“It is not the fittest of the species that survives, it is the most adaptable to

change”

Charles Darwin

bordalierinstitute.com

meta-activism.org

What is the Compelling Opportunity in Medicine?

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.

Blue Ocean Strategy

Value Innovation

Costs

Buyer Value

ValueInnovation

What is the External Landscape?

Francis Collins NIH Vision

• Large Biology Projects with High Throughput Technologies

• Translational Research

• Global Health

• Health Care Reform

• Sustaining Biomedical Research

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)

What Do Health, Disease and Nature Share in Common?

freelancingscience.comfreelancingscience.com

forums.treehugger.com

http://education.mit.edu/starlogo-tng/learn/flocking-activity

www.bioteams.com/images/swarm_behavior.jpg

corpusoptima.com

corpusoptima.com

unreasonablydangerousonionrings.blogspot.comengineering.tufts.edu

They are Complex Adaptive Systems Made up of Networks

What Else Works in Networks?

clickonf5.org

The Tipping Point and Social Networks

www.flickr.com

NEJM 2007 (357): 406-07

Almost Everything

Medical Center Strategic Portfolio

Patient Care

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Ca

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Cri

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Ima

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Personalized Health Care

Key Research Programs

Human Genetics

Biomedical Informatics

Behavioral Medicine

Signature Programs

Edu

cation

Innovation and intellectual impact

Academic excellence and knowledge

Clinical Excellence and Service Delivery

Creating the future of medicine to

improve people’s lives

Personalized Health Care is P4/Systems Medicine

Resilience To Sustainability

Wellness from the Individual to the World

P4 MedicinePartnerships

28

Predictive

Preventive

Personalized

Participatory

Using a person’s genetic makeup and family history to generate predictions about his or her health

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Diane Balster

• Genetic testing revealed BRCA2mutation

• Chose preventive procedures to minimize her risk

• Predictive care at Ohio State gives people the knowledge they need to make informed decisions

Predictive

Preventive

Personalized

Participatory

Using a person’s health-related information to prevent disease before it starts

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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

Predictive

Preventive

Personalized

Participatory

Customizing medical care to the individual patient

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Janet Graves

• Routine test revealed hypertrophic cardiomyopathy

• Chose to treat condition with implantable cardiac defibrillator

• Extended family undergoing genetic testing

Predictive

Preventive

Personalized

Participatory

Encouraging patients to actively participate in their personal choices about illness and well-being

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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

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Your Plan for Health

• Faculty and staff 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

YP4H

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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.

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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 expansion helps prevent medical complications

Catherine Lucey, MD

P4 Medicine: Disease to Wellness

How Do We Define Wellness?

Your Environment Regulates DNA Activity

Behavior Environment Gene

Physical

Defining and Quantifying Health

Behavior

Environment

Genetics

Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. -- WHO, 1948

Health is the ever-changing process of achieving individual potential in the physical, emotional, social, mental, spiritual, and environmental dimensions.-- Bridget Melton, 2010

Physical

Dimensions for Measuring Health

Behavior

Environment

Genetics

• Optimism• Faith/Spiritual• Relationship: family and

social network• Empathy• Social functioning• Lifestyles

Physical

Dimensions for Measuring Health

Behavior

Environment

Genetics

• Diet / Nutrition• Sleep / biorhythm• Micro-biomes• Geo-locations• Employment / workplace• Culture

Physical

Dimensions for Measuring Health

Behavior

Environment

Genetics

• Family health history• Genetic test (SNPs)• Pharmacogenomics test• DNA sequences and epigenetics• Transcriptomics• Targeted genetic screening• Network analysis (systems and

computational biology)

Physical

Dimensions for Measuring Health

Behavior

Environment

Genetics • Biometrics• Autonomic nervous system• Grip /core strengths• Balance• Endurance• Cognitive functioning• Bio markers

Program at OSUMC

Two Main Pilot Projects: Wellness and Care Coordination in Chronic Disease

wellness.ucsd.edu/WhatisWellness.shtmlkardiol.com/?tag=heart-failure

P4 Approach to Wellness

Longitudinal PHA/Biomarker data leads to Care Team review and

recommendations

Your Strategic Plan For Health

Customer visit medical home team and/or family physician to review and finalize plan:

• Current strengths and weaknesses

• Opportunities for improvement

• Health and wellness targets for next 2, 5, and 10 years

• Action Plan: recommendations

Optional special and/or virtual clinics that meet individual needs

Molecular Diagnostics Genetic Counseling

Behavioral Health

Nutrition

Exercise & performance

• Biomarker and Genetic risk factor awareness and education

• Behavioral risk factor awareness and mitigation strategies; happiness, optimism

• Evidence-based recommendations

• Nutrition and diet changes that meet each person’s unique needs

• Exercise and physical performance routines designed for individual needs

Sleep Medicine & Circadian Rhythm

• Sleep medicine and circadian rhythm analysis

• Assist individuals for best rest to promote health

Chronic Disease

Stratify Identify

www.indezine.com/.../peopleanimation_02.jpgacl.com

Prevent/Treat

www.socialsecurityinsider.com/wp-content/uplo

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)

Reduce Variability to Decrease Cost and Increase Quality

Stratify Populations

Single Nucleotide Polymorphisms in Clinical Medicine: Pharmacogenomics

science.marshall.edu

Pharmacogenomics

pharmainfo.net

Analyze Data to Create Knowledge

http://www.sys-bio.org/contentimages/WhyWeNeedComputer.png

Hubs are Strong Links in Networks

Group Working on Complex Adaptive Systems and Networks in Health Care

Identify Networks and Key Regulatory Nodes Controlling Networks

http://mcdb.colorado.edu/courses/3280/lectures/class16-2.html

Engage Consumers

Participatory Medicine

ama-assn.org

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

You Tube is the 2nd Most Used Search Engine on the Internet

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

Networks, Participation, the Power of Games and Crowdsourcing

Jane McGonigal and Games

Finding the Red Balloon

techcrunch.com

What Are Health Applications?

bryankorourke.com

Social Media and Smoking Cessation

www.health.com/.../0,,20209135,00.htmlhttp://www.euroclinix.net/health-news/smoking-cessation/facebook-helping-people-to-kick-the-habit-231.html

Personalized Medicine Home

Dedicated PCP or NP

Assigned Care

Coordinator

Patient tracking

and registry functions

Patient self-management

support

Visits, Lab-Test, and Referral tracking

Telemed tools

Be the Change That You Want to See in the World

Mahatma Gandhi