Improving Population Health One Person at a Time

Transcription

1 Improving Population Health One Person at a Time Session #PH5, March 5, 2018 India Hook-Barnard, PhD Director, Research Strategy Associate Director, Precision Medicine 1

2 Conflict of Interest India Hook-Barnard, PhD Has no real or apparent conflicts of interest to report. 2

3 Agenda What is Precision Medicine? What will/does it look like? Building a Knowledge Network From molecular to clinical to population Paradigm shift individuals at the center How do we get there? Cross Sector Collaboration, Research, Innovation, Application UCSF Approach Examples 3

4 Learning Objectives Recognize the relationships between precision medicine, personalized medicine, the omics; and population health Discover the unexpected role of precision medicine in achieving value by delivering downstream benefits Describe near and long term strategies for integrating precision medicine into daily clinical workflow 4

5 What is Precision Medicine? How did we get here? Image credit California Biotech Foundation

6 What is Precision Medicine? As envisioned in the 2011 National Academy of Sciences (NAS) report, Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease, precision medicine aims to use advanced computing tools to aggregate, integrate and analyze vast amounts of data from research, clinical, personal, environmental and population health settings, to better understand health and disease, and to develop and deliver more precise diagnostics, therapeutics, and prevention measures. Cover Art: Nicolle Ranger Fuller, Sayo-Art LLC Photo: Graham Bell/Corbis

7 The Human Genome Project NAS 1988 Feb 2001 June 26, 2000 June 25, 2010, Scientific American The First Law of Technology says we invariably overestimate the short-term impact of a truly transformational discovery, while underestimating its longer-term effects.

8 The Human Genome Project The cost of sequencing the first human genome was about $400 million. Today, the cost of sequencing one genome stands at $9,500, and, within the next four or five years, we expect to reach the point where we can sequence an individual's genome for $1,000 or less. This impressive decline in cost has fueled a rapid expansion in the medical applications of DNA sequencing and related technologies. Francis Collins, June 25, 2010, Scientific American 2011

9 The Human Genome Project The cost of sequencing the first human genome was about $400 million. Today, the cost of sequencing one genome stands at $9,500, and, within the next four or five years, we expect to reach the point where we can sequence an individual's genome for $1,000 or less. This impressive decline in cost has fueled a rapid expansion in the medical applications of DNA sequencing and related technologies. Francis Collins, June 25, 2010, Scientific American

10 A Framework for a New Taxonomy of Disease Can we understand and treat disease based on mechanisms rather than signs and symptoms? Can we create a New Taxonomy of Disease?

11 Toward Precision Medicine The Committee is of the opinion that realizing the full promise of precision medicine, whose goal is to provide the best available care for each individual, requires that researchers and health care providers have access to very large sets of health and disease related data linked to individual patients. Committee on A Framework for Developing a New Taxonomy of Disease NAS,

12 Building the Knowledge Network GIS layers organized by geographic positioning Transportation Land Use Census Tracts Structures Postal Codes Raster Imagery Information Commons organized around individual patient Genomics Microbiome Exposures Behaviors Clinical tests Phenotypic data Google Maps Knowledge Network

13 Building the Knowledge Network Genetic code - Molecular Mechanisms Billing code -EHR, Biospecimens, Clinical Outcomes Zipcode - Environmental Factors, Social Determinants Information Commons organized around individual patient Genomics Microbiome Exposures Behaviors Clinical tests Phenotypic data Knowledge Network

14 Building the Knowledge Network Genetic code - Molecular Mechanisms Billing code -EHR, Biospecimens, Clinical Outcomes Zipcode - Environmental Factors, Social Determinants Enable Discovery Improve Clinical Care Inform Public Health Information Commons organized around individual patient Genomics Microbiome Exposures Behaviors Clinical tests Phenotypic data Knowledge Network

