Building an innovative model for personalized healthcare

Health Informatics on FHIR: How HL7's New API is Transforming Healthcare, 2018

The US Healthcare System 2.1 Introduction This chapter briefly describes the US healthcare system and some of the most important of its many problems. This is a complex topic that I cannot adequately cover in a short, introductory book, so I have provided a number of suggested supplemental readings. For a very complete and detailed discussion of the topics raised here (and others) I suggest the Institute of Medicine 1 publication The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary which is available for purchase or free download. 2 Some readers may wonder why I devote an entire chapter to a topic filled with structural, policy, economic and even political issues in what is, after all, a health informatics book. Based on my prior experience, I know that many readers may have little background in the US healthcare delivery system. My distinguished former Georgia Tech industrial engineering colleague, Dr. William Rouse, describes US healthcare as a complex adaptive system. Paraphrasing him, such a system is (a) nonlinear and dynamic and does not inherently reach fixed-equilibrium point so it may appear to be random or chaotic and (b) composed of independent agents whose behavior is based on physical, psychological, or social rules rather than the demands of system dynamics. Because agents' needs or desires are not homogeneous, their goals and behaviors are likely to conflict. In response to these conflicts, agents tend to adapt to each other's behaviors. Agents are also intelligent so, as they experiment and gain experience, agents learn and change their behaviors accordingly. Thus overall system behavior inherently changes over time and may range from valuable innovations to unfortunate accidents. An article in the January 11, 2006 NY Times provides a clear

Health Care System , 2025

The U.S. healthcare system, as of February 2025, embodies a paradox of exceptional strengths and persistent challenges, presenting a critical juncture for reform. This study examines its technological innovation ($50 billion R&D, NIH 2023) and patient choice (85% insured satisfaction, KFF 2024) against high costs ($12,555/capita, CMS 2023), 28 million uninsured (Census 2023), health disparities (Black maternal mortality 55 vs. 19, CDC 2023), and COVID-19’s 1.1 million deaths (CDC 2023). Proposing reforms—cost control ($500 billion savings, CBO 2024), universal coverage, telemedicine, and equity-focused innovation—it assesses feasibility in Trump’s second term (70% drug pricing support, Pew 2024). Targeting a 15% GDP system by 2035 (Urban Institute, 2024), it urges stakeholders to transform potential into equitable performance.

Journal of Clinical Research & Bioethics, 2012

Personalized medicine consists of targeted genetic testing leading to diagnostic, preventive and treatment outcomes. In its consideration of genetic predisposition, personalized medicine may not completely account for social determinants of health in its implementation. Effectively coordinating certain provisions of the 2010 Patient Protection and Affordable Care Act would mitigate this gap in personalized medicine. Personalized medicine would affect health disparities as well as provide information on genetic illness through the recommendations outlined here.

The concept of personalized medicine not only promises to enhance the life of patients and increase the quality of clinical practice and targeted care pathways, but also to lower overall healthcare costs through early-detection, prevention, accurate risk assessments and efficiencies in care delivery. Current inefficiencies are widely regarded as substantial enough to have a significant impact on the economies of major nations like the US and China, and, therefore the world economy. A recent OECD report estimates healthcare expenditure for some of the developed western and eastern nations to be anywhere from 10% to 18%, and growing (with the US at the highest). Personalized medicine aims to use state-of-the-art genomic technologies, rich medical record data, tissue and blood banks and clinical knowledge that will allow clinicians and payors to tailor treatments to individuals, thereby greatly reducing the costs of ineffective therapies incurred through the current trial and error clinical paradigm. Pivotal to the field are drugs that have been designed to target a specific molecular pathway that has gone wrong and results in a diseased condition and the diagnostic tests that allow clinicians to separate responders from non-responders. However, the truly personalized approach in medicine faces two major problems: complex biology and complex economics; the pathways involved in diseases are quite often not well understood, and most targeted drugs are very expensive. As a result of all current efforts to translate the concepts of personalized healthcare into the clinic, personalized medicine becomes participatory and this implies patient decisions about their own health. Such a new paradigm requires powerful tools to handle significant amounts of personal information with the approach to be known as “P4 medicine”, that is predictive, preventive, personalized and participatory. P4 medicine promises to increase the quality of clinical care and treatments and will ultimately save costs. The greatest challenges are economic, not scientific. Keywords: Clinical practice, Companion & molecular diagnostics, Healthcare, Incentives, Personalized medicine, Translational genomics.

JAMA, 2008

2009

Context: Systems science provides organizational principles supported by biologic findings that can be applied to any organization; any incongruence indicates an incomplete or an already failing system. U.S. health care is commonly referred to as a system that consumes an ever- increasing percentage of the gross domestic product and delivers seemingly diminishing value. Objective: To perform a comparative study of U.S. health care with the principles of systems science and, if feasible, propose solutions. Design: General systems theory provides the theoretical foundation for this observational research. Main Outcome Measures: A degree of compliance of U.S. health care with systems principles and its space-time functional location within the dynamic systems model. Results of comparative analysis: U.S. health care is an incomplete system further threatened by the fact that it functions in the zone of chaos within the dynamic systems model. Conclusion: Complying with systems science pr...

BMC Medicine, 2013

Considerable variety in how patients respond to treatments, driven by differences in their geno-and/ or phenotypes, calls for a more tailored approach. This is already happening, and will accelerate with developments in personalized medicine. However, its promise has not always translated into improvements in patient care due to the complexities involved. There are also concerns that advice for tests has been reversed, current tests can be costly, there is fragmentation of funding of care, and companies may seek high prices for new targeted drugs. There is a need to integrate current knowledge from a payer's perspective to provide future guidance. Multiple findings including general considerations; influence of pharmacogenomics on response and toxicity of drug therapies; value of biomarker tests; limitations and costs of tests; and potentially high acquisition costs of new targeted therapies help to give guidance on potential ways forward for all stakeholder groups. Overall, personalized medicine has the potential to revolutionize care. However, current challenges and concerns need to be addressed to enhance its uptake and funding to benefit patients.

2010

Cost. Access. Quality. These are three objectives that must drive a responsible discussion regarding reform of the delivery of health care in this country, and specifically, decreasing (or at least controlling) cost while increasing access and quality. A fool's errand? Maybe. A zero-sum game, with any reduction in cost leading to a concomitant decrease in access and quality? Not necessarily. Why is reform needed? Quite simply, because the health care system of the United States is falling short in the areas of cost,' access 2 and, by certain measures, even quality.' This year the Law Review of Mississippi College School of Law dedicated its annual symposium to bringing together scholars to discuss these and other difficult issues surrounding health care reform. As the articles and essays in this symposium issue demonstrate, it succeeded. The symposium was held on Friday, February 26, 2010, just one day after President Obama's "failed" 4 summit on February 25, and less than a month prior to the President signing the historic Patient Protection and Affordable Care Act (PPACA) on March 23. There is timely, and then there is timely!

Global Social Welfare, 2016

Shaped by the institutions, ideas, and interests that drive American policymaking, the US health care delivery system is uniquely complex, costly, and unequal. Initially private, it has become an increasingly complex public/private mix, as incremental reforms adopted over many decades have sought to correct market failures to finance and deliver health care services to vulnerable populations, particularly segments of the low-income demographic. While successive reforms have led to better coverage and access over time, they are unlikely to lead to universal access due to their inability to reduce, or even contain, costs over the long run.