Personalised Medicine in European Hospitals

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Personalised Medicine in European Hospitals
www.pwc.com/es

Personalised Medicine
in European Hospitals
Personalised Medicine in European Hospitals
PwC and the European Hospital and Healthcare Federation (HOPE)
  have joined forces to identify key elements in the development of       Participants
  personalised medicine in European hospitals. This collaboration
  will help determine of the current state and the desired future state   PwC and HOPE would like to express
  of personalised medicine practices within European hospitals, and       sincere gratitude to the European
                                                                          hospitals that contributed to the
  will thoughtfully facilitate the creation of a culture of customised
                                                                          development of this paper with their
  healthcare.                                                             knowledge, experience and time.

  Personalised medicine can be defined as products and services that      Special thanks go to the following
  leverage the science of genomics and proteomics (directly or            contributors:
  indirectly) and capitalise on the trends towards wellness and
  consumerism to enable tailored approaches to prevention and care.       • R
                                                                             aimon Belenes,
                                                                            Chief Executive Officer, Hospital
                                                                            Clinic de Barcelona (Spain)
  The dawn of personalised medicine brings not only new advances
  to our healthcare system today, but also key challenges. This new       • Alain Bonnin,
                                                                             Professor of Medical Parasitology and
  science has led many participants in the healthcare industry, such
                                                                             Mycology; Director Parasitology
  as providers, to consider how best to adapt to these challenges and
                                                                             Mycology Laboratory; Director
  foster a consumer-focused culture. Hospitals have a clear                  Biological Resource Center Ferdinand
  opportunity to adapt to the new healthcare paradigm and provide            Cabanne – University Hospital of
  services that are targeted to the individual patient. It is important      Dijon (France)
  to recognise, however, that different hospitals operate and require     • J ulia S. Johansen,
  different models. Just as doctors will no longer be able to apply the      Professor, Senior Consultant, DMSc at
  same forms of treatment to patients, hospitals will not be able to         Herlev Hospital/Copenhagen
  apply the same approach to addressing the challenges brought on            University Hospital at Herlev
  by personalised medicine. Hospitals and providers have many                (Denmark)
  options for how they respond to the changing market. And as             • J orma Penttinen,
  evidenced in the interviews we completed with several European             Medical Director, Kuopio University
  hospitals, personalised medicine can be designed and implemented           Hospital (Finland)
  into a hospital model in a variety of ways.                             • B
                                                                             orut Peterlin,
                                                                            Head of Clinical Institute of Medical
  Many European hospitals have already begun to define what                 Genetics, University Medical Centre
  personalised medicine means to their hospital and have developed          Ljubljana (Slovenia)
  their strategies for implementation. And as hospitals solidify their    • G
                                                                             yörgy Pfliegler,
  definition and vision of personalised medicine as well as their           Head of Division of Rare Diseases
  approach for implementation to create a culture of customised             Institute of Medicine, Medical and
                                                                            Health Science Center University of
  healthcare, leading practices will continue to emerge.
                                                                            Debrecen (Hungary)

2     Personalised Medicine in European Hospitals
Personalised Medicine in European Hospitals
Table of contents
The impact of personalised medicine today                                       4

Part I. Personalised Medicine in European Hospitals
1. General overview of personalised medicine                                   7

2. The pressure to be personalised – Key trends
    that have changed the healthcare paradigm                                   8

3. Next steps for hospitals and providers                                    11

4. Conclusions                                                               15

Part II. Hospitals in focus
List of Participating Hospitals                                               18

Herlev Hospital / Copenhagen University Hospital at Herlev,
Denmark                                                                       19

Kuopio University Hospital, Finland                                           25

University Hospital of Dijon, France                                          29

Medical and Health Science Center University of Debrecen,
Hungary                                                                       34

University Medical Centre Ljubljana (UMCL), Slovenia                          38

Hospital Clinic de Barcelona, Spain                                           42

The impact of personalised medicine tomorrow                                  46

                                  Personalised Medicine in European Hospitals      3
Personalised Medicine in European Hospitals
The impact of
   personalised medicine today

