First Look at Patient Preferences
In this era of value-based care, new approaches are a necessity to curtail rising healthcare costs. Not surprisingly, many of these solutions involve some aspect of personalized healthcare. It’s no mystery that treating an individual rather than a population costs less, but the challenge facing many healthcare organizations is knowing what solutions to implement, and at what cost.
A new concept that addresses not only value, but also patient satisfaction scores, is patient preferences. Simply put, we as humans like it when our likes are preemptively validated. Case in point: Netflix. They've figured out a way to give you movie choices based on what you like. If you like the choices they've made for you, you are a satisfied customer and highly likely to return, or better yet, tell a friend.
Now this may not be so simple in a healthcare setting, but there is no reason we shouldn’t begin looking at the world of patient preferences. Step one for many organizations is to define patient preferences. Cleveland Clinic’s Center for Personalized Healthcare is strategically looking at what facets of patient preferences would have immediate benefit for patients while avoiding costly and time intensive implementations. We are moving forward with the understanding that to gain maximum benefit, we will need to tap deep into valuable data where it lives; in the EHR.
Patient preferences can be divided into three distinct areas of exploration beginning with fundamental preferences like meal choices, religious/cultural needs and specifics related to a patient’s comfort. Do they prefer to be woken for the administration of non-essential medication or would they rather address these needs after they've awoken? Do they prefer one pillow or two? What do they like to be called? Knowing these answers before walking into the patient’s room can create an immediate sense of familiarity which has the potential to ultimately improve their satisfaction with their stay.
Shared decision-making (SDM) is the second area to explore. This is best described as the collaboration between doctor and patient where clinicians offer their expertise while patients use their preferences and values to arrive at a mutually agreed upon decision. Electronic tools are necessary to track and maintain patient preferences. While there is plenty of research to be done, it is not too early to start thinking about how we can begin contributing to patients’ medical decisions.
Lastly, we are looking at patient/doctor matching. We all learn differently and every human is subject to perceptions, learning styles and personality traits. Matching doctors and patients could potentially streamline communication and contribute to value-based healthcare. The challenge is collecting patient data and leveraging it at the right time in a way that is meaningful. It would be helpful for schedulers to have a limited subset of physicians to choose from based on the callers’ predetermined preferences.
Implementing programs around patient preferences will certainly address many tenets in modern healthcare such as value, better outcomes, and better patient experience. While there is a long way to go, the Center for Personalized Healthcare is looking at what is achievable now and what we must act on to launch larger projects for the future.
Cleveland Clinic’s Center for Personalized Healthcare Celebrates Personal Healthcare Month
In 2012, Ohio governor John Kasich declared November to be Personal Healthcare Month in the State of Ohio. Cleveland Clinic’s Center for Personalized Healthcare celebrated with several education and awareness events.
On November 18, the Center for Personalized Healthcare teamed up with the Genomic Medicine Institute to present the educational course “A Personal Journey through Genomics.” This half-day course educated physicians and advanced practice nurses about the concepts of genetics and genomics, as well as direct-to-consumer genomic testing.
In early November, we hosted a visiting professor, Dr. Howard McLeod. Dr. McLeod is the Medical Director of the DeBartolo Family Personalized Medicine Institute at Moffitt Cancer Center. His presentation at Medicine Institute Grand Rounds educated physicians and residents about using pharmacogenetics to guide therapy.
We also developed a Family History Toolkit to help individuals collect their family health history. The toolkit, available online at www.clevelandclinic.org/family, gives people guidance as to what information to collect and how to best collect it. The downloadable tool also provides individuals with user-friendly forms that they can print, complete, and then share with their doctors and their family members. Thanksgiving Day is National Family Health History Day (designated by the U.S. Surgeon General), so it is a great time to collect and update family health histories.
Every quarter, we recognize a person or team as Personalized Healthcare Heroes. From November 1-15, all of our heroes from 2012 and 2013 were featured on the Information Skyway (between the A and F buildings). Each hero’s photograph was displayed, along with a quote about their role in personalized healthcare. Our heroes are integral to our initiatives, and featuring them on the skyway was a great way to honor them and to communicate their contributions to the Cleveland Clinic community.
We held an awareness table in the International Café on Cleveland Clinic’s main campus to promote personalized healthcare to patients, visitors, and employees.
In addition to these events, Dr. Kathryn Teng, has appeared in several local and national media spots (on-air and print) promoting the importance and clinical utility of family health history.
