personalized health care: the foundation of rational health reform
DESCRIPTION
Dr. Ralph Snyderman presented, "Personalized Health Care: The Foundation of Rational Health Reform" to the attendees of the 2009 Personalized Health Care National Conference. Ralph Snyderman, MD, is chancellor emeritus of Duke University and the founder and chairman of Proventys, Inc. From 1989 to 2004, he served as chancellor for Health Affairs and dean of the School of Medicine at Duke. During his tenure, he led Duke’s medical center to a position of international prominence in academic medicine. We thank Dr. Snyderman for sharing this presentation with the world.TRANSCRIPT
©2009 RALPH SNYDERMAN 1
Personalized Health Care: The Foundation of Rational Health Reform
Ralph Snyderman, MDChancellor Emeritus, Duke UniversityJames B. Duke Professor of Medicine
Personalized Health Care National ConferenceOhio State University Medical Center
October 1 , 2009
©2009 RALPH SNYDERMAN 2
1900s
Germ Theory
Chemistry
Physiology
Pathology
Physics
Science and Medicine
Find ItFix It
Understanding Disease
©2009 RALPH SNYDERMAN 3
Concepts of Disease
Reductionism: Single factor
Causative Factor Disease
©2009 RALPH SNYDERMAN 4
Contemporary Practice of Medicine
• Disease-oriented
• Find it, fix it
• Reactive
• Sporadic
• Physician-directed
• Very expensive
©2009 RALPH SNYDERMAN 5
1900s
Germ Theory
Chemistry
Physiology
Pathology
Physics
2000s
Genomics
Proteomics
Metabolomics
Systems Biology
Informatics
Micro/Nano Processing
Science and Medicine
Find ItFix It
Predict ItPersonalize It
Understanding Disease
Understanding Health, Disease and Complexity
©2009 RALPH SNYDERMAN 6
Concepts of Disease
Emergence: Multiple factors
Reductionism: Single factor
Baseline Risk
Environmental Factors
Preclinical
Progression
Disease Initiatio
n
Disease Progress
ion
Irreversible
Damage
Causative Factor
Enhance Health and Well-Being
Disease
©2009 RALPH SNYDERMAN 7
Time
Cost
1/
reve
rsib
ilit
y
Dis
ease
Bu
rden
Typical Current
Intervention
Earliest Clinical
Detection
Earliest Molecular Detection
Baseline Risk
Initiating Events
Stable Genomics
Dynamic Tracking
Therapeutic Decision Support
Personalized, Predictive, Prevention
Prevention Early Intervention
End of Life Care
DiseaseManagement
Personal Health Plan
©2009 RALPH SNYDERMAN 8
New Clinical Tools
• Health risk analysis
• Pathogenesis tracking
• Molecular diagnosis
• Clinical event prediction
• Therapeutic potential analysis
©2009 RALPH SNYDERMAN 9
Predictive Model Development
CLINICAL DATA COHORT
OTHERPROTEOMICGENETICCLINICAL
PREDICTIVE MODELER
ADDITIONAL DATA;
NEW BIOMARKERS
STATISTICAL VALIDATION
y = f (x1, x2,…xn )
OUT OF SAMPLE POPULATIONS
DATA
PREDICTION MODELS
BASELINE RISK
DISEASE PROGRESSION
EVENT PREDICTION
DECISION SUPPORT
PATIENT PHYSICIAN
PATIENT’S DATA
PREDICTIVE MODEL
CLINICAL EVENT
©2009 RALPH SNYDERMAN 10
Traditional Medical
Evaluation and
RecordChief Complaint
History of Illness
Past Medical History
Family History
Social History
Physical Exam
Diagnostic Tests
Assessment and Plan
Personalized Health Plan
Health Risk Assessment
Current Health Status
Tracking Wellness and Pathogenesis
Clinical Event Prediction
Wellness Plans
Therapeutic Plans
Paradigm Shift to Personalization
©2009 RALPH SNYDERMAN 11
Personalized Health Plan
PATIENT’S EVALUATIONMedical “work up” -- including
relevant predictive factors and biomarkers
PATIENT’S OUTCOMETracking Data
Clinical Event Data
Patient’s DigitalData Base
Risk ModelsLibrary
PERSONALIZED HEALTH PLANCurrent Health Status
Health Risk AssessmentHealth Risk Tracking
Disease Event PredictionHealth and Wellness Plans
Therapeutic Plans
©2009 RALPH SNYDERMAN 12
Fragmented Health Care
PRIMARY
CARE
PRIMARY
CARE
SPECIALTY CARE
SPECIALTY CARE
HOSPITAL CARE
HOSPITAL CARE
ERCARE
ERCARE
URGENT
CARE
URGENT
CARE
SELFCARESELFCARE
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Model for Personalized Health Approach
PERSONAL HEALTH PLAN
Health Risk AssessmentCurrent Status
Health TrackingHealth and Wellness Plan
Health EnhancementResources
Navigator
Health Care Provider Team
And Resources
Integrated Delivery System
PATIENT PHYSICIAN
©2009 RALPH SNYDERMAN 14
Personal Health Plan Coordinates Care
PRIMARY
CARE
PRIMARY
CARE
SPECIALTY CARE
SPECIALTY CARE
HOSPITAL CARE
HOSPITAL CARE
ERCARE
ERCARE
URGENT
CARE
URGENT
CARE
SELFCARESELFCARE
Health Navigator
PersonalHealthPlan
©2009 RALPH SNYDERMAN 15
Clinical Decision Support at the Point of Care
EHR
Clinical Risk PredictorsClinical Decision SupportDiagnostics SelectorsTherapeutic PredictorsPayer Adjudication
PDx Server
Clinical Research
New Model ValidationBiocausality Engine
©2009 RALPH SNYDERMAN 1616
Example: A point-of-care predictive test for prevention of febrile neutropenia (FN)
©2009 RALPH SNYDERMAN 17
Key Factors in Health Care Reform
• Universal access
• Health education and personal empowerment
• Personalized prevention and strategic health planning
• Biomedical research and regulatory reform
• Delivery systems integration
• Reimbursement reform
©2009 RALPH SNYDERMAN 18
“There is nothing more difficult to plan, more
doubtful of success, nor more dangerous
to manage than the creation of a new
system. The initiator has the enmity of
all who profit from the old institution and
merely lukewarm defenders in those who
would gain the new ones.”
Niccolo Machiavelli
©2009 RALPH SNYDERMAN 19
“Is is not the strongest of the species
that survives, but rather the one most
responsive to change.”
Charles Darvin