                                                    Personalised medicine aims to provide        •G enetic screening is widely used
                                                    the timely, precise, personalised              for treatment in cancer patients.
                                                    diagnosis and treatment of patients,           Cardiology, neurology, radiology,
                                                    with a particular emphasis on wellness         and the treatment of diabetes are
                                                    and disease prevention. Although               among the key disciplines that
                                                    personalised medicine has already              benefit from the genetics field.
                                                    been introduced into practice, it is still     Advances in genomic and proteomic
                                                    in its early stages of implementation in       science have led to more cost-
                                                    the European healthcare market. This           efficient discoveries, with doctors
                                                    report outlines the move towards               more inclined to use targeted
                                                    personalised medicine in six European          treatments.
                                                    hospitals — located in Denmark,              •S tem cell programs and
                                                    Finland, France, Hungary, Slovenia              treatments are still relatively new.
                                                    and Spain — compares the path each is           Although there are several programs
                                                    taking, and discusses the following             underway, most of the hospitals
                                                    commonalities:                                  surveyed are not yet applying this
                                                                                                    field in the clinical setting.
                                                    • Most of the European hospitals            • Telemedicine services are not yet
                                                       are focused on initiatives related           fully deployed. Devices for
                                                       to diagnostics and therapeutics.             monitoring chronic diseases are
                                                       The European landscape is working            currently being developed and
                                                       in several ways to develop new               implemented in various clinical
                                                       imaging technology and genetic               services, such as cardiology and
                                                       tools, such as biomarkers and                neurology.
                                                       biochips.

4     Personalised Medicine in European Hospitals
Personalised Medicine in European Hospitals
• Only a few European hospitals            the life science and medical sectors is
   focus on nutrition and physical          essential in fostering innovation in
   activities to encourage wellness         the field of personalised medicine.
   and improve the treatment of            •T
                                             he main barriers for the
   patients; most do not tackle             implementation of personalised
   prevention as part of their              medicine within the European
   approach. The reason could be that       hospital environment are: lack of
   other factors, such as primary care      research funding, lack of strong
   providers and public health media        scientific evidence in some fields,
   campaigns, already encourage             lack of knowledge among doctors,
   patients to monitor their own health     and lack of a clear reimbursement
   status and maintain a healthier          system for related services.
   lifestyle.
• Developing relationships or             Our study revealed that, although
   affiliations with other sector          Europe is starting the paradigm shift
   organisations is a usual practice       towards personalised medicine, many
   within the European hospital            barriers still need to be addressed. To
   market. Public and private hospitals    keep the process on track, healthcare
  (EU and US hospitals), public entities   professionals and policy makers must
  such as the National Health Service      aim to ensure that personalised
  (NHS) and laboratories, universities     medicine contributes to the
  and biotech and pharmaceutical           improvement of population health with
  companies, are among the main            clear and robust evidence of patient
  partners to undergo personalised         value, and they must remember that the
  medicine projects. Cooperation           shift towards personalised medicine is a
  between the many stakeholders in         process rather than an endpoint.

                                                                                Personalised Medicine in European Hospitals      5
Personalised Medicine in European Hospitals
Part I. Personalised Medicine
in European Hospitals
Personalised Medicine in European Hospitals
1. General overview of
    personalised medicine
                                                                                                              develop in the future and how the
                                                                                                              person will respond to a given
                                                                                                              treatment, enabling the development
                                                                                                              of a tailored health strategy.
                                                                                                           • I t is preventive; it facilitates a
                                                                                                              proactive approach to health and
                                                                                                              medicine, which shifts the focus from
                                                                                                              illness to wellness.
                                                          Personalised medicine is broadly                 • I t is participatory; it empowers
                                                          defined by PwC, as “products and                    patients to make informed choices
                                                          services that leverage the science of               and take responsibility for their own
                                                          genomics and proteomics (directly or                health1”.
                                                          indirectly) and capitalise on the trends
                                                          towards wellness and consumerism to              The human genome project and
                                                          enable tailored approaches to                    dwindling costs in genomic and
                                                          prevention and care”. This definition            proteomic sequencing is creating this
                                                          encompasses everything from high-                “new science” that focuses on the
                                                          tech diagnostics to low-tech foods,              consumer. New science is no longer a
                                                          technologies that enable storage, and            concept of the future; it is here today.
                                                          analysis and linking of patient and              Key trends over the past decade have
                                                          scientific data.                                 challenged the healthcare
                                                                                                           environment, payers, pharmaceutical
                                                          Personalised medicine or the “new                and life sciences companies, and
                                                          science”, also referred to as “P4                providers to become more consumer
                                                          Medicine” by Dr. Leroy Hood, co-                 focused in their own right. Providers
                                                          founder of the Institute for Systems             have their own unique set of challenges
                                                          Biology, encompasses the following               that will need to be addressed in order
                                                          principles:                                      to successfully create a culture of
                                                                                                           personalised healthcare for the patient.
                                                          • “It is personalised; it is based on an        Correspondingly, it is important to
                                                             understanding of how genetic                  understand the key trends that have
                                                             variation drives individual                   pushed healthcare to be more
                                                             treatment.                                    personalised, the challenges that
                                                          • It is predictive; it is able to identify      providers face, and how hospitals are
                                                             what conditions a person might                adapting to this new environment.

