“When you take an amazing insti­tution and superimpose amazing times, you have an amazing opportunity. And that for us is to reimagine and reinvent medicine for this century in the same way it was invented here 125 years ago,” said Antony Rosen, vice dean for re­search for the Johns Hopkins University School of Medicine.

Rosen was one of the presenters on two panels who spoke at the Johns Hopkins Medicine Town Meeting— held Sept. 12 at The Johns Hopkins Hospital—on how Johns Hopkins is innovating patient care through promis­ing telemedicine and precision medicine initiatives.

PRECISION MEDICINE

An expert on the precision medicine panel, Rosen explained the premise behind Johns Hopkins inHealth, a program driven by innovative patient care and new ways of measuring disease. “You’ll find that diseases aren’t single diseases; they’re comprised of subgroups that can help you predict what’s going to happen to future patients,” he said.

The Johns Hopkins prostate cancer ac­tive surveillance program is an example of a precision medicine approach to care. H. Ballentine Carter, co-director of the Precision Medicine Center of Excellence for Prostate Cancer, asked the audience if they had a loved one who has been diagnosed with prostate cancer. As nearly everyone in the room raised their hands, he said, “Each one of those hands repre­sents an individual, but not one disease because prostate cancer is a spectrum of diseases. It spans diseases that are kind and gentle, but also deadly.”

Carter has monitored over 1,500 prostate cancer patients for the past 20 years to track their disease trajectory. He works hand-in-hand with Scott Zeger, biostatistician for The Johns Hopkins University, to store the data and analyze it. “We take those 20 years of informa­tion and look at a patient sitting in front of us to understand what their likely tra­jectory is by comparing all the evidence for that patient with the 1,500 previous men,” says Zeger. “We give this informa­tion to Bal [Carter], which enables him to make a better decision for the patient’s care.”

According to Peter Pronovost, senior vice president for patient safety and quality for Johns Hopkins Medicine, precision medicine is about discovering new ways of interpreting measurement and putting them into practice. “We’re using tools to pick up who has sepsis 24 hours before they might have clinical symptoms,” he said. “We’re helping to improve cancer diagnoses, because we know that 30 percent of our cancer pa­tients who come here get their diagnoses changed.”

TELEMEDICINE

“Telemedicine brings us closer,” said Nicholas Maragakis, director for the ALS Center for Cell Therapy and Regenera­tion Research. For ALS patients, who of­ten have debilitating physical limitations, Maragakis said examining remotely via a video visit enables care providers to “go” into their homes, avoiding many hours of travel time and coordination with family members who need to trans­port them. “I saw a patient who was in Maryland via video visit and we brought in his daughter living in New York City,” Maragakis said. Earlier that morning he communicated with a patient from the Dominican Republic via telemedicine.

Telemedicine has been instrumental in addressing population health challenges, according to Steven Snelgrove, president of Howard County General Hospital, who shared examples of how his hospital is using telemedicine to form closer ties in the community. “How many people like getting that call that your child is in the nurse’s office?” he asked the audience. “We partnered with six Title 1 elementa­ry schools and connected them through telemedicine to our emergency depart­ment physicians. We’ve been able to keep 96.8 percent of our children back in the school system so parents don’t have to come pick them up.”

What is Johns Hopkins doing that makes telemedicine more innovative than at other institutions? According to Rebecca Canino, administrative direc­tor for the Office of Telemedicine, Johns Hopkins is embedding telemedicine directly into its operations. “We’re not bringing in third party vendors or paying extra costs,” she said. “With the help of our experts, we’re building it in Epic to create a smooth continuum of care. We’re all looking at the same record, and this is huge when you look at the safety portion of telemedicine, which puts us head and shoulders above everyone else.”