Genomic Medicine at Geisinger – David Carey, PhD; Associate Chief Research Officer, Director and Senior Scientist, Geisinger Clinic’s Weis Center for Research

1. Genomic Medicine at Geisinger David J. Carey, PhD Weis Center for Research Geisinger Clinic Danville, PA October 14, 2010

3. Geisinger Clinic

4. ~800 physician group practice (1/3 primary care; 2/3 specialists); ~400 advanced practitioners

5. 40 community-based outpatient clinics

6. 2 Tertiary/quaternary specialty and teaching/research hospitals (Geisinger Medical Center; Geisinger Wyoming Valley) plus several ambulatory surgery centers

7. 230,000 member health plan (Geisinger Health Plan)

8. Strategic commitment to Healthcare IT

9. Regional demographics

10. 2.6 million in service area

11. Rural, older, poorer (relative to national averages)

14. > $100M invested to date (hardware, software, manpower, training)

15. Running costs: ~ 4.6% of annual revenue of ~$2.5B

16. EHR fully-integrated across all ambulatory and inpatient sites of care

17. > 3.5 million distinct patient records

18. EHR data: 1.6 million office visits per year, 15 million orders, 7,000 peak concurrent users

19. > 2,000 non-Geisinger referring physician users

20. Electronic check-in kiosks

21. Web-based patient portal (MyGeisinger); >150,000 users

23. Searchable data warehouse

25. Operational data (e.g., events, scheduling)

26. Claims data (e.g., ambulatory, hospital, pharmacy)

29. Specialty clinic >15,000Blood samples 21,408 Serum samples 31,063 DNA samples 13,931 Tissue samples 2,745 Total samples >72,000

30. Age Distribution of Geisinger Primary Care Patients and MyCode Participants (N=417,469) (N=16,995)

32. Common Conditions in the MyCode Primary Care Cohort (16,714 total patients) ConditionNumber Osteoarthritis 4,177 Breast cancer 387 Prostate Cancer 402 Coronary artery disease 1,495 Hyperlipidemia 9,214 Ischemic stroke 1,240 BMI >40 1,864 Type 2 diabetes 3,727 Asthma 1,910

33. HDL Cholesterol In the MyCode Primary Care Cohort

34. BMI Distribution – MyCode Primary Care Cohort 800 Mean: 32.0 Median: 30.5 sd: 10.6 MyCode Females 600 Number 400 200 0 10 14 18 22 26 30 34 38 42 46 50 54 58 62 66 70 BMI 800 Mean: 30.0 Median: 30.0 sd: 7.1 MyCode Males 600 Number 400 200 0 10 14 18 22 26 30 34 38 42 46 50 54 58 62 66 70 BMI

35. Weight Loss After Gastric Bypass Surgery

36. Areas of Active Genomic Medicine Research (partial list) Obesity and associated co-morbidities Weight loss after gastric bypass surgery Preeclampsia Myoproliferative neoplasia Abdominal aortic aneurysms Antiplatelet therapy Prescription drug addiction Obstructive sleep apnea Non-alcoholic steatohepatitis Breast cancer

39. Interpretation of results – clinical action

40. clinical-prediction rules (algorithm driven?)

41. physician/patient education