1
     PwC, “The new science of personalized medicine: Translating the promise into practice”, 2009.

                                                                                                      Personalised Medicine in European Hospitals      7
Personalised Medicine in European Hospitals
2. The pressure to be personalised – Key trends
       that have changed the healthcare paradigm

  The shift in the healthcare paradigm to                                                                                                    model. These trends can be grouped into                                personalised treatment regimen and
  personalised medicine did not happen                                                                                                       four categories:                                                       cost-efficient approach to healthcare.
  overnight. Over the last decade,                                                                                                                                                                                  By identifying the optimal point of
  advances in genomics and technology as                                                                                                     • Genetic trends                                                      intervention for treatment, healthcare
  well as the patients´ inclination towards                                                                                                  • Patient trends                                                      providers can improve quality of care
  care that is consumer focused have                                                                                                         • Technology trends                                                   and reduce costs by effectively timing
  contributed to this development. The                                                                                                       • Wellness trends                                                     treatment intervention and eliminating
  dawn of personalised medicine brings                                                                                                                                                                              waste from insufficient or excessive
  not only new advances to our healthcare                                                                                                    Genetic trends — Advances in                                           treatment regimens.
  system, but also distinct challenges.                                                                                                      genomic and proteomic sequencing                                        As genome sequencing costs decline,
  This new science has led many players                                                                                                      have resulted in cost-efficient                                        doctors and patients alike are more
  in the healthcare industry, such as                                                                                                        discoveries that are bending the                                       inclined to seek treatments that are
  providers, to consider how best to adapt                                                                                                   cost curve                                                             targeted to the patient’s illness. Today,
  to these challenges and foster a                                                                                                           Advances in genomic and proteomic                                      genome sequencing costs are
  consumer-focused culture. But before                                                                                                       sequencing over the past decade have                                   approximately $20,000 per genome, a
  the industry can address these                                                                                                             led to the development of “targeted”                                   stark contrast to 2001 sequencing costs
  challenges, it must first understand the                                                                                                   diagnostics and therapeutics that                                      of almost $100,000,000 per genome (see
  trends that have pushed healthcare to                                                                                                      leverage knowledge of an individual’s                                  Figure 1).
  evolve towards a more personalised                                                                                                         genetic makeup to create a more

   Figure 1:
   Cost per genome from the National Human Genome Research Institute

         $ 100.000.000

          $ 10.000.000

           $ 1.000.000

             $ 100.000

              $ 10.000

               $ 1.000

                                   01             02           0   3           0   4           0   4           0   5           0   5           0   6          06 07 t- 07      08   08       09 - 09       0    0
                              p-             p-             t-              r-              t-              r-              t-              r-              t- pr-           r- ct-       r-      l     r-1 ct-1
                         se             se             oc              ap              oc              ap              oc              ap              oc       a  oc     ap      o    ap      ju    ap      o

  Source: Wetterstrand KA. DNA Sequencing Costs: Data from the NHGRI Large-Scale Genome Sequencing Program
  available at: www.genome.gov/sequencingcosts. Accessed 19 April 2011.

8     Personalised Medicine in European Hospitals
Personalised Medicine in European Hospitals
Patient trends — Accessibility                               advice available online and more                            A few key examples of recent progress
    creates consumer-focused                                     patients/consumers becoming well                            made in healthcare technology in
    healthcare                                                   educated on health management,                              Europe are described in Figure 3.
    Patient empowerment is part of a                             individuals will expect one-on-one
    broader trend towards consumer-                              customised service from physicians.
    focused healthcare, enabled by easy
    access to health information that was
    previously available only to medical                         Technology trends — Connectivity
    professionals.2 Not surprisingly, patients                   fosters treatments in non-
    are looking to various online resources                      traditional settings and
    for medical advice or diagnosis. In fact,                    encourages the “anytime,
    global consumers surveyed online by                          anywhere” mind set
    PwC said their top information source                        Connectivity allows for customised
    on health was online websites (See                           solutions both inside and outside the
    Figure 2).3 Social networking sites                          home. Developments such as telehealth,
    ranked eighth in this survey. Physicians                     home health, and web applications
    and providers are no longer viewed as                        enable a new paradigm of personalised
    the primary source for medical                               care outside the confines of a doctor’s
    information as online resources create                       office or clinic. Consumers are becoming
    educated patients that can now form                          empowered to predict their own medical
    their own opinion on how to handle                           risks, detect diseases, and track/manage
    their health. Online websites allow                          their health status overall through
    patients to feel as if they are in control of                genetic testing products for in-home use
    their health and that advice is targeted                     — furthering the concept of health
    to their needs. With more medical                            management “anytime or anywhere”.

        Figure 2:
        Where do you go to find information to make decisions about your healthcare? (Select
        all that apply)

                                   Health website                                                             48%

                                          Doctors                                                       43%

                         Through friends or family                                          30%

                        Magazines or newspapers                                           27%

                                       TV or radio                                  24%

                                      The hospital                             22%

                                      Government                              21%

                       Social networking websites                       17%

                              Community services                  14%

               Health clubs (e.g., gymnastic, yoga)         8%

                                          Schools          7%

                                                      0%   10%      20%               30%         40%     50%       60%

    Source: PwC’s Health Research Institute Global Consumer Survey. HealthCast 2010.

