Transcript Personalized Health Care

American Health
Information Community
Personalized Health Care Workgroup
Report to Quality Workgroup
Understanding the Role of Clinical Decision
Support in Personalized Health Care
Gregory Downing
ONC Lead, PHC Workgroup
October 3, 2007
PHC Workgroup Overview
Broad Charge:
Make recommendations to the Community for a process to foster a
broad, community-based approach to establish a common pathway
based on common data standards to facilitate the incorporation of
interoperable, clinically useful genetic/genomic information and
analytical tools into electronic health records to support clinical
decision-making for the clinician and consumer.
Specific Charge:
Make recommendations to the Community to consider means to
establish standards for reporting and incorporation of common
medical genetic/genomic tests and family health history data into
electronic health records, and provide incentives for adoption across
the country including federal government agencies.
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Personalized Health Care (PHC) Workgroup
Member List
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Co-Chairs:
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Partners HealthCare
American Academy of Family Physicians
Staff Co-Chair:
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John Glaser
Douglas Henley
Gregory Downing
Office of the Secretary, HHS
Members:
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Carolyn Clancy
Beryl Crossley
Paul Cusenza
Andrea Ferreira-Gonzalez
Becky Fisher
Felix Frueh
Emory Fry
Alan Guttmacher
Kathy Hudson
Betsy Humphreys
Charles Kennedy
Joel Kupersmith
Stephen Matteson
Deven McGraw
Amy McGuire
Mark Rothstein
Steve Teutsch
Janet Warrington
Andrew Wiesenthal
Marc Williams
Dennis Williams
Agency for Healthcare Research and Quality
American Clinical Laboratory Association, Quest
Consultant
Virginia Commonwealth University
Patient Advocate
Food and Drug Administration
Department of Defense
National Institutes of Health/NHGRI
Genetics and Public Policy Center
National Institutes of Health/NLM
WellPoint
Department of Veterans Affairs
Pfizer
National Partnership for Women and Families
Baylor College of Medicine
University of Louisville
Merck
Affymetrix
Permanente Federation
Intermountain Healthcare
Health Resources and Services Administration
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PHC Workgroup Senior Advisors
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Senior Advisors:
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Mary Beth Bigley
Greg Feero
Joseph Kelly
Muin Khoury
Katherine Kolor
Michele Lloyd-Puryear
Elizabeth Mansfield
Clement McDonald
Armando Oliva
Dina Paltoo
Jonathan Perlin
Gurvaneet Randhawa
Lisa Rovin
Maren Scheuner
Jean Slutsky
Reed Tuckson
Mollie Ullman-Cullere
Grant Wood
Office of the U.S. Surgeon General
National Institutes of Health/NHGRI
Centers for Medicare & Medicaid Services
Centers for Disease Control and Prevention
Centers for Disease Control and Prevention
Health Resources and Services Administration
Food and Drug Administration
National Institutes of Health/NLM
Food and Drug Administration
National Institutes of Health/NHLBI
HCA, Inc.
Agency for Healthcare Research and Quality
Food and Drug Administration
RAND Corporation
Agency for Healthcare Research and Quality
UnitedHealth Group; SACGHS
Harvard Partners Center for Genetics and Genomics
Intermountain Healthcare
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PHC Vision and Priorities
• Personalized Health Care is a consumer-centric system in
which clinicians customize diagnostic, treatment, and
management plans
• Four perspectives were identified as important to the vision
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Clinician
Researcher
Health Plan/Payer
• Four priority areas across each perspective
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Genetic/Genomic Tests
Family Health History
Confidentiality, Privacy, and Security
Clinical Decision Support
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Why Address Clinical Decision Support (CDS)?
• Consumer-clinician interactions can be augmented by CDS
tools
• The data involved in PHC is complex
• Deployment of genetic technologies into mainstream health
care will depend on CDS tools
• Genetic/Genomic Tests and Family Health History
– Recommendation that a PHC Use Case be developed to
address these two aspects was accepted at the July 31, 2007
AHIC meeting
• Confidentiality, Privacy, and Security
– Background documents and recommendations will be advanced
to the CPS Workgroup in the next several months
• Clinical Decision Support
– Work with ONC, AHIC to address common goals and
applications
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How did the PHC WG Approach CDS?
• Visioning Session (March-April, 2007)
– CDS will be needed to facilitate evidence-based decisions by
clinicians and consumers related to genetic information
– Risk assessment algorithms, predictive tools, and prevention
messages will increasingly use genetic information
– Incentives for development of CDS to support PHC
• Staff Activities/Background work (June-July, 2007)
– Examined commercially available CDS tools, systems that are
deploying CDS across their organization
– Coordinated fact finding with CDS Roadmap team
– Developed background papers on resources, issues
• AHIC/ONC Activities (June-present)
– Working with internal CDS team to ensure coordination of
activities
• AHRQ Activities
– Products from previous work/projects
– New RFP solicitation
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Planning for PHC CDS Activities
• PHC Workgroup meeting on CDS: September 17, 2007
– Moderated by Jonathan Teich and Jerry Osheroff
– All day, in person in Washington, DC
• Meeting Agenda:
– Panel 1: CDS Tools – Services and Systems
– Case Study: CDS for Pharmacogenomics-Guided Warfarin
Dosing
– Panel 2: Evidence Development for CDS
• Assumptions prior to the meeting
– The concepts and deployment of CDS tools and systems are
still early in development
– Identified clinically useful, web-based CDS tools but not
embedded in electron health records
– There are many complex and challenging issues involved in the
development of useful CDS tools
– There is a high demand for CDS tools to support PHC
– CDS is recognized as a critical, and substantial unmet need
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PHC Workgroup Findings on CDS
• PHC Workgroup meeting on CDS: September 17, 2007
• Findings
– Many of the CDS developers had funding or important
interactions with AHRQ
– Patient engagement and inclusion of patient preferences in CDS
configurations will be critical in order to truly personalize
healthcare
– Focus on CDS applications for primary/ambulatory care
– CDS tools could be used to empower the consumer
– Design of CDS tools to fit into natural workflow is of high
importance
– Examine the use of standards or a national repository to
maximize efforts and widely deploy evidence
– Look for potential pilot studies or existing examples of
repositories of best practice guidelines
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Potential Future CDS Activities for AHIC WGs
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Examine a shared decision-making model to connect the consumer and
clinician
Examine CDS tool use in a chronic-care and prevention settings
Can best practices for workflow in CDS tools be developed?
How do we build individual variations into widely deployed systems?
Use the CDS roadmap to consider establishing a national repository of
best practices in a standardized way
Examine how to present new and old knowledge in a consistent way
Discuss various CDS issues during the October and November
workgroup meetings
Examine potential areas of early success
– Family history tools, breast cancer risk assessment, newborn
screening
– See how existing CDS tools can be deployed across EHR systems
Use findings in use case development
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