How Stanford Health Care is bringing precision medicine into preventive primary care

By Heather Mack

Hearing the word “precision” in healthcare typically conjures ideas of cutting edge technologies and treatments like targeted genetic therapy. But it has another meaning in primary care: leveraging data from a variety of sources to deliver personalized, preventive care.

“It’s a way to bring the big data – whether that is on the population level, from digital health devices like wearables, or additional insights from ‘omics diagnostic tests – into the clinical practice,” Dr. Megan Mahoney, who is chief of general primary care at Stanford University’s division of Primary Care and Population Health, told MobiHealthNews. “Then we ask, how do we synthesize data to identify a patient out of a large population who can be managed and treated to prevent an adverse outcome, disease worsening, or hospitalization?”

It’s exactly that question that Mahoney and her colleagues are trying to answer, and she will share details about a new program underway at Stanford during HIMSS’ Precision Medicine Summit in Boston next week.  

While the core goal of precision medicine is to determine which specific disease or health indicators can guide tailored interventions, much of that promise is focused on people who are actively in treatment for disease. Stanford Health Care wants to move that process upstream and redesign primary care practice.

“Precision medicine, as we hear about it, is more focused on crafting a tailored treatment once a diagnosis is made. What is interesting to me right now is less about how to tailor sophisticated treatment to specific diseases and more about upstream strategies to prevent disease worsening,” Mahoney said. “Focusing on prevention is where the country needs to go right now in order to rectify the healthcare crisis we are facing now."

First off, that means getting more hands on deck in care delivery.

“Historically, the physician has preferred to provide very individual care to very individual patients, and we have to start moving towards team-based care,” Mahoney said. “A more team-based care means providers and physicians can practice at the top of their license, focusing on assessment, diagnosis and treatment rather than administrative tasks or other protocol requirements that could be passed on to another care team member, like a health coach or physical therapist.”

To do that, they will begin a yearlong pilot with 50 to 100 patients from demographically and socioeconomically diverse backgrounds, and will identify ways to reach them to offer preventive care and engagement opportunities based on electronic health records dashboards. From there, they can identify patients who could benefit from genetics counseling or sequencing as well as discern which outreach and educational methods have the best engagement outcomes. Chief Medical Information Officer Christopher Sharp (who will co-present with Mahoney at the Summit), will be responsible for leading the team in building out technological interfaces to create registries and data analytics capabilities.

“We’ll be able to see which patients are most likely to benefit from precision healthcare, such as those with multiple chronic conditions or those who could benefit from pharmacogenomics testing, and we will be reaching out to them in several ways,” Mahoney said.
The pilot will primarily aim to assess the feasibility and acceptability of such a model, Mahoney said. They will work to provide interventions in a mode that is preferred by the patient, taking care not to overload them with a barrage of new technology. The pilot will intentionally recruit some patients who are already using wearables, and the only new tool introduced will be the HealthPals platform.

Ultimately, Mahoney said, the pilot will seek to demonstrate that healthcare teams can respond efficiently and effectively to big data and reduce costs through methods that are scalable.

“Everyone is facing economic pressures to reduce costs, and we are really looking at the future at Stanford to demonstrate how we can give better care when physicians are solely focused on practicing at the top of their license rather than being used as a secretary to document notes through Epic when they could be using devices or tools to generate that data,” said Mahoney. “We need to get away from this situation we have now where patients are generally unhappy they only interact with their doctors for 15 minutes. They get to know their dog’s veterinarian better.”