A: While the term “personalized care” has become popular contemporary with the maturation of genomic medicine, it is clear that the entire context of care – including social, behavioral, and environmental factors – drives the outcomes we are hoping to achieve. Personalized care should be seen as tailoring care to the broadest set of variables that define an individual and influence their health.

A: A challenge with moving genomic data into the process of healthcare has been making the information available to the busy clinician in a timely manner, so that it supports the clinical decision, rather than delaying treatment or diagnosis. Making genomic information available to clinicians pre-emptively, “available the moment I need it,” rather than exclusively through reactive testing, has the potential to transform clinical decision support. Our experience is that clinicians will utilize genomic information a high percentage of the time, particularly for drug ordering, when the personalized guidance is presented to them in a “just-in-time” manner as they are placing an electronic order.

A: Among many opportunities, by most accounts reducing waste by eliminating tests and treatments that have no demonstrable impact on improving health has the most financial potential, approaching $1T per year, or roughly 1/3 of the US healthcare spend. Academic medical centers (AMCs) play a special role in the nation’s health ecosystem, providing the best-equipped setting for research and clinical care to co-exist in the care process. To realize that potential, leveraging investments in health IT and large dataset analytics, AMCs are in a strong position to rigorously test the true impact of existing and new healthcare practices, from precision therapy to routine IV fluid choices.

A: The physician shortage is real, and is most acutely felt outside the largest cities, although with the aging baby boomer population consuming more healthcare resources, a large percentage of Americans will eventually experience difficulty accessing physicians. The shortage is too severe to be mitigated by expanding MD training, and equally impacts primary care and specialty care disciplines. The only realistic solution is to expand the role of non-physician professionals, already growing in number to exceed MD’s, in the care continuum, allowing the physician workforce to focus on clinical decision making and procedures it is uniquely qualified to perform. As such, providing optimal access, safety, and quality for the largest number of patients requires systems of care that are built upon robust communication pathways and care protocols supporting all professionals – MD and non-MD – working as a team to care for patients.