated PCP or NP Assigned Telemed tools Care Coordinator Visits, Lab- Patient Test, and tracking Referral and registry tracking functions Patient self- management support
  71. 71. Be the Change That You Want to See in the World Mahatma Gandhi

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