Leroy Hood‘s fledgling institute for personalized medicine struck its first big partnership with an academic medical center two years ago. Now it’s branching out to include some Northwest hospitals that are philosophically a lot closer to the community than to the academy.
The P4 Medicine institute, a nonprofit inside the Seattle-based Institute for Systems Biology, is announcing today it has formed an alliance with PeaceHealth, a nonprofit Catholic health system with 17,000 employees at community medical locations around Washington, Oregon & Alaska. PeaceHealth is the first community health system to enter the P4 medicine network, after Ohio State University became the first academic medical center to join two years ago.
By working with the Institute for Systems Biology and Ohio State, PeaceHealth is seeking to put itself on the edge of Hood’s “P4” vision, shorthand for predictive, preventive, personalized and participatory medicine. This is about using the new tools of molecular biology and software to analyze genes and proteins not just for understanding basic cell processes, but also to help monitor patients and guide their wellness before symptoms of disease pop up. By running some pilot projects with both academic and community hospitals, Hood’s institute hopes to establish a road map that other institutions might be able to follow.
“Health and wellness, prevention, is a part of our mission and always has been,” says Peter Adler, PeaceHealth’s senior vice president for strategy, innovation and development. He notes that PeaceHealth isn’t a primary research center—its job is to deliver care to patients—but it sees itself as an early adopter that can put good research ideas into practice.
“We think PeaceHealth can be the downstream leg, once there’s an innovation that’s proven clinically effective, we then become the operational site, the mainstreaming side of the partnership,” Adler says. “We can feed the information we get back into ISB and Ohio State. And we will share our successes with the healthcare community at large. We have the ability to spread innovation rapidly across our clinics—we think we can be a platform.”
PeaceHealth also has an advantage with deep roots in the communities it serves. With more than 100 years of history, it has longstanding relationships built up with families, often treating several generations of family members in small communities. Those relationships could be important to scientists who are looking to study families as they narrow down their searches for abnormal genes and proteins.
Hood says he’s been looking for a community health partner for a long time to join the P4 Medicine institute, because he doesn’t want the vision to be limited to a bunch of rarefied academic centers.
“I’m an incredible democrat,” Hood says. “By that I mean healthcare should be for all patients. I think too often, a lot of the focus in medicine is on the big clinical centers, where practice is very different than it is in the community. We wanted to create an environment where this P4 medicine can experience a wide range of opportunities, in urban and rural environments.”
PeaceHealth provides access to a lot of patients and doctors, offering scientists at the Institute for Systems Biology with a lot of potential biological samples to analyze. The PeaceHealth network performs 44,000 surgeries a year, administered more than $139 million worth of charity care last year, and performed more than 4.8 million lab tests. There a lot of different ways in which people in the PeaceHealth network could contribute DNA for, say, genome sequencing or blood for protein analysis.
A lot of the details still need to be worked out on the initial pilot projects. Just as examples, Adler suggested it might be possible to look at a patient’s genotype to see what kind of drugs or vitamin supplements might work best for them. Another idea might be to see which people are predisposed to, say, colon cancer, and then use that information to steer them toward colonoscopies at younger ages.
Handling the personal data is one of the inherent rubs of all collaborations of this kind, since there are plenty of unpleasant things people might learn about their health through hard-core genomic and proteomic screening. PeaceHealth, Adler says, “will never ever go outside the lines of patient confidentiality and HIPAA protections that are mandated by law. We’d never engage in any activity that would violate patient full knowledge, participation, and choice.”
Still, the scientists really want to be able to dig deep into the data and find things they weren’t specifically looking for from the beginning of a research project. That means not just doctors and scientists, but ethicists and sociologists need to craft systems to make people comfortable with being participatory—the last piece of Hood’s “P4” puzzle. Key to making that happen, Hood says, is making sure the data doesn’t contain identifying information. He adds that people should also be allowed to choose how much data they want to receive.
“We have to make sure these data are available for mining in the future,” Hood says. “If you say, ‘Look, if we mine this data for the future, it’s going to change the health of your kids and grandkids,’ that’s a pretty strong point for a lot of people, and they’d be willing to think about it.”
Mauricio Flores, a lawyer who joined the P4 Medicine institute as executive director in December, says work needs to be done on developing procedures that provide more back-and-forth communication between patients and researchers, beyond the typical informed consent form that people sign at the beginning of a study. “We need to go beyond the IRB model,” he says, referring to institutional review boards charged with protecting patients.
The collaboration was sparked by an introduction from Tom Cable, the longtime venture capitalist who serves on the board of the Institute for Systems Biology. Cable got to know PeaceHealth through an initiative to build a new medical center for the San Juan Islands. Hood says Cable urged him to consider PeaceHealth as a community partner, and encouraged PeaceHealth officials to attend one of Hood’s public talks at Town Hall in Seattle.
While the initial meetings led to today’s collaboration, the implementation of P4 Medicine can’t move fast enough for Hood. The P4 Medicine institute needs an information technology partner, and Hood says he doesn’t think the current offerings on the market today are up to this kind of task, capturing and analyzing billions of data points on genes and proteins. And when we spoke two years ago about the Ohio State collaboration, he said he hoped the first pilot project would get underway in six to nine months, which didn’t happen. He didn’t offer a timeline this time for getting PeaceHealth’s pilot projects up and running.
Still, Hood says he’s as enthusiastic as ever about the vision and growing acceptance of it. He says he’s hopeful he’ll enlist another partner—an academic center in the South that will represent African-American patients “fantastically well.”
Adler, of PeaceHealth, sounded equally bullish about his organization’s role. “The lens at which we look through the world isn’t just through the lens of a hospital,” Adler says. “Our mission is to focus on the health of individuals and communities. There just haven’t been many tools with scientific evidence to support wellness, for us or anyone else in U.S. healthcare.”
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