All the pressures being exerted on the healthcare industry during this period of unprecedented change is giving strategists a lot to consider as the model of care transforms. Among the major issues is how providers can offer a high level of personalized care to populations of patients in a cost effective manner using the information technology tools that are currently available.
As it happens, there are people like Neal Kaufman, MD, out there who are focused on just that situation. As founder and chief medical officer for Los Angeles-based DPS Health, Kaufman is dedicated to using health communications technology as a vehicle for public education and disease intervention. In his crosshairs are obesity and diabetes, two of the nation’s biggest health threats.
"We focus on the middle-risk individual who may have no health impact at the moment, but who is overweight, pre-diabetic and well on the way to health problems in 10 to 15 years," Kaufman said. "By getting these individuals to lower their weight, it changes their trajectory so that they don’t get added morbidity from cardiovascular disease, hypertension or diabetes at a time when it hasn’t happened yet."
[See also: Mount Sinai kicks up personalized care.]
Kaufman’s clinical background is in pediatrics and over the years his interest in public health has grown. His experience with obesity and diabetes management goes back to the late 1990s when he was involved in a landmark diabetes prevention program at the University of Pittsburgh. Study results published in 2002 showed that a randomized control trial of 3,200 participants lost between 5 percent and 7 percent of body weight, significantly decreasing the risk of diabetes. The program consisted of skilled clinicians closely working with participants on healthy diet and exercise and importantly, keeping them motivated.
"It was a highly effective program," Kaufman said. "But it was also unaffordable and unscalable because of the nature of the interaction."
Advancing IT infrastructure allowed a sophisticated Internet diabetes intervention program to develop in 2006 and now seven years and five version updates later it has served approximately 5,000 people. The average participant is age 55, is significantly obese and at risk for diabetes and its other co-morbidities. Growth has been so dynamic that Kaufman says it will serve 6,000 to 7,000 this year alone.
The key to that success, Kaufman says, is the ability to maximize patient interaction with clinician coaches using modern communications tools.
[See also: Top 5 pathways to personalized medicine.]
"This is an intervention, a program with a curriculum that offers monitoring, tracking and feedback so individuals can pick and choose how involved they want to be," he said. "The clinician coach is there as a resource and by using asynchronous e-mails, the cost is much less. There are also chat sessions moderated by a coach who can answer clinical and technical questions."
4 Ps of personalization
As senior program manager and consulting psychologist for Andover, Mass.-based Dynamic Research Corp., Andrew Ritcheson, finds personalized medicine to be "extremely interesting for a lot of reasons because it suggests a very exciting future for all of us in tailoring treatments, diagnostics and pharmacological approaches."
From a scientific perspective, personalized medicine is diving into deeper degrees of individuality by identifying genetic markers that show predisposition to certain illnesses. For instance, actress Angelina Jolie recently made news when she announced she had a preventative double mastectomy because she had a gene for breast cancer.
The medical research frontier embraces four principals known as the 4 Ps – preventative, participatory, predictive and personalized. The potential is exhilarating, Ritcheson says, because advanced genetic science can help promote optimal health with preemptive treatments and protocols.
"This is a major horizon that will bear fruit in our lifetimes," he said. "It is a field and philosophy that is in its early years."
Despite all of its promise, there are also caveats that all practitioners must heed, Ritcheson said.
"There are legal, moral and ethical considerations that complicate this approach," he said. "We have to be delicate and diligent in examining all the ramifications. It is even more complicated by the fact that any gene will be expressed in some way by environmental factors. So just because you have a gene doesn’t mean you will get a disease."
The Blue Button factor
Personalized medicine also consists of patients having control over their medical information and nowhere is that more apparent than at the Department of Veterans Affairs. Through a patient portal called MyHealtheVet, veterans, active duty service members, their dependents and caregivers have "anywhere, anytime Internet access" to VA healthcare information and services.
Launched nationwide in 2003, MHV is a free, online personal health record that empowers veterans to become informed partners in their healthcare. The portal is designed to give veterans and their families access to secure, current health and benefits information as well as the ability to record and store important health and military history information.
Guarav Mathur of Creative Computing Solutions in Rockville, Md., serves as project lead and has facilitated the portal’s development for several years. Among the integral workings of the portal is a “Blue Button” functionality that enables users to access their health information and engage in patient-centered care. Since the project began in 2010, there have been 3 million Blue Button downloads, Mathur said.
"The Blue Button is the symbol of the capability to provide healthcare data for patients," he said. "The VA was one of the first agencies to start this initiative, which has a high level of functionality and simplicity. A download can be made with two or three clicks maximum – the White House was insistent about that."
The Blue Button has been expanded significantly this year, Mathur said, incorporating more functionality, more self-reported information, enhanced user interface and improved messaging capabilities.
"By getting these individuals to lower their weight, it changes their trajectory so that they don’t get added morbidity from cardiovascular disease, hypertension or diabetes at a time when it hasn’t happened yet."
