The new UC-San Francisco Medical Center at Mission Bay sits on the site of what was once a wasteland of abandoned railroad tracks. It has evolved from a single bioscience office in 2003 — an overflow of scientists from UCSF’s Parnassus campus — to an 878,000-square foot complex housing three hospitals catering to women, cancer patients and children.
The medical center moves the university one step closer to achieving its precision medicine mission by integrating research and patient care, and providing more efficiency, a UCSF spokesperson said.
Across the street from the school’s research labs, Mission Bay allows UCSF to combine technology, a data system and life sciences — “something we have not been able to do previously,” said Mark Laret, CEO of the new medical center during a pre-opening conference last week.
To Keith Yamamoto, vice chancellor of research at UCSF and executive vice dean of the UCSF Medical School, Mission Bay Medical Center represents an opportunity for UCSF to promote its core mission — precision medicine — an initiative supported by President Obama and first announced during his 2015 State of the Union address.
Precision medicine focuses on tailoring medical decisions and practices for individuals based on their genetic information.
Yamamoto said the concept of precision medicine resulted from a committee established to create a framework for a new approach to human disease based on molecular data and a subsequent 2011 report, Toward Precision Medicine, for the National Academy of Sciences.
Improving clinical diagnoses and ensuring appropriate therapies “require designing and creating interoperable platforms putting different kinds of data under one roof,” Yamamoto said. “A data warehouse will provide the opportunity to build on information and to access large amounts of data. We may not know the endpoint but having the information gives us the confidence to find correlations among diseases through gene sequencing, studying blood protein and understanding the effect of exposure to the environment.”
Yamamoto anticipates data would form the basis for new hypotheses for the benefit of all practitioners.
He calls precision medicine “personalized medicine on steroids” because of its ability to incorporate objective genomic information and social data to study all the factors contributing to a disease such as cancer.
“The data will help us decide what direction to take in therapy and tailor it to a specific pathway,” he said. “Social data is key because genetic makeup may be only one factor contributing to a cancer.”
In early 2013, UCSF described its vision of precision medicine as one that would allow the institution to “cross-reference an individual’s personal history and biology with patterns found worldwide and use that network of knowledge to pinpoint and deliver care that’s preventive, targeted, timely and effective.”
The Obama Initiative
Backed by a $215 million investment built into the proposed fiscal year 2016 federal budget, President Obama’s initiative will “pioneer a new model of patient-powered research that promises to accelerate biomedical discoveries and provide clinicians with new tools, knowledge and therapies to select which treatments will work best for which patients,” according to the White House.
Yamamoto sees the initiative as a way of putting data onto a common platform, providing the power to make therapy decisions, offer treatment advice and make diagnoses at the individual level. However, he emphasized the importance of studying not just a single person, but all of the organisms in his or her environment to realize the total picture.
Other key elements of the national Precision Medicine Initiative include:
- A cohort of a million Americans to voluntarily contribute their health data to potentially improve health outcomes and promote the development of new and more precise medical treatments;
- More and better treatments for cancer by designing and testing effective tailored treatments, expanding genetically based clinical trials, exploring cancer biology and establishing a national “cancer knowledge network,” as stated in a White House Fact Sheet;
- Privacy protection;
- A review of current regulations to determine what changes might be needed to support the development of the new research; and
- Public/private partnerships to build an infrastructure for expanding cancer genomics.
NIH Director Francis Collins and Harold Varmus, director of the National Cancer Institute, said digital health tools will be integral.
In an article, “A New Initiative on Precision Medicine“ published by The New England Journal of Medicine, they wrote:
“The initiative will encourage and support the next generation of scientists to develop creative new approaches for detecting, measuring and analyzing a wide range of biomedical information — including molecular, genomic, cellular, clinical, behavioral, physiological and environmental parameters.”
Precision medicine, however, is not without challenges, according to Yamamoto. He said issues of security, privacy, regulations, misuse of data and policies surrounding sharing information with insurers will present hurdles on the road to practicing precision medicine.
Mission Bay Enhances UCSF’s Core Aim
Technology is supporting the precision medicine mission with a number of new features at the Mission Bay hospital, including:
- Bedside patient tablets enabling patients and their families to email providers with questions about treatment;
- Large bedside overhead screens with patient information, including electronic health records; and
- A fleet of 25 robots used as curriers transporting medications, medical supplies and equipment, hospitality items and waste.
“Over the last decade, we have invested heavily in information technology to revolutionize patient safety and quality,” said Seth Bokser, associate chief medical information officer for UCSF at Mission Bay. “We are focused on clinician and patient-facing technology and are using IT apps, integrated with our [EHR] and other clinical systems, to connect, engage, inform and activate our patients and families.”
Robots used in pharmacy management have been on staff since 2011 at UCSF’s other two hospitals at Parnassus and Mount Zion. Once a prescription is written, it is electronically transmitted to the pharmacy where robots pick, package and dispense the order, and then deliver the medications to attending nurses. Nurses must use a thumbprint scan to access a drawer with the medications located on the robot. All prescriptions have bar codes and are scanned to ensure the right patient receives the correct drug and dosage.
Bokser said the process enables the prescription to be tracked from initiation to delivery to the patient, minimizing errors and closing the loop to provide more efficiency, security, privacy and quality. “It also enables doctors more time to do what they do best — patient care,” he said.
“The new hospital campus represents a collaboration of medicine and technology that will attract first-class talent,” said Sam Hawgood, chancellor of UCSF, during a pre-opening conference. The breath of the center’s technology will also allow UCSF to empower patients through patient-facing, leading-edge applications, he said.