Transcript Redefining Personalized Medicine

Redefining
Personalized
Medicine
Dr. Scott Joy
October 16, 2013
Not Just for Specialists
Challenged by a presentation on how
genetic factors are associated with the
risk and progress of diabetes, Dr. Joy
thought that he could bring more value
to his patients using ‘personalized’
medicine.
Reference:
Joy, Scott V., MD. Redefining Personalized Medicine
in the Primary Care
Setting. Medscape. Oct 10, 2013.
http://www.medscape.com/viewarticle/812376?n
lid=35763_1521
Personalized Medicine 1.0
• Assess health status
• Focus on collecting biometric data
– Blood pressure
– Cholesterol
– Body mass index
– Allergies (food, medication)
– Family/social history
• Treat detected problems
• The ‘Platinum’ Edition
– Calculate 10-year risk for a cardiac event (Framingham
Risk Score)
– Calculate risk of developing diabetes (Diabetes Risk Test)
– Calculate risk for bone fracture due to osteoporosis (FRAX
score)
Personalized Medicine 2.0
• Leverage technology and patient
participation to provide a more
efficient and better experience for
both patient and provider
• Pre-visit, Patient uses secure portal
to:
– Schedule appointment
– Update medical, family, and social
history
– Update medications and allergies
– Identify and Schedule needed lab tests
Personalized Medicine 2.0
• The day before the appointment, the patient gets a
reminder email and uses secure portal to:
–
–
–
–
Verify insurance info
Confirm labs have been completed
Lists goal(s) for appointment
Checks in online
• The provider can review all information prior to the
appointment
– Has biometric data in advance
– Knows exactly what the patient wants to get out of
the visit
– Can focus on discussion of specific indicators and
setting goals for improved wellness
Personalized Medicine 2.0
Summary
• Includes all of 1.0 ‘Platinum’
• Patient portal
• Bidirectional electronic
communication between patients,
providers, and practices
• Integrated risk calculators into the
EHR with prepopulation of relevant
clinical data
• List of community resources
Personalized Medicine 3.0
Personalized Medicine 3.0
•
Pre-appointment genetic testing completed at home using a buccal swab.
•
Data are analyzed and the results are automatically uploaded into the EHR.
•
Painless skin sensor monitors metabolic and activity levels
•
Monthly summaries of these data are uploaded into the EHR and
crosschecked with biometric data, family/social history, medication and
allergy lists, and data from risk calculators.
•
By the visit, the health information system has generated an enhanced
health risk assessment that includes risk of developing chronic conditions
based on genetic test results, biometric data, and medical/family/social
history
•
Recommendations to alter risks of developing these conditions are
suggested to the provider, along with pharmacologic recommendations
based on her pharmocogenomics profile.
•
Community resources to help and support engagement in healthy
behaviors that are available in the zip codes where the patient lives and
works are identified and presented for consideration
The Challenge:
• Take our currently fragmented systems
and integrate them into the clinical
workflow of a primary care practice and
the health information systems that
support these practices.
• Build on the collection of data
in a patient's EHR, introduce
genetic testing results as a
variable, and leverage HIT
to synthesize these data to
produce recommendations
that will enhance the health and
safety of the patients we serve