    2
         PwC Health Research Institute, “Health Cast: The customization of diagnosis, care and cure”, March 2010.
    3
         PwC’s Health Research Institute Global Consumer Survey in “HealthCast: The customization of diagnosis, care and cure”, March 2010.

                                                                                                                         Personalised Medicine in European Hospitals      9
Personalised Medicine in European Hospitals
Figure 3:
    Examples of care-anywhere networks through technology
      Territory                                                                         Experience

                       The government is making a progressive attempt to mobilise care from the hospital to homes equipped with electronic monitoring
   France
                       devices.

                       Leading the trend towards home automation, where sensors, central locking systems, radio frequency identification (RFID), ringing-
   Netherlands
                       mats and cameras are used to monitor patients.
                       P’ASMA is a web-based application that helps patients manage their asthma. The physician registers the patient’s clinical data, asthma
   Portugal            control data and a specific treatment plan. At home, the patient downloads his or her data and receives immediate graphic and written
                       feedback based on the defined treatment plan. The system also delivers automatic messages and alerts online to each patient.
                       Capio Health Care has a daily dialogue with its psychiatric patients via email, for example, by using Montgomery-Åsberg Depression
   Sweden              Rating Scale (MADRS) or comprehensive psychopathological rating scale (CPRS). And for orthopaedic rehabilitation patients, Capio
                       sends their patients animated training programs via email.
                       Toumaz Technology is conducting a clinical trial with the Imperial College Healthcare NHS Trust to test a digital “patch”, a disposable
   United
                       device with a wireless sensor that sticks to a patient’s chest and can monitor, in real time, vital signs such as temperature, heart rate
   Kingdom
                       and respiration.
   Source: PwC Health Research Institute, “Health Cast: The customization of diagnosis, care and cure”, March 2010.

   Wellness trends — With greater                                allow them to feel greater ownership in                   higher quality of service. Patients are
   focus on the consumer, healthcare                             the responsibility for their health.                      researching more on the Internet for
   is trending from diagnostics to                                                                                         information on healthcare and
   wellness                                                      Today’s trend towards consumerism                         healthcare coverage. As Figure 4 shows,
   Personalised medicine encourages                              attempts to inject something that’s been                  the share of online health information
   patients to be more active in the decision                    missing from health benefits — a                          seekers has doubled since 2004.
   making responsibilities of managing their                     consumer who cares more about cost
   health, and therefore enables a consumer-                     and quality. By providing financial
   focused market. Today, patients can                           incentives and information to patients,
   search online for symptoms they are                           the healthcare system can encourage
   experiencing; find individuals who may                        them to assume a greater role in
   share the same disease state; monitor                         managing their own healthcare and the
   their health within the confines of their                     associated costs, with the intention of
   own home; or become more                                      enabling patients to make more value-
   knowledgeable on how to avoid, prevent,                       driven healthcare decisions. As patients
   or treat a certain illness. These factors                     are asked to contribute more towards
   typically push healthcare decisions and                       their healthcare coverage costs, they are
   treatments closer to the consumer and                         pushing for more information and

                                                                   Figure 4:
                                                                   Individuals from EU-27 using the Internet for seeking health-related information –
                                                                   Percentage of individuals aged 16 to 74.

                                                                               50

                                                                               40                                                                       33%         34%

                                                                                                                                          28%
                                                                               30                                          24%
                                                                                                                19%
                                                                                      17%         16%
                                                                               20

                                                                               10

                                                                                0

                                                                                 2004            2005           2006      2007           2008          2009        2010

                                                                 Source: Eurostat 2010. Note: Health-related information: injury, disease, nutrition, improving health, etc.
                                                                 Within the last three months before the survey.