Celebrating Personal Healthcare Month brings awareness to the fact that preventing disease, diagnosing disease early, and customizing therapeutic interventions provide for better outcomes and quality of care for individuals, often times at a lower cost to the patient and the healthcare system.
Sonja O’Malley, PMP, Personalized Healthcare Hero Award Recipient
This quarter’s recipient, Sonja O’Malley, is the Director of HIT Commercialization for Cleveland Clinic Innovations. As such, she has worked closely with many members of the CPH team, helping in many phases of product development. Specifically, she has contributed in the early stages of creative design, providing critical feedback, guidance, and helping to provide the framework for the Patient Preferences tool that is currently being developed. She has also helped to manage the commercialization process for MyFamily and the Personalized Medication Program, again providing critical feedback and guidance.
Our team has enjoyed working with Sonja. She is approachable and easy to work with. We appreciate her expertise, organization, professionalism, and follow-through. We thank her for her commitment to our initiative and her dedication to helping us bring personalized healthcare information and tools to the standard practice of medicine.
We applaud Sonja for her hard work, and look forward to working together on future personalized healthcare initiatives.
Pharmacogenomics Clinical Specialist to Expand Integration of Pharmacogenetics into Clinical Care
The Center for Personalized Healthcare welcomes our new collaborator, J. Kevin Hicks, PharmD, PhD. Dr. Hicks is a Pharmacogenomics Clinical Specialist in Cleveland Clinic’s Pharmacy Institute. He is participating in the implementation of Cleveland Clinic’s Personalized Medication Program, which is a combined effort between the Center for Personalized Healthcare and the Pharmacy Institute.
Kevin joined Cleveland Clinic following a fellowship in pharmacogenomics at St. Jude Children’s Research Hospital and residencies at the University of Tennessee Health Science Center and St. Jude Children’s Research Hospital.
Dr. Hicks received his Bachelor of Science from the University of Alabama at Birmingham, and both his PharmD and PhD in Pharmacology from the University of Michigan.
As a fellow, Kevin was involved in the development of an automated system that integrated pharmacogenetic test results and interpretations into an electronic medical record. He received a Presidential Trainee Award from the American Society for Clinical Pharmacology and Therapeutics (ASCPT) for this work.
He also is an active member of the Clinical Pharmacogenetics Implementation Consortium (CPIC) of the Pharmacogenetics Research Network and was the lead author on the CPIC guideline for CYP2D6 and CYP2C19 genotypes and dosing of tricyclic antidepressants.
Kevin brings both clinical expertise and a passion for pharmacogenetics to Cleveland Clinic.
“Cleveland Clinic is world-renowned for innovative health care. The implementation of clinical pharmacogenomics will greatly complement Cleveland Clinic’s pioneering efforts while providing the best personalized healthcare possible to our patients.”
Pharmacogenetics is the study of how genetic variations influence drug response. For certain medications, pharmacogenetic test results can help identify those at a higher risk of adverse drug events or those at a higher risk of non-response to a drug.
Pharmacogenetics and the Personalized Medication Program align with value-based healthcare in that their use can help improve treatment outcomes while decreasing costs associated with adverse drug events, as well as avoiding test duplication. Over 100 FDA-approved drugs contain pharmacogenomic information in their drug insert labeling. Kevin will work with the Center for Personalized Healthcare to develop and expand the Personalized Medication Program.
What’s New in the News?
In this segment of the Center for Personalized Healthcare E-newsletter, we highlight a recent journal article or news story that focuses on personalized healthcare topics. This quarter’s article is from Alzheimer’s researchers from around the world and discusses results from a meta-analysis that identified 11 new susceptibility loci for Alzheimer’s disease. These newly associated loci are related to late-onset Alzheimer’s disease, and this discovery has doubled the number of identified genes associated with Alzheimer’s disease. This discovery may pave the road for more research to be conducted on memory disorders, and could potentially lead to ways in which these disorders may be more accurately treated or even prevented.
In more personalized healthcare news, the U.S. Food and Drug Administration recently issued a warning to 23andMe, Inc. to cease marketing of their personal genome testing services. The letter outlines that the testing service, which is considered a device, has been marketed without marketing clearance or approval in violation of the Federal Food, Drug, and Cosmetic Act. On December 5th, 23andMe followed up with an announcement that they will fully comply with the FDA. This means that future customers will continue to receive ancestry data and raw genetic data but they will not be provided any sort of interpretation. The company will continue with their research and education efforts.