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Center for Personalized Healthcare Fall 2013

Celebrating our Heroes

Jeff Chalmers, PharmD, RPh

Dave Stowe, RPh

The Personalized Healthcare Hero award is given quarterly to a Cleveland Clinic employee or employees who demonstrate a commitment to the personalized healthcare initiative, embraces personalized healthcare approaches in their daily activities, and advocates for integration of personalized healthcare into the standard practice of medicine. In addition, this individual or individuals contribute to advances in personalized healthcare and support the specific initiatives and projects sponsored by the Center for Personalized Healthcare (CPH). Recipients of this award will be announced quarterly in our E-newsletter and recognized formally once yearly.

This quarter we have two recipients: Jeff Chalmers, PharmD, RPh and Dave Stowe, RPh from Pharmacy Informatics. Jeff Chalmers is a Pharmacy Informatics Specialist and oversees the pharmacy informatics team which has been instrumental in developing the Personalized Medication Program (PMP), a program to incorporate select genetic tests into the prescribing workflow and to avoid duplication of genetic testing. Dave Stowe is also a Pharmacy Informatics Specialist and has been the key driver in programmatically implementing the PMP. Both have dedicated invaluable effort to PMP planning, implementation, and support. They continue to help the CPH monitor and make improvements to the program. They have contributed significantly with creative ideas and solutions and high quality, time-sensitive work.

Our team has enjoyed working with Jeff and Dave. We appreciate their expertise and experience in informatics and their commitment to improving quality and efficiency in healthcare delivery through IT solutions.

We applaud Jeff and Dave for their work. We thank them for their partnership, and we look forward to continuing our collaboration as we strive to improve our current PMP implementation as well as prepare for future personalized healthcare initiatives.

The Link between Personalized Healthcare and Value-Based Healthcare

In healthcare, it seems like the newest buzz word is “value.”  It is widely known in the U.S. that we pay more for healthcare than most developed countries, yet we suffer from some of the poorest health outcomes.  Dr. Kathryn Teng, Director of the Center for Personalized Healthcare and Staff Physician in Internal Medicine, and Dr. David Longworth, Chair of the Medicine Institute, recently published a manuscript in Personalized Medicine titled “Personalized healthcare in the era of value-based healthcare.”  The paper outlined the current climate of healthcare in the U.S. and offered insight as to how personalized healthcare approaches can improve value.

So what is value?  Value is the ratio of quality to cost.  Therefore, increasing quality and reducing cost improves value.  The Medicine Institute, under the direction of Dr. Longworth, is a national leader in value-based healthcare.  They are changing the way healthcare is delivered with the introduction of care paths and the patient-centered medical home (PCMH).  Both of these approaches put the patient at the center of their healthcare and positions their primary care physician as their healthcare manager.  A comprehensive healthcare team is assembled, which can include specialists as well as a nurse care coordinator.  These approaches have been shown to improve value.

How does personalized healthcare fit into improving value?  Personalized healthcare approaches help to tailor healthcare to individual patients, based on their biology (genetics, molecular information, family history) and other factors (environment, preferences, behaviors).  Personalized healthcare can improve value by assisting with disease risk prediction.  Identifying those people who may be at risk for certain diseases can lead to early identification or, even better, prevention.  This leads to better outcomes and decreased cost; in other words, improved value.  Another way personalized healthcare can improve value is through pharmacogenetics.  Pharmacogenetics can be used to tailor certain drug therapies to optimize efficacy and/or to avoid adverse drug events.  Pharmacogenetics helps to provide the right medication to the right patient, thus leading to increased value. 

Personalized healthcare, value-based healthcare, and patient-centered medical homes are all working together to put Patients First.

Formal Recognition for our Heroes

The Personalized Healthcare Hero award was started in the summer of 2012 and is given quarterly to a Cleveland Clinic employee who demonstrates commitment to the personalized healthcare initiative, embraces personalized healthcare approaches in their daily activities, and advocates for integration of personalized healthcare into the standard practice of medicine. In addition, these individuals have contributed to advances in personalized healthcare and supported the specific initiatives and projects sponsored by the Center for Personalized Healthcare.

