1. 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

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

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

4. 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

5. PPM+ and the Leeds Care Record linking organisations

6. PPM+ and the Leeds Care Record linking organisations
Clinical Documents

7. 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

8. PPM+ and the patient portal Redesigning the presentation of data

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

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

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

12. 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+

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

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

15. 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

16. 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

17. 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)

18. 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

19. 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 ?

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

21. Thankyou
Dr Geoff Hall
Senior Lecturer in Medical Oncology Chief Clinical Information Officer – LTHT