The document describes Ohio State University Medical Center's vision to transform medicine through personalized health care. Their goal is to move from today's reactive, disease-based system to a proactive, wellness-based system using systems biology tools. They plan to create predictive, personalized, precise and preventive (P4) medicine through discovery platforms using omics data, modeling, and imaging. These platforms will be translated through diagnostics, devices, and targeted therapeutics. Applications include pilot programs, a personalized medicine collaborative, and accountable care organizations. The overall vision is to improve quality and lower costs through disruptive innovation and personalized strategic health plans.

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

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

4. 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

5. How Do We Create Change?

6. 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.

7. Do We Need to Change?

8. 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.

9. 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

10. What is Our Vision at The Ohio State University?

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

13. New precision diagnostic tools

14. Personalized:

15. Through system medicine and genomic tools

16. Precise

17. Preventive:

18. Focused on wellness

19. Participatory

20. Patient empowered and participates in all phases of care

21. On demand and delivered at the patient’s place of choosing Wellness and Risk Management

22. Alignment : One University

23. The Structure of Our Plan

25. Translate Discover Disseminate Apply

27. -Omics, including microRNA

28. Mathematical and Agent-Based Modeling

29. Systems Biology

30. Imaging

31. Biobank Tagged to Deindentified Data MartDiscover

32. 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?

34. Systems view focuses at understanding:

35. The complexity of the system

36. The networks activated in the system

37. The control methods of the system

38. Key nodes in the systemwww.sysbio.de/figs/sysbio8.gif

39. The Institute for Systems Biology

40. How Can We Simplify This Complexity?

41. Network Hubs / Tipping Points

42. “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

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

44. MicroRNA Carlo Croce, MD

48. Devices

49. Targeted Therapeutics

50. Alignment Between Clinicians and Scientists

51. Wellness

52. Center for Clinical and Translational Science (CTSA) Translate

53. CTSA is an outcome of the Roadmap for Research from NIH

55. Pilot Programs

56. Coriell Personalized Medicine Collaborative

57. Grid-enabled IT

58. Accountable Medical Care Organization, including Medical Home Teams

59. Tele-Health

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

62. 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.

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

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

66. Family health history

67. Life style / exercise

68. Behavioral / stress

70. Customer provides sample and send sample to lab via mail

71. Lab runs genetic test and post test results to customer web portal

73. Send in signed consent form or bring the form to meeting with physician.

74. Care team (Prime care physician, exercise physiologist) perform physical exam of customerConfidential and privileged. Do not copy or distribute. © OSU Medical Center, 2009

75. Information Warehouse

76. Transforming Medicine:Disruptive Innovation

77. 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)

78. Wellness

80. Genetic counselor

81. Psychologist

82. Exercise physiologist

83. Bio-nutrition counselor

84. Nurse

86. Major health risk factors

87. Current state of physical health

88. Current state of emotional health

90. Opportunities for improvement

91. Health and wellness targets for next 2, 5, and 10 years

92. Action Plan: recommendationsConfidential and privileged. Do not copy or distribute. © OSU Medical Center, 2009

96. Opportunities for improvement

97. Health and wellness targets for next 2, 5, and 10 years

98. Action Plan: recommendations

99. Evidence-based recommendations

101. Chronic Disease

104. P4 Medicine Medical School Curriculum

105. Social Networking and Media

107. The Power of Process N Engl J Med 1999;340: 286-92

108. Improving people’s lives through personalized health care