©2007 RALPH SNYDERMAN Third Annual Prospective Health Care Conference "Where are We Now?" Ralph Snyderman, MD Chancellor Emeritus, Duke University November 1, 2007
©2007 RALPH SNYDERMAN Third Annual Prospective Health Care Conference "Where are We Now?" Ralph Snyderman, MD Chancellor Emeritus, Duke University November.
Dec 17, 2015
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©2007 RALPH SNYDERMAN
Third AnnualProspective Health Care Conference
"Where are We Now?"
Ralph Snyderman, MDChancellor Emeritus, Duke University
November 1, 2007
©2007 RALPH SNYDERMAN
Contemporary Practice of Medicine
• Disease oriented
• Find it, fix it
• Reactive
• Sporadic intervention
• Physician-directed
• Not Standardized
• Not Personalized
©2007 RALPH SNYDERMAN
The Inflection and Opportunities for Intervention
Dis
ease
Bur
den
Time
Cos
t
1/re
vers
ibili
ty
Health Care Cost vs. Disease Progression
Typical Current Intervention
Earliest Clinical
Detection
Earliest Molecular Detection
Initiating EventsBaseline Risk
©2007 RALPH SNYDERMAN
Factors Impacting Medicine Today
• Genomics
• Proteomics
• Metabolomics
• Medical technologies
• Informatics
• Risk Prediction
©2007 RALPH SNYDERMAN
Tools Needed for Prediction and Personalized Care
Dis
ease
Bur
den
Time
Cos
t
1/re
vers
ibili
ty
Typical Current Intervention
Earliest Clinical
Detection
Earliest Molecular Detection
Initiating EventsBaseline Risk
Decision Support Tools:
Baseline Risk Preclinical Progression
Disease Initiation and Progression
Assess Risk Refine Assessment Predict/Diagnose Monitor Progression
Predict Events
Inform Therapeutics
Sources of New Biomarkers:
Stable Genomics: Single Nucleotide Polymorphisms (SNPs) Haplotype Mapping Gene Sequencing
Dynamic Genomics: Gene ExpressionProteomics Metabolomics Molecular Imaging
Therapeutic Decision Support
©2007 RALPH SNYDERMAN
Prospective Health Care
Risk Assessment and Decision Support Tools
Dis
ease
Bur
den
Time
Low Risk High Risk
Early Chronic Cos
t
1/re
vers
ibili
ty
Personal Lifestyle Plan
Disease Management
Risk Modification
Personalized Health Plan
Late Chronic
Participating Population
©2007 RALPH SNYDERMAN
Needs for Prospective Health Care
• Health risk assessment tools
• Therapeutic evaluation tools
• Aligned health care providers
• Aligned reimbursement systems
• Motivated consumers
©2007 RALPH SNYDERMAN
So, Where Are We Now?
• Research
• Clinical Models
• Personalized Medical Records
• Payers
• Advocacy Groups
• Medical Education
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