Leading the Biomedical Revolution in Precision Health: How Stanford Medicine is Developing the Next Generation of Health Care Annual Stanford Medicine Population Health Sciences Colloquium October 26, 2015 Lloyd B. Minor, M.D. Carl and Elizabeth Naumann Dean, Stanford University School of Medicine

2 A bold vision for 2025 Health care todayPrecision Health tomorrow after-the-fact  predictive and preventive one-size-fits-all  personalized fragmented  patient-centered uninvolved  participatory low value  preeminent

3 The P’s of Precision Health predictive and preventive targets interventions and stops disease before it starts personalized tailors care to individual variations (i.e., Precision Medicine) patient-centered coordinates care and empowers patients and families participatory involves individuals in their own health care preeminent delivers the best health outcomes at the lowest cost

4 Predictive and Preventive Targets interventions and stops disease before it starts todaytomorrow Lipid profileImmune profile

5 Personalized Tailors care to individual variations (i.e., Precision Medicine) todaytomorrow Percentage of patients whose tumors were driven by certain genetic mutations Some targeted treatments for cancerTargeted treatments for other diseases

6 Patient-centered Coordinates care and empowers patients and families todaytomorrow

7 Participatory Involves individuals in their own health care By 2020, eighty percent of the adult population will own a smartphone Economist, February 28, 2015 todaytomorrow

8 Preeminent Delivers the best health outcomes at the lowest cost Cost Outcomes Value todaytomorrow trial-and-error dosing adverse drug reactions late diagnoses reactive treatment unnecessary hospitalizations

9 Now is a time of unprecedented possibilities for human health, a time when new knowledge and technologies are accelerating the pace of biomedical discovery. A biomedical revolution is underway. Why now?

10 Why Stanford Medicine? A place driving change. San Francisco Bay Area

11 The Precision Health difference

12 How will Stanford Medicine lead? Innovative investments and creative collaborations Fundamental Research & Biomedical Data Science Transformative Biomedical Platforms Preeminent Clinical Care

13 Cardiac Care Cancer Care Maternal, Fetal, Newborn Health Transplantation Brain & Behavior Fundamental Research & Biomedical Data Science Health Care Value Science Human Immunology Genomics/ Omics Population Health Sciences Stem Cell/ Regenerative Medicine Neurosciences ChEM-H Cancer Biology Cancer Care Cardiac Care Diagnostics/ Imaging Predictive, Preventive, and Longitudinal Care Brain & Behavior Musculoskeletal/ Orthopaedics Stanford Health Care Lucile Packard Children’s Hospital Stanford

14 The driver: Big data Biostatistics (quantitative models) Biomedical Informatics (qualitative models) New Stanford Department of Biomedical Data Science Genomics Epigenomics Metabolomics EMR history Lab tests Imaging Social factors Environment Lifestyle choices

15 Building a learning health system Data influences practice and practice influences data

16 My discovery Superior Canal Dehiscence

17 Vital role for population health sciences Lifestyle Choices Infectious Agents Medical Care Genetics Environment Social Factors

18 Partnering with Google

19 Health technology

20 Sharing health data We need to incentivize individuals to share their data and create a new culture of engagement. Survey on participation in Large-Scale Research Cohort Science, 10 July 2015: Vol. 349 no pp

21 There’s a role for all of us Together we at Stanford Medicine have an opportunity to develop the next generation of health care.

Leading the Biomedical Revolution in Precision Health: How Stanford Medicine is Developing the Next Generation of Health Care