15 Building the Knowledge Network Genetic code - Molecular Mechanisms Billing code -EHR, Biospecimens, Clinical Outcomes Zipcode - Environmental Factors, Social Determinants Enable Discovery Improve Clinical Care Inform Public Health Information Commons organized around individual patient Genomics Microbiome Exposures Behaviors Clinical tests Phenotypic data Knowledge Network

16 Changing Paradigm old ecosystem Research, Clinical Care and Population Health are often siloed Individuals Research Clinical Care Public Health Citizens Data/knowledge flows mostly in one direction and slowly. Clinicians are (unintentional) gatekeepers between individuals and research. Most personal Information (and decisions) occur outside of the clinical setting.

17 Changing Paradigm new ecosystem Patient -centered, partners in research and care: Enable Data Sharing Address needs, risks and benefits for all stakeholders.. Move from treatment of disease to risk assessment, prediction, prevention. Incentivize Partnerships - Drive technological innovation and cultural change.

18 Changing Paradigm new ecosystem Patient -centered, partners in research and care: Enable Data Sharing Address needs, risks and benefits for all stakeholders.. Move from treatment of disease to risk assessment, prediction, prevention. Incentivize Partnerships - Drive technological innovation and cultural change.

19 Opportunities and Barriers Technical issues collecting, managing, aggregating, analyzing data Data sharing cultural barriers; who gets credit, IP, publication Participant engagement who owns, and controls, the data Trust transparency, consent, privacy, security (national security) Health Justice need everyone to contribute, all must benefit Cost reimbursement; short term vs long term use

20 Cross Sector Partners.edu,.gov,.com,.org Patients, Healthy Participants, Citizens, Communities Academia Local/City, State, Federal, International Public Health Officials, Regulators, Policy Makers, Industry - Pharma, Biotech, Hi-tech, Payers, Health systems Foundations, Non-profits

21 Precision Medicine at UCSF Support, promote, and leverage individual efforts across continuum of basic research, clinical discovery and delivery, population health and prevention; aim to share, connect, and analyze data; build knowledge network toward Precision Medicine PrecisionMedicine.UCSF.edu

22 Precision Medicine at UCSF Approach Precision Medicine Platform Committee Representative leads for the focus elements and programs think strategically, coordinate, convene stakeholders, and build partnerships Keith Yamamoto, Chair Nancy Adler -Omics - Social, Behavioral Exposures Alan Ashworth -Precision Cancer Medicine Kirsten Bibbins-Domingo - Precision Public Health Michael Blum -Digital Health Sciences Atul Butte -Computational Health Sciences Dan Dohan -Stakeholder Engagement/Policy Donna Ferriero -Children s Precision Medicine Jenny Grandis -Clinical Discovery Bob Hiatt -Population Health Research Michael Korn -Molecular Oncology Geoff Manley -Neuroscience Precision Medicine Mary Norton -Women s Precision Medicine Neil Risch -Omics - Genomics Kate Rankin -Neuroscience, Knowledge Network PrecisionMedicine.UCSF.edu

23 Precision Medicine at UCSF Example Efforts Support and leverage individual efforts across continuum of basic research, clinical discovery and delivery, population health and prevention; aim to share, connect, analyze data, build knowledge toward Precision Medicine Cell Cancer Map Initiative: Discover molecular networks of cancer Molecular Oncology Initiative: Clinical genomics, diagnostics SF Cancer Initiative: Targeted prevention, early detection UC DataWarehouse: Connecting ~16M EHR from across UC system Biobank, econsent: Simplified collection and uniform consent SPOKE: Scalable Precision Open Knowledge Engine Precision Public Health: Social Determinants, Health Justice California Initiative to Advance Precision Medicine (CIAPM): UCSF host ATOM Consortium: DOE, NCI, GSK, UCSF PrecisionMedicine.UCSF.edu

24 Combining Healthcare Data From Across the Six University of California Medical Schools and Systems Figures courtesy of: Atul Butte, MD, PhD, Professor, Director of UCSF s Institute for Computational Health Sciences (ICHS)