10     Personalised Medicine in European Hospitals
3. Next steps for hospitals
        and providers
                                                     proteomics specialists with holistic                  generation of doctors on personalised
                                                     knowledge of many different diseases                  medicine techniques and create
                                                     and an understanding of gene                          curricula that are actionable by a
                                                     interactions, eliminating the need for                physician. The European Personalised
                                                     patients to see a variety of specialists to           Medicine Association (EPEMED) is a
                                                     treat their ailments”.4 To educate the                not-for-profit organisation that puts this
                                                     next generation of physicians and nurses              very idea into action. EPEMED brings
The steep learning curve must be                     in the complex issues raised by genomic               together key leaders across the
met with education and expertise                     and proteomic science, universities need              healthcare industry to discuss
Hospitals must adapt to the changing                 to update their programs.                             personalised medicine, its key
healthcare paradigm and take on the                                                                        challenges, and best practices. It aims to
aggressive learning curve by educating               In addition to formalised training,                   provide a proactive platform for the
their healthcare providers on the science            conversations with leaders in the field of            harmonisation of personalised medicine
and clinical application of genomics and             personalised medicine across the                      development and implementation across
proteomics. Doctors will no longer be                healthcare industry (e.g. government,                 Europe, focusing on the crucial role of
able to apply one approach to a set of               provider, payer) and academia could                   diagnostics, to make personalised
patients with a disease state that is                offer considerable value. Conversations               medicine a reality.5 Key players from the
seemingly similar. These patients may                and working groups between payers and                 healthcare industry, regulators, payers
have a dozen different gene-based                    providers, for example, could identify                and government have an avenue to
variations of the disease, each of which             the most efficient reimbursement                      foster collaboration, learn from one
could require a variation of the                     methods for diagnostic tests.                         another and improve patient care
treatment. With formal schooling or                  Discussions between physicians and                    through EPEMED.
training programs, “some physicians                  academics/professors could identify the
might be trained as genomics and                     best approach to educating the next

                                                     Personalised Medicine in Action: Hospital Spotlight
                                                     • T he multidisciplinary staff of the Experimental Cancer Therapy Unit at the
                                                        Herlev Hospital in Copenhagen, Denmark is trained in handling blood
                                                        samples for pharmacokinetics pharmadynamics and translational
                                                        research.
                                                     • Genetic diagnostics is done at the University of Eastern Finland, Kuopio,
                                                        which collaborates closely with the Kuopio University Hospital. Knowledge
                                                        on monogenic forms of diseases and the potential of modern genetics is
                                                        part of the course work for medical students.
                                                     • T he Medical and Health Science Center University of Debrecen in Hungary
                                                        trains new doctors to practice personalised medicine. There are PhD
                                                        courses on the field.
                                                     • T he University Medical Centre Ljubljana, Slovenia, has a Clinical Institute
                                                        of Medical Genetics, which aims to develop tests and counselling as it
                                                        relates to personalised medicine.

 PwC, “The new science of personalized medicine: Translating the promise into practice”, 2009.
4

 Association European Personalised Medicine, EPEMED, retrieved 4 May 2010, from http://www.epemed.org/index.html.
5

                                                                                                      Personalised Medicine in European Hospitals      11
Effective technology is the                            Due to different needs among                                        interoperable countrywide, due to
  foundation for personalised                            specialities, hospitals find it more                                various restrictions such as technology,
  medicine                                               difficult to integrate EHR systems,                                 lack of standards or legal frameworks.
  The foundation for personalised                        although a few countries have more                                  This lack of standardisation also results
  medicine will be distributed access to                 than 50% of their hospitals supported by                            in challenges for cross-border care in
  health information, not just for health                EHR systems.9 Most installed EHR                                    Europe.
  professionals.6 With the institution of                systems in European countries are not
  electronic health records (EHRs),
  genomic, proteomic and personalised
  medicine data could be shared. Greater
  sharing of data that is instantaneous                   Figure 5:
  could accelerate research efforts                       In the next five years, which of the following changes, if any, are most likely to
  dramatically. Results from a PwC survey                 affect your health system? (multiple response question)
  demonstrated that a majority of
  respondents felt that within the next five                         Merging of information technology & healthcare                                                      84
  years, “merging of information
                                                                 Relaxation of scope of practice laws that will enable
  technology and healthcare” will most                                        clinicians to provide more primary care
                                                                                                                                                          58

  likely affect their health system (See
                                                                         Increased use of virtual health communities                                     56
  Figure 5).
                                                                                              Personalised medicine                                 45
  Technology alone, however, will not be
  sufficient. A great deal of thought will                                       More travel/tourism among patients                                 45

  need to be put into what data will be                                  Relaxation of country restrictions on foreign
                                                                                                                                                   44
  captured, where it will come from, what                                                         medical graduates

  the appropriate data types and formats                           More health insurance coverage for travel/tourism                               43
  will be, and how it should be presented
  to a physician.7                                                                                                       0     10   20   30   40   50    60    70   80   90

