2/15/2018 DISCLOSURES Open MS BioScreen: • Research Support An Open-Access MS management tool for patients and providers Riley Bove, MD • Scientific Advisory Boards Assistant Professor • Roche Genentech • Genzyme Sanofi • Novartis GOAL OF PRECISION MEDICINE FOR MS (A DATA PROBLEM): THE PATIENT, CLINICIAN AND NEXT-GEN DATA ON THE SAME PAGE GOALS • Open Access • No commercial interests • Free • Fast (web) • Patient facing • Outside of UCSF Gourraud PA, et al. Precision medicine in chronic disease management: The multiple sclerosis BioScreen. Ann Neurol. 2014 Nov;76(5):633-42. PMID: 25263997 www.openmsbioscreen.org 1
2/15/2018 • Near term: Monitor adoption of the site • Who, where, how often, what for • Longer term: Disease monitoring 2
2/15/2018 prEDSS and EDSS: • Not equivalent • But similar: Correlation of 0.9 between EDSS and pr- EDSS Keeping MS-relevant information in one place (especially with multiple providers) • Replaces hours of chart digging • Satisfaction with doctor-patient relationship • Can focus the clinical encounter on managing the patient 3
2/15/2018 CONTEXTUALIZATION – CONTEXTUALIZATION – A Modern, Virtual Case Load A Modern, Virtual Case Load The EPIC Study at UCSF - Expression, Proteomics, Imaging, Clinical Time to Cane Dependency (EDSS=6) A modern, treated, cohort Followed annually since 2004 Low rates of progression London Lyon British Nova Scotia Ontario France Columbia Cree BAC et al. ANN NEUROL 80:499–510; 2016 4
2/15/2018 TOWARDS PERSON-CENTERED CARE Focus on what is actionable Start medication? Intensify rehabilitation strategies? MORE TAILORED FUNCTIONAL GOALS EDSS vs Daily Step Count x Daily Step Count, Averaged Across Days, for All Patients 17500 15000 12500 10000 x 7500 x x x 5000 2500 x 0 13 19 11 8 17 12 0−1.5 2−3.5 4 4.5−5.5 6 6.5 EDSS (Range: 1070 – 7150) (Range: 2300 – 18,600) Block et al, J Neurology 2016 5
2/15/2018 Visualizations to Explore • Risk vs. Benefit • Early vs. Delay Start • Short term vs. Long Term • Risk Tolerance 1. Upload MRIs to a linked vendor site 2. MRIs are processed 3. Visualize MRIs over time SUMMARY – CLINICAL UTILITY • MS-relevant information in one place • Virtual Caseload as ‘second opinion’ • Towards Patient-Centered Care • Person-centered functional goals • Educational modules to explore risks, benefits, short vs. long term outcomes • Caveats (not all patients and not all doctors will want this) • Next steps: Other Conditions 6
2/15/2018 COMING TO THE CLINIC: UCSF’S WEILL MS BioScreen WHAT ABOUT UCSF CLINIC PATIENTS? EHR Advanced MRI Analytics Disease Severity (e.g. EDSS, SDMT, etc) EXPAND ACCESS BEYOND THE INSTITUTE An Open Access, web-based version for Research patients and external collaborators Research Open MS BioScreen Patient Scan from EHR, Research EHR NATALIZUMAB UCSF processing GLATIRAMER OCRELIZUMAB MS BIOSCREEN Home-based Test – e.g. Daily Steps (Fitbit) Labs and Vaccines iPAD Research Patient EHR Mean Patient ADVANCED RESEARCH DATA IN THE CLINIC A tool that launches and pulls directly from Genetics and other Biomarkers our Epic EMR and research data Research UCSF MS BioScreen MS BioScreen Team 7
Recommend
More recommend
