Precision Medicine’s “Last Mile” Problem · 2019. 2. 9. · CrunchR Analytics Virtual Desktop...

www.HIMSSConference.org #PrecisionHIT

FEBRUARY 11, 2019ORLANDO, FL

Precision Medicine’s

“Last Mile” Problem

2

https://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-global-perspective

3

https://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-global-perspective

A Trillion

Dollars!

Johns Hopkins inhealth

PRECISION MEDICINE

Nexus of measures, models and forecasts

Charting to Health

+ Improve pace of discovery

+ Remove barriers

Translation

of discoveries

into Delivery

+ Multidisciplinary approach

+ IRB approved and secure

+ Deliberately practicing what we learn

+ Expand the reach of care

Discovery

for research

OUR APPROACH

Centers of Excellence

Vision for

Clinical ImpactSeeking clinical impact, not open

ended research, by providing

templates for:

• Framing scientific aims coupled with

measurement

• Afferent data collection

• Research cohort development

• Data management

• Novel approaches to subgrouping

• Data science driven clustering

• Organization capability growth –

data science

• Sustainable funding

CoEs commit to value framework

and plan:

• Point of care application

• Impact / Cost Measurements• Efficiency of Care / Reimbursements

• Value to Health System / Payors

• Value to Industry

• Reputation

• Grants / Philanthropy

• Lower Research Barriers / Cost

• Path to sustainability / commercialization

Drives all other phases

Science

Old Model

• Study within own disease space

• Questions and Measures

constrained – exclusively focused

on open ended discovery

• “First Copies” – Everyone built

their own research system from

scratch

• Not limited by what you already have

and what you already know

• “Does it matter?” – For example,

if you define a new patient subgroup,

can you measure whether that

identification is useful in practice?

• Modular – apply data, expertise,

and patterns from multiple areas

• “Docker Containers” concept

New Model

Traditional Roles

• Multidisciplinary team with

clinical and research

responsibilities

• Faculty

• Data managers

• Research staff

• Clinical staff

• Shared across the research

enterprise to allow better application

of tools and patterns across fields

• Data Scientist – Advanced analytics,

Data-driven hypothesis generation

• Operational Lead – Value within

JH Health System

• Health Economist – Value outside JH

Key New Roles

HDInsightADLS

Azure Cloud

EMR

Imaging

PhysMon

Registry

Genomics

CrunchR Analytics

Virtual Desktop

Schema on Read

Containerized analytics, portable to compute

RDSSQL Server

Postgres

Object and file store

Identity,features

normalized & coalesced

Commons

Tech Stack

Delivery

Practice what

we’ve learned

Extending reach

to all patients

who can benefit

Workflow

Integrated

Minimum-

Viable-Data

Patient Centered Outcome

Informed

PRECISION HAS A

LAST MILE PROBLEM

How do you reach patients? Can you reach providers?

At scale?

Interoperable?

Proprietary?Clinically Valid?

AI Lifecycle?

Adoptable?

Integrated?

Privacy & consent?

Liability?

Reimbursable?

Creating framework to

evaluate, prioritize and select

high impact conditions for

intervention.

Maryland is primed

for intervention

HSCRC Care

Redesign

Reimbursement

Total cost

of care

CRISP

Impact to Johns Hopkins:

$$$ hundreds of millions

Maryland impact

$5B+COPD Cases

190,000

Scale Matters: COPD

Empower

the patient

Meeting providers

where they are

Care

Redesign

Minimum-

Viable-Data

CLOSING

THE GAP Shift to open-

ecosystems

www.HIMSSConference.org #PrecisionHIT

Dwight Raum

Johns Hopkins Medicine

@HopkinsMedicine

@HopkinsInHealth