  Because medical and academic research                  Source: PwC’s Health Research Institute Global Health Leaders Survey

  centres often work in information silos,
  connecting EHRs is challenging due to
  differing data standards. Agreement on
  common data formats and standards
  will serve to reduce complexity and
                                                         Personalised Medicine in Action: Hospital Spotlight
  allow doctors and hospitals to share
  data among one another.8                               • T
                                                            he Experimental Cancer Therapy Unit, Department of Oncology at HEH, has
                                                           access to MRI, CT and PET-scans and a variety of other interventional
  Although the agreement on common                         diagnostic radiology and clinical physiological assessments.
  data and data consistencies is a huge                  • G
                                                            enetics offers the possibility to diagnose monogenic diseases accurately at
  task that requires time, effort and                      Kuopio University Hospital.
  money, there are some promising                        • N
                                                            ew imaging technologies, such as 3 Tesla MRI and PETscan, are available at
  initiatives from the European                            the University Hospital of Dijon.
  perspective such as EUROREC Institute                  • T
                                                            he Medical and Health Science Center University of Debrecen uses
  (EuroRec). This is an independent                        telemedicine to remotely monitor cardiology patients with remote ECG
  not-for-profit organisation that promotes                (holter).
  the use of high-quality Electronic Health
                                                         • T
                                                            he University Medical Centre Ljubjana develops and uses their own analysis
  Record systems (EHRs) in Europe.
                                                           software tools for the application of personalised medicine techniques.
  EuroRec has also developed some tools
  to exploit its repository and has                      • T
                                                            he Hospital Clinic in Barcelona uses remote monitoring devices for cardiac
  elaborated (standard) procedures for                     pathologies and chronic diseases.
  the certification of eHealth products.

  6
     PwC, “The new science of personalized medicine: Translating the promise into practice”, 2009.
  7
    HealthcareLeaders Media in collaboration with PwC, “Breakthroughs: The Impact of Personalized Medicine Today”, 2010.
  8
    PwC, “The new science of personalized medicine: Translating the promise into practice”, 2009.
  9
    Electronic Health Record Systems-A Main Pillar in European e-Health Developments for Better Delivery of Care. G. Comyn, Head of Unit “ICT for Health”, DG INFSO,
      European Commission, 2007.

12     Personalised Medicine in European Hospitals
Changes in the healthcare                             medical education and clinical care                    treatment. This has reduced the cost of
paradigm create opportunities to                      makes them well positioned to identify                 treatment for key populations.11
innovate and bend the cost curve                      unmet market needs and discover new
As the emphasis on wellness grows and                 targeted therapies. Academic medical                   Willingness to collaborate will give
payers and consumers seek alternative,                centres also have access to massive                    providers the competitive edge
less expensive forms of care, hospital                amounts of patient data, which                         While these changes in the healthcare
admissions will likely decrease.                      accelerates the discovery process.                     paradigm have posed challenges to
Providers will be challenged to deliver               Moreover, this creates an                              hospitals and providers, they may have
new forms of care in order to maintain                unprecedented opportunity to redefine                  also created opportunities for key
consistent revenue. But through the new               the research data continuum by                         participants in the healthcare industry
wave of preventative medicine and                     launching an exchange of data that                     overall, particularly for non-traditional
wellness, hospitals may be able to create             goes full circle — from a researcher’s                 healthcare participants. Personalised
new sources of revenue by launching                   laboratory to a patient’s bedside                      medicine, specifically, is a highly
new services and products focused on                  back to the researcher’s laboratory                    complex field, and no one organisation
wellness and disease prevention, which                again.                                                 or industry has the requisite resources,
will in turn create greater demand for                                                                       knowledge and tools needed to
molecular tests to determine                          The introduction of personalised                       implement solutions in this field. This
predispositions and/or therapeutics as                medicine at the point of care will require             new science not only creates
well as the corresponding health                      a huge change in the way healthcare is                 opportunities for hospitals and the
services required.10                                  organised. How this might be done is                   industry to innovate, but also to
                                                      illustrated by a system in France for the              collaborate within or outside their
Hospitals linked to universities may                  treatment of cancer. France’s National                 industries to create the best possible
have brighter prospects, as they are                  Cancer Institute has set up a network of               solutions.12
prepared to take the lead in                          28 regional centres, linked with
personalised medicine research. Their                 hospitals, where the tumours of cancer                 The following are a few examples of the
unique combination of academic                        patients can be rapidly analysed to                    types of innovation emerging through
research, state-of-the-art technology,                establish their suitability for drug                   collaborative relationships:

                                                          Personalised Medicine in Action: Hospital Spotlight
                                                          • S
                                                             everal departments at the Herlev Hospital/Copenhagen University in
                                                            Denmark have focused on nutrition and physical activity to improve
                                                            wellness and treatment of patients.
                                                          • T
                                                             he Medical and Health Science Center University of Debrecen in
                                                            Hungary has a special nutrition centre where patients receive a personal
                                                            diet, and they are currently building a wellness centre focused on
                                                            rheumatologic services.

10
    HealthcareLeaders Media in collaboration with PwC, “Breakthroughs: The Impact of Personalized Medicine Today”, 2010.
11
   European Perspectives in Personalised Medicine, May 2011. European Commission.
12
   PwC, “The new science of personalized medicine: Translating the promise into practice”, 2009.