Our first reward recipient was Tom Daly, MD, of the Pathology and Laboratory Medicine Institute, who has contributed greatly to the field of pharmacogenetics and assay development. Other heroes include Carol Burke, MD, Daniel Sullivan, MD, and Tara Mastracci, MD, who have all contributed to the MyFamily tool which incorporates family history collection and clinical decision support. Gina Petredis and Ryan Miday from Government Relations were integral in getting November declared as Personal Healthcare Month in the State of Ohio. This quarter’s heroes are Jeff Chalmers, PharmD, RPh and Dave Stowe, RPh from Pharmacy Informatics who have been instrumental in developing the Personalized Medication Program, which incorporates pharmacogenetics into the standard of practice at Cleveland Clinic. All of our heroes are essential to the success of integrating personalized healthcare into the clinical practice here at Cleveland Clinic, as well as promoting personalized healthcare messages. These individuals go above and beyond their typical duties due to their passion and dedication for personalized healthcare.

We will be featuring our heroes in a skyway presentation during Personal Healthcare Month this November. Please visit the Information Skyway (connecting the A building to the F building) the first two weeks of November to see our heroes and learn a little more about personalized healthcare.

The nominees are selected by Dr. Kathryn Teng and the entire Center for Personalized Healthcare team. If you would like to nominate an individual for this award, please contact cphinfo@ccf.org.

Genetics Education Symposium: Discovering a Roadmap for Clinical Practice

As the field of genomics plays a growing role in clinical practice, healthcare providers must be ready to apply these concepts into every day practice.  “The need for educational programs addressing the tools and resources available is crucial to the successful implementation of genomics-enabled personalized healthcare, according to Charis Eng, MD, PhD, founding Chair of Cleveland Clinic’s Genomic Medicine Institute and Director of its clinical arm, the Center for Personalized Genetic Healthcare (CPGH.)"

The Genomic Medicine Institute is proud to announce a Genetics and Genomics Education Symposium taking place on September 5, 2013. This education event, “Genetics and Genomics: Roadmap for Clinical Practice,” aims to empower healthcare providers and their patients with the knowledge about genetics in practice.  This forum will address topics surrounding the delivery of evidence-based genetic and genomic medicine, including: 

• Implications of genetic and genomic information on patient care
• Emerging genomic technologies
• Utility of patient-care models influenced by genetic and genomic information
• Successful clinical partnerships across multiple specialties

We hope you will consider joining us for what promises to be an informative event! To register, visit www.ccfcme.org/genetics

Ethical Dilemmas: Dr. Kathryn Teng Weighs In

Dr. Kathryn Teng participated in a panel addressing ethical dilemmas as part of the 2013 Cleveland Clinic Bioethics Research Day. Moderated by Ruth Farrell, MD, MA, of the Department of Bioethics and the Department of Obstetrics and Gynecology, Dr. Teng was joined by three other Cleveland Clinic physicians: Cynthia Kubu, PhD, Deep Brain Stimulation Program, Elliot Philipson MD, MBA, Maternal-Fetal Medicine/Obstetrics and Gynecology and Terence Gutgsell, MD, Solid Tumor Oncology/Harry R. Horvitz Center for Palliative Medicine.

When asked about how the Affordable Care Act and HCAP/patient satisfaction scores in healthcare delivery may present new ethical issues, Dr. Teng cited pain management as a particular challenge: “Pain poses a dilemma for us in primary care. It is considered the fifth vital sign, and there is great pressure to treat it. However, pain is subjective, and we are under close scrutiny for the number of prescriptions we write. It is now our responsibility to go to the Ohio Automated Rx Reporting System to check on whether patients are getting prescriptions from multiple doctors at multiple pharmacies. While we really don’t want to give narcotics, our access to resources such as pain specialists may be limited. This poses a dilemma for many physicians.”

When the topic of Bioethics and innovation in healthcare was brought up, Dr. Teng had some specific thoughts with regards to moving personalized healthcare to the forefront of primary care:

“Personalized healthcare asks how we can integrate patients’ individual biology, preferences and environment to provide individualized, customized care. Although we are moving forward with more standardization, we know that the one-size-fits-all approach is really not working in terms of quality metrics and healthcare costs.”

“How can we do two things better? Identify the populations that require different tracks of evidence-based care, and use this information to activate and engage our patients toward better health? We know that we can’t do it alone — we need our patients to participate in this journey with us.”

What's New in the News?

In this new segment of the Center for Personalized Healthcare E-newsletter, we will highlight a recent journal article or news story that focuses on personalized healthcare topics. This quarter’s article is from Stanford University and discusses results from a study that showed the use personal genomic testing (direct-to-consumer) among medical students enhanced the students’ learning with regards to genomics and personalized healthcare. If you are Cleveland Clinic Staff, and would like to utilize personal genomic testing to learn more about genomics, please register for our conference, “A Personal Journey through Genomics” by emailing cphinfo@ccf.org with “genomics” in the subject line.