25 Figures courtesy of: Atul Butte, MD, PhD Professor, Director of UCSF s Institute for Computational Health Sciences (ICHS)

26 Medication Strategies for Treating Diabetes Patients How are patients currently treated? Multiple options within standard of care Some treatments cost 100X more than others Which option to choose? What will provide the best outcome for the individual patient? Figures courtesy of: Atul Butte, MD, PhD, Professor, Director of UCSF s Institute for Computational Health Sciences (ICHS)

27 Medication Strategies for Treating Diabetes Patients Figures courtesy of: Atul Butte, MD, PhD, Professor, Director of UCSF s Institute for Computational Health Sciences (ICHS)

28 Medication Strategies for Treating Diabetes Patients Figures courtesy of: Atul Butte, MD, PhD, Professor, Director of UCSF s Institute for Computational Health Sciences (ICHS)

29 Medication Strategies for Treating Diabetes Patients Figures courtesy of: Atul Butte, MD, PhD, Professor, Director of UCSF s Institute for Computational Health Sciences (ICHS)

30 1,640 Unique Medication Trajectories for Treating T2D at UCSF Figures courtesy of: Atul Butte, MD, PhD, Professor, Director of UCSF s Institute for Computational Health Sciences (ICHS)

31 6,543 Unique Medication Trajectories for Treating T2D UC-Wide Figures courtesy of: Atul Butte, MD, PhD, Professor, Director of UCSF s Institute for Computational Health Sciences (ICHS)

32 Precision Medicine In Practice Figures courtesy of: Atul Butte, MD, PhD, Professor, Director of UCSF s Institute for Computational Health Sciences (ICHS)

33 Precision Population Health What is the role of precision medicine in advancing population health? What needs to be present to assure that precision medicine helps alleviate and not exacerbate disparities in health? How can new technologies and big data be used to address public health and prevention? Lead: Kirsten Bibbins-Domingo, PhD, MD, MAS PrecisionMedicine.UCSF.edu

34 Precision Population Health What is the role of precision medicine in advancing population health? What needs to be present to assure that precision medicine helps alleviate and not exacerbate disparities in health? How can new technologies and big data be used to address public health and prevention? At UCSF we are advancing these important discussion across multiple domains: 1. Improving data science and technology approaches to address public health issues (with an emphasis on prevention), 2. Increasing representation of diverse populations in both participation in research studies as well as in the receipt of precision medicine therapies, and 3. Integrating social, environmental, and behavioral determinants of health with other -omics measures for both new scientific discovery and better targeted interventions. Lead: Kirsten Bibbins-Domingo, PhD, MD, MAS PrecisionMedicine.UCSF.edu

35 Precision Population Health

36 Precision Population Health

37 Precision Population Health

38 Precision Population Health

39 Precision Population Health

40 Precision Population Health Lead: Robert Hiatt, MD PhD

41 Precision Population Health Lead: Robert Hiatt, MD PhD

42 Precision Population Health Lead: Robert Hiatt, MD PhD

43 Launched by Governor Edmund G. Brown Jr. in April 2015 UCSF serves as host institution $3M, 2 years $10M, 2 years $10M 2018 Proposed - $30M, establish as Institute

44 Goals: Collaboration Innovation Patient Impact Key Efforts: Demonstration projects Convening Stakeholders Economic Analysis Asset Inventory

45 Demonstration Projects

46 Demonstration Projects

47 Precision Medicine Advisory Committee Drafting a report with recommendations Would love to hear your ideas, challenges, and opportunities!

48 Questions India Hook-Barnard, PhD Director of Research Strategy Associate Director, Precision Medicine Executive Director, CIAPM Please complete online session evaluation! 48

49 Please use blank slide if more space is required for charts, graphs, etc. To remove background graphics, right click on selected slide, choose Format Background and check Hide background graphics.