                                                                                                       Personalised Medicine in European Hospitals      13
European universities and medical                        centres for national networks of clinical             (EATRIS) is based on translation centres
  schools form partnerships with                           research centres and clinical trials units,           created by clinics and biomedical
  research centres abroad to enhance                       and is able to provide support and                    research institutions with translational
  innovation.                                              services to multinational clinical                    experience.
  • The University of Minnesota and Mayo                  research.
     Clinic, under the mantle of the                    • Biobanking and Biomolecular Resources              We expect to see complex networks of
     Minnesota Partnership for Biotechnology               Research Infrastructure (BBMRI) forms              collaboration to emerge, within and across
     and Medical Genomics, have formed a                   an interface between specimens and                 industries and between the public and
     strategic research relationship with the              data (from patients and European                   private sectors, as individual organisations
     Karolinska Institute of Stockholm,                    populations) and top-level biological and          or industries deal with the complex
     Sweden, the top-rated medical research                medical research. During the past three            challenges that come with this new focus
     university in Europe. Leaders of each                 years, BBMRI has grown into a                      on personalised medicine.17 As
     institution signed memoranda of                       53-member consortium with over 280                 collaborative partnerships develop, it will
     understanding to commit to the formal                 associated organisations (largely                  be important to consider how these
     ongoing collaboration, called the                     biobanks) from over 30 countries,                  complex alliances can be appropriately
     Frontiers of Biomedical Research.13                   making it the largest research                     managed so that all parties can benefit
                                                           infrastructure project in Europe.                  from the innovations that emerge.
  Pharmaceutical companies have shown                   • The European Advanced Translational
  their commitment to developing                           Research Infrastructure in Medicine
  personalised treatments by
  collaborating with companies in their
  industry.
  • Procter & Gamble and Inverness Medical                Personalised Medicine in Action: Hospital Spotlight
     Innovations, a diagnostics company,
                                                           • T
                                                              he Herlev Hospital/Copenhagen University Hospital is collaborating with
     created a $325 million joint venture to
                                                             other universities in Denmark, the European Union and the United States for
     create diagnostics products.14
                                                             research purposes and treatment of patients, as well as with the National
  • Merck and AstraZeneca collaborated to
                                                             Laboratory for Sustainable Energy and many biotech and pharmaceutical
     combine two experimental cancer drugs,
                                                             companies.
     one from each company, to create a
     cocktail that could provide better results            • T
                                                              he Kuopio University Hospital in Finland is collaborating with several
     than each alone.15                                      institutions for research purposes, including the National Institutes of Health
                                                             of the US Department of Health and Human Services, the University of
  Non-traditional healthcare companies                       Southern California and the University of Ann Arbor in the United States, and
  are working together to increase                           the University of Gothenburg in Sweden.
  innovation in technology that will                       • T
                                                              he University Hospital of Dijon, France, is collaborating with several
  monitor the individual’s health.                           organisations, including other university hospitals, scientific groups and
  • Intel and General Electric formed an                    biotech companies. In particular, the University Hospital of Dijon collaborates
     alliance to market home-based health.                   with the Cancer Centre Georges François Leclerc, which develops its own
     The primary objectives were to enable                   research programs, some of which are common within the University
     remote monitoring of patients and lower                 Hospital of Dijon, INSERM research centre and the biotech company
     healthcare costs by reducing the number                 Oncodesign.
     of necessary hospital visits.16                       • T
                                                              he Medical Health Science Center University of Debrecen, Hungary, is
                                                             collaborating with orphan drug companies, such as Genzyme, a laboratory
  Multicentre networks of clinical                           testing research on Fabry disease.
  research in Europe.
                                                           • The
                                                               University Medical Centre Ljubljana, Slovenia, is collaborating with other
  • The European Clinical Research
                                                             universities, companies providing consumables, government and health
     Infrastructures Network (ECRIN) is
                                                             insurance companies.
     based on the connection of coordinating

  13 Universityof Minnesota, Mayo Clinic sign research pact with Karolinska. Available at http://www.ahc.umn.edu/media/releases/umayokaro/index.htm.
  14 “P&G  partners with Inverness in diagnostics venture” Mass High Tech, 18 May 2007. Available at http://www.masshightech.com/stories/2007/05/14/daily43-PG-
      partners-with-Inverness-in-diagnostics-venture.html.
  15 Ron Winslow, “AstraZeneca, Merck to Test Cancer Drugs in ‘Cocktail’”, Wall Street Journal, 2 June 2009. Available at http://online.wsj.com/article/
      SB124380640803770139.html.
  16 Gran Gross, “Intel, GE partner on home health tech”, NetworkWorld, 2 April 2009. Available at http://www.networkworld.com/news/2009/040209-intel-ge-partner-

      on-home.html.
  17 PwC, “The new science of personalized medicine: Translating the promise into practice”, 2009.

