PPM+ and the Leeds Care Record The support and delivery of Personalised Medicine Dr Geoff Hall Senior Lecturer in Medical Oncology Chief Clinical Information Officer – LTHT geoff.hall2@nhs.net

PPM+ - 2001 to 2013 PPM v1 – the Yorkshire Cancer Record

PPM+ and the Leeds Care Record towards an integrated digital care record

PPM+ Patient lists – ward, team views 2013 to 2016 – PPM+ LTHT / commercial collaboration Trust-wide All patients, all locations, all platforms 2.5 million patients 4 million diagnosis events 5,000 clinical users Plain text EPR – e.g. letters Coded database – e.g. diagnosis

PPM+ and the Leeds Care Record linking organisations

PPM+ and the Leeds Care Record linking organisations Clinical Documents

PPM+ and the patient portal How can we extend access to the patient ? Passive viewer of healthcare data Active contributor to healthcare data Custodian and controller of access

PPM+ and the patient portal Redesigning the presentation of data

PPM+ and the patient portal Collaborate with commercial organisations and charities

Personalised medicine within oncology Has cytotoxic chemotherapy peaked ? ICON 5, international collaboration, 4312 patients, 5 chemtherapy regimens in ovarian cancer

Personalised medicine within oncology Cytotoxic chemotherapy Study 19, Randomised Phase II of PARP inhibition Maintenance therapy after platinum chemotherapy

Personalised medicine within oncology Caris Life Sciences Advanced molecular profiling IHC, FISH, NGS, PCR, Pyro sequencing NHS Regional Innovation Fund Recurrent ovarian cancer Caris profile on diagnostic specimen Assess impact on clinician decision Frequency of ‘druggable’ target Supported by `routine’ data from PPM+

Personalised medicine within oncology Caris Life Sciences 58 year old, stage 3c, high-grade serous ovarian cancer Germline testing, NHS

Personalised medicine within oncology Caris Life Sciences 58 year old, stage 3c, high-grade serous ovarian cancer Caris Profile, Trial Germline testing, NHS

Personalised medicine at home Philips Healthcare Chemotherapy is toxic, potentially life-threatening Nausea and vomiting, alopecia, diarrhoea, mucositis Myelosuppression and neutropenic sepsis Medical emergency Clinical review and blood count Admission for IV antibiotics Prior to next cycle Toxicity (neutropenia must resolve) Blood counts before treatment Patient card

Personalised medicine at home Philips Healthcare SBRI Phase I - Neutropenic sepsis Incidence and health economics KTP collaboration – University and Philips Predictive model for neutropenic sepsis

Personalised medicine at home Philips Healthcare SBRI Phase I - Neutropenic sepsis Incidence and health economics KTP collaboration – University and Philips Predictive model for neutropenic sepsis SBRI Phase 2 - Home monitoring of chemotherapy patients Patient reported symptoms, signs Hb, white count with differential TSB SBRI funded trial (Leeds) Health economic analysis (Oxford)

Personalised medicine at home Philips Healthcare SBRI Phase 2 - Home monitoring of chemotherapy patients Trial I – Proof of concept T0, T1 (+24h), T2 (+20 days) Can patient home test without support ? Does data flow - Patient-Philips-Docobo-Leeds Trial 2 – Daily monitoring High risk patients Daily monitoring ↓unnecessary admissions ↓ unnecessary attendance Define predictor of severe neutropenia

Personalised medicine at home Philips Healthcare Future plans - Home monitoring of chemotherapy patients If patient has profile consistent with risk of severe neutropenia gCSF, antibiotics ? Stop routine use of gCSF in high risk patients ? If patient pyrexial but well with marginal counts Home management without admission ? If patient profoundly neutropenic and pyrexial Antibiotics at home by paramedics ?

Personalised medicine New models of care underpinned by “next generation informatics” “high quality integrated care requires an integrated digital care record”

Thankyou Dr Geoff Hall Senior Lecturer in Medical Oncology Chief Clinical Information Officer – LTHT geoff.hall2@nhs.net