The final day of the inaugural Partners HealthCare World Medical Innovation Forum was a fittingly profound end to a thought-provoking meeting that featured leaders from business, research, and clinical practice discussing the most important and relevant topics of the day related to healthcare and brain disease.
Reshaping Innovation Through Electronic Health
The day began with a conversation on the history and current implementation of electronic health records between Partners’ Chief Clinical Officer, Gregg Meyer, MD and Judy Faulkner, the founder and CEO of leading electronic medical records company, EPIC Systems. Faulkner shared the story behind and the philosophy with which grew the company 100% organically (without mergers or acquisitions) from a 2-employee shop in a basement in Madison, Wisconsin, to a healthcare software powerhouse with approximately $2 billion in annual revenues and over 6,000 employees. She explained that EPIC Systems designed the software from the very beginning with the patients and their records as the central focus and organizing principle.
EPIC systems supports all functions related to patient care, including registration, scheduling; clinical systems for doctors, nurses, lab technologists, pharmacists, radiologist and billing systems for insurers. With the comprehensive implementation of EPIC at Partners currently underway, Faulkner offered some suggestions about the implementation based on the experience of EPIC’s other major clients. She suggested that providers and administrators should take advantage of EPIC’s customization options, training offerings, user groups, and especially “MyChart,” the patient engagement platform, which is unusual among its peers because it has 10 times the number of patient users as it does provider users—illustrating that the patients are very engaged. Patients see it has a form of freedom, being able to fill out their own information in some cases, providing better care through self service. The applications vary from engagement through scheduling and payment, to video doctors’ “visits.”
Gene Editing, Gene Therapy, and the Eye as a Gateway
During this panel discussion, leaders from industry and research discussed the progress and promises of developing effective gene therapies. Eric Pierce, MD, PhD, of Mass. Eye and Ear and Harvard Medical School, stated his sense that the community is truly “on the threshold of using all these technologies.” The panelists recalled some of the challenges and failures of the past 20 years, but highlighted some extraordinary advances, compelling drug candidates, and continued confidence in gene therapies becoming a more and more integral therapy for providers for both rare and eventually more common diseases (including HIV, sickle cell anemia, and thalassemia). Another panelist noted the great success of the CRISPR gene-editing platform, stating that scientists were overheard making statements rarely heard in genomics, such as “I tried it and it worked”. CRISPR is empowering scientists to make quick and inexpensive edits to stretch of DNA with a level of ease and efficiency not previously possible.
MS Transformed: Harnessing Biology and Inflammation
“MS Transformed: Harnessing Biology and Inflammation” brought together an expert panel across disciplines: Tim Coetzee, PhD, Chief Advocacy, Services, and Research Officer at the National Multiple Sclerosis Society, Alfred Sandrock, MD, PhD, Group Senior Vice President and Chief Medical Officer at Biogen, Howard Weiner, MD, Founder and Director of the Partners Multiple Sclerosis Center, and Michael Panzara, MD, Group Vice President and Therapeutic Area Head of Multiple Sclerosis and Neurology at Genzyme.
The panelists began the conversation by providing context into the multiple sclerosis (MS) landscape since the condition’s initial description 150 years ago. At the beginning of Weiner’s career in the 1970s, there was very little understanding of MS and no treatments or MRI scans available for diagnosis, treatment, and assessment of the disease. Today, MS is thought to be a success story within neurologic disease discovery as there are 12 FDA approved drugs on the market. The rapid rate of drug discovery and available MS therapies is largely due to a greater understanding of the mechanisms behind MS, the identification of testable targets, and measurable outcomes thanks to advances in biomarkers and MRI imaging.
These 12 drugs currently on the market are utilized as treatments of the relapsing-remitting type of MS and there are no known therapies specifically for secondary-progressive MS. This leaves behind a large population of MS patients in terms of therapeutic development and makes the current treatment choices far from perfect. Clinically, MS patients often go through a trial and error process to see which medications work best for them. Some patients can switch therapies for years before finding the right fit for them while brain damage continues to occur.