14     Personalised Medicine in European Hospitals
4. Conclusions

                                                                                                            on which treatment(s) should be used
                                                                                                            when reading genetic data. This
                                                                                                            includes making better use of modern
                                                                                                            imaging technologies as well as the
                                                                                                            more effective use of decision support
                                                                                                            tools. While many new potential
                                                                                                            biomarkers are being discovered, the
                                                       Although a great deal of progress has                rate at which these are being qualified
                                                       been made in genomic and proteomic                   and validated is slow.
                                                       research and the field of molecular               • Universal standards for managing
                                                       genomics, many challenges remain.                    genomic information in electronic
                                                                                                            medical records will be necessary to
                                                       The learning curve poses new                         implement this technology and ensure
                                                       challenges for doctors and                           clinical data is collected and
                                                       scientists                                           interpreted in a standardised
                                                       • Recognising which genes or biological             manner.20
                                                          mechanisms signify that a patient is
                                                          predisposed to certain diseases and            The least evident challenge is
                                                          how this in turn translates into               often the hardest to overcome
                                                          knowledge that can be used for                 • Consumer behaviour, an obstacle that
                                                          prevention and treatment strategies               may not be apparent, will be key when
                                                          poses a large learning curve that                 implementing personalised medicine
                                                          scientists and doctors will have to               and creating a culture that can adapt
                                                          overcome.18                                       to these changes.21
                                                                                                         •H  ow we manage our personal health
                                                       • Diseases need to be reclassified to               and lifestyle are not only difficult
                                                          reflect new knowledge about human                 habits to modify but also play a key
                                                          biology. Many clinical entities                   role in our susceptibility to disease
                                                          currently described as single diseases            and disease management. Swinging
                                                          may in fact be more than one disease,             the pendulum from treatment to
                                                          requiring different treatment                     prevention and from illness to
                                                          approaches.19                                     wellness will be essential to
                                                                                                            implement a consumer-focused
                                                       Implementation of effective                          culture.
                                                       technologies is no easy task                      •P  atients need to be educated and
                                                       • Key challenges remain in determining              physicians need to be instructed in the
                                                          the appropriate type and                          new technologies and methods that
                                                          sophistication of technology needed               allow for a more personalised
                                                          for doctors to make effective decisions           diagnosis of diseases and treatments.

18 PwC, “The new science of personalized medicine: Translating the promise into practice”, 2009.
19 European Perspectives in Personalised Medicine, May 2011. European Commission.
20 PwC, “The new science of personalized medicine: Translating the promise into practice”, 2009.
21 PwC, “The new science of personalized medicine: Translating the promise into practice”, 2009.

                                                                                                    Personalised Medicine in European Hospitals      15
These challenges will need to be           • Provide new health and wellness
                                                     addressed at European, national,              products and services to the
                                                     regional and local levels.                    community.
                                                                                                • Work with patients to educate them
                                                     With any challenge, however, comes            about the need to proactively manage
                                                     opportunity. The shifting healthcare          their own health and commit to
                                                     paradigm provides hospitals and               wellness programs and the benefits
                                                     healthcare systems around the world           that some programs have derived from
                                                     with an opportunity to adapt to the           putting them into practice.
                                                     changing needs of the patient, treat the   • Look to other industries to understand
                                                     disease sooner and create cost-cutting        how to market directly to patients and
                                                     measures by instituting alternate forms       deliver excellent customer-centric
                                                     of medicine or treatment. Key                 services.
                                                     recommendations are evident as the         • Collaborate in research projects to
                                                     health industry considers how to              boost personalised medicine research
                                                     respond to the emerging personalised          productivity and effectiveness as well
                                                     medicine market and explore                   as ensure that proper policy
                                                     sustainable business models.                  recommendations are developed to
                                                                                                   accelerate and support this emerging
                                                     Recommendations for providers/                market.
                                                     provider systems are as follows:           • Encourage collaboration between
                                                     • Learn genomics and proteomics to           personalised medicine experts and
                                                        develop effective prevention and           doctors with expertise in the field in
                                                        treatment plans.                           the development of new care models.

16     Personalised Medicine in European Hospitals
• Implement interoperable electronic          hospitals and providers to respond to the
   health records to enable the sharing of     changing market. Personalised medicine
   genomic, proteomic, and other health        can be set up and implemented into a
   data related to personalised medicine       hospital model in a variety of ways, as
   among research and healthcare               discussed in the interviews with several
   organisations.                              European hospitals in Part II of this
                                               document. As demonstrated through the
It is clear that key challenges exist as the   preceding “Hospital Spotlights”, many
pressure to be personalised continues to       European hospitals have already begun
mount. As evidenced through the above          to define what personalised medicine
recommendations, hospitals and                 means to their hospital and have
providers have a clear opportunity to          developed their approach to
adapt to the new healthcare paradigm           implementation.
and provