Towards a P4 Healthcare System: Predictive, Preventive, Personalized & Participatory

Transcription

1 Towards a P4 Healthcare System: Predictive, Preventive, Personalized & Participatory Bull, 2012 Natalia Jiménez Lozano Business Development Manager BULL e-health Consultancy & Business Solutions Tlf: natalia.jimenez@bull.es 1

2 Clinical Case Bull,

3 The future

4 Betty s story in the future

5 Whole Genome Sequencing is She consults her physician, who suggests complete genome sequencing for

6 Gene Variants are linked to the probability to suffer a disease After genetics tests, Betty is found to have three gene variants that have been shown conclusively in well validated studies to increase her risk of early heart attack 5-fold. Predictive

7 Participation, Life styles and targeted drugs She and her doctor design a program of prevention based on diet, exercise, and medication precisely targeted to her genetic situation. Preventive, Personalized & Participatory

8 Betty s story in 2012

9 Lack of adherence to a healthy life style Betty s doctor never asked for genetic tests. She eats an unhealthy diet, gains weight, and develops high blood pressure.

10 Moreover, Betty s hypertension is treated with a drug that causes a hypersensitivity reaction, so she stops treatment.

11 Betty s story gone wrong Betty dies in the ER from MI

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13 Revolution

14 From reaction to prevention Evidence-based Medicine P4 Medicine

15 What is P4 Medicine?

16 The Four Pillars of P4 medicine Bull,

17 The four pillars of P4 medicine

18 Predictive Preventive Personalized Participatory

19 colon cancer

20 Predictive

21 Preventive Begin colonoscopy at the age 40 Avoiding high fat diet

22 Personalized

23 Patients can respond differently to the same medicine

24 Why some patients don t respond to the treatment?

25 Why a drug causes side effects in some patients?

26 Drug dose of antidepressant determined by drug metabolism genetic profile DEPRESSION

27 Participative

28 Increase patient compliance to the treatment Asthma

29 Familial Hypercholesterolemia

30 Inherited forms of hypercholesterolemia can increase the risk of myocardial infarction before the age of 40 more than 50-fold in and 125-fold in

31 Genetic Testing Conventional monitoring

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33 Adherence to the treatment? Pre Testing 38% Post-testing 86%

34 Predictive Preventive Personalized Participatory

35 Genome Sequencing High-throughput technology Bull,

36 It took 13 years and 3 billion dollars to sequence the human genome by Traditional Methods

37 Genomics is only a way station

38 Solexa technology (Illumina) 454 Pyrosequencing (Roche) Ion Torrent (Life Technologies)

39 Breakthrough

40 The Rapidly Decreasing Cost of Sequencing Complete Genomes

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42 January 2012 Ion Proton Sequencer, priced at is designed to sequence the entire human genome in a day for

43 Pacific Biosciences stated that their secondgeneration machine, which is scheduled for release in will be capable of providing a full genome sequence for a person in just

44 Health Information Technology Bull,

45 Personalized Medicine Coalition

46

47 Short Medium Long Term

48 Short

49 Data Overload + Processing needs

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51 Term Short Medium

52 FUTURE CLINIC Centro Investigación Príncipe Felipe Diagnostic Tests Output Personalized Treatment Guidelines Knowledge Databases Electronic Medical Record

53 Short Medium Long Term

54 In the next 5 to 10 years, every patient will be surrounded with a cloud of billions data points, and the challenge is going to be to reduce this enormous data dimensionality to simple hypotheses about health and disease for the individual Leroy Hood, MD, PhD, President and Co-founder of Institute for Systems biology

55 I can t manage the huge amount of data about my patients

56 After 2015, hospital and physicians face penalties for not using Health IT, such as electronic health records (EHRs), in a meaningful way, which should include molecular information

57 Reduce the cost of Health Care

58 Unsustainable upward climb Trial-and-error dosing Hospitalization of patients who have severe reaction to a drug Reactive treatment Late diagnoses

59 Potential Cost Savings

60 Early detection and treatment of lung cancer Early stage surgery costs are approximately half those of late-stage treatment

61 Reducing the prescription of drugs to which individual patient do not respond: 30-70% of total cost in some cases

62 Genetic testing could prevent warfarin

63 warfarin Genetic testing could prevent 17,000 strokes & 85,000 serious bleeding events

64 warfarin Genetic testing could prevent 17,000 strokes & 85,000 serious bleeding events 43,000 visits to the ER

65 warfarin Genetic testing could prevent 17,000 strokes & 85,000 serious bleeding events 43,000 visits to the ER Saving $1,1 billion annually

66 Genomics: present and future

67 1 Website for Medical Doctors

68 1 Website for Medical Doctors 2 Alert pop-up Important information!

69 1 Website for Medical Doctors 2 Alert pop-up Important information! 3 Database Query 2,000 Patients Database

70 1 Website for Medical Doctors 2 Alert pop-up Important information! 4 Query Output 80 patients at risk 3 Database Query 2,000 Patients Database

71 1 Website for Medical Doctors 2 Alert pop-up Important information! 5 Preventive Actions 4 Query Output 80 patients at risk 3 Database Query 2,000 Patients Database

72 Bull,

73 Bull,

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