Towards Personalized Health Services

The continuing innovation and development in medicine, life sciences and technology are constantly creating new and improved opportunities to prevent, diagnose, treat and monitor diseases and promote health. This combines with a changing and increasing demand for health services by the population due to e.g. the ageing of the populations, changing life styles and emerging consumerism. Consequently, health expenditures are on the rise with governments trying to establish ways to contain healthcare costs. However, it's becoming clear that the demand cannot be satisfied by increasing the supply nor regulated by policies and incentives. Instead, new, radical ways are needed to tackle the demand-supply mismatch. Several converging activity threads have emerged that aim at a renewed health services environment. These can be grouped into three main categories. The first one deals with extending healthcare to health management, in other words addressing health needs pervasively 'from cradle to grave'. Industry is responding to this with activities ranging from ubiquitous computing to industry alliances, such as the Continua Alliance, to an integrated life-long electronic healthcare record. The second group of activities deals with augmenting a patient's health and illness data with her genotype data and is leading towards personalization of diagnosis and therapy. The third group deals with 'healthcare engineering'. The aim is to turn the current disease and episodic care oriented system around to be a service environment which is proactive and engages and empowers the individual in her health and illness management. Combined these three threads point towards personalized health services where the individual is a central actor in managing her own health and the prevention, diagnosis, treatment and monitoring services are optimized based on personal preferences, life styles, medical and health history, and genetics. The road to such a personalized health services environment is paved with challenges. These can roughly be placed into three categories with increasing difficulty of realization. If the innovation takes place within the established boundaries of healthcare professions and organizations, its diffusion will be relatively smooth provided it meets the criteria concerning cost-effectiveness, quality etc. If the innovation challenges existing boundaries, but there is evidence of its value through best practice studies (like EBM / Cochrane and HTA), it will diffuse into routine use although more slowly than in the first category. The most challenging case arises when organizational and professional boundaries should be changed, roles of actors in service delivery redefined and/or in the reimbursement practices modified. The presentation will be illustrated with case examples.