The emphasis on increased treatment options for individuals with MS leads into the question of what a cure will inevitably look like. Dr. Weiner mentions his three prong approach to a “cure”, which consists of: 1) rebuilding a damaged nervous system, possibly via stem cells and myelin repair, 2) controlling attacks through individualized therapies to stabilize the condition, and 3) eradicating MS through a preventative vaccine. Under this notion, the pioneering drug discovery process of the last two decades has led many MS patients to a “cure” as their disease remains stable without attacks.
Looking ahead, the panel enthusiastically agreed about the possibilities precision or individualized medicine will have for patients with MS and their physicians. The ability to prescribe the right drug to the right patient at the right time in the disease course will treat MS with greater efficacy and lead to an increased quality of life beyond the current trial and error system. Individualized therapies will undoubtedly involve continuous follow-up with patients that monitoring devices and big data will likely play a role in. It is not uncommon for current patients with MS to schedule clinical visits every 6 to 12 months, and a great deal can change in their symptoms and care during that time. Sandrock, MD describes a future that will utilize technology similar to a Google Watch for patients to measure their daily symptoms and regimens and scan for lesions and brain shrinkage without full-blown MRI imaging — all while contributing to pivotal clinical trials. Lastly, the panel mentioned an emphasis on drug discovery to help prevent and treat the secondary-progressive disease course. Upcoming therapies may also rely on the microbiome or human gut for answers addressing the role of the immune system in MS.
As Panzara concluded, the questions that we will ask and developments we will make in MS research and care over the next 5 years are unpredictable and will surprise us.
The Century of the Molecule Becomes the Century of the System
Brigham and Women’s Hospital surgeon, bestselling author, and healthcare thought leader Atul Gawande, MD gave a moving and thought-provoking talk on healthcare quality and healthcare costs from the 19th century until today. He discussed the great reduction in inpatient mortality at MGH from the 1950s to the 1990s. Then, Gawande noted that the relative lack of improvement from approximately 1990 coincided with a dramatic increase in the cost per patient. He used this trend to frame a conversation about increasing cost and complexity without improvements in quality. He subsequently discussed the extraordinary reductions in patient mortality in surgery that had been achieved around the world at very little cost with the introduction of a coordinated systems approach and simple checklists used before and after surgery.
Using personal anecdotes and experiences, he discussed his more recent work around death and dying. He explained that since the 1980s, the trend has been that most Americans are dying in institutions and often while undergoing dramatic interventions. He explained that this flies in the face of many people’s preference — when asked – -to die at home and/or without such dramatic and often painful curative or “life-saving” measures. He closed by discussing the systems, planning, and checklist efforts he was helping to develop and implement to improve the experience of death for people and their families — often simply by making sure that providers, patients, and family members simply take time to discuss the patients’ preferences and priorities around death and dying.
The Builder’s Roundtable: Perspectives of Public/Private Payer Architects
In this session, Partners SVP Tim Ferris, MD moderated a lively and insightful discussion about healthcare costs, payers, and economics with Aetna CEO Mark Bertolini and Affordable Care Act architect Peter Orszag, PhD, who is a Citigroup senior executive and former Director of the United States Office of Management and Budget (OMB) and Director of the United States Congressional Budget Office (CBO).
During this conversation, Bertolini shared his own dramatic personal and family healthcare history, as well as his perspective that healthcare in the United States was on a “burning platform” and that the Affordable Care Act created the impetus for conversations that needed to happen. Both agreed that the fee-for-service models are unsustainable and do not incentivize quality or cost control. They also agreed that the Affordable Care Act and related reforms were helping to move the country toward a new model that would be predicated on outcomes and include some mechanism to align incentives to encourage providers, consumers, and other market actors to contain escalating healthcare costs.
While emphasizing that extraordinary challenges remained, both shared some concrete reasons for hope. Bertolini shared that a targeted pilot program that Aetna had run to prevent hospitalizations among heart failure patients had reduced hospital visits by approximately 49%. Orszag shared his perspective that the recently announced 2.8% unadjusted Medicare cost increase was a positive sign that it is indeed possible to control healthcare costs and also that the Affordable Care Act may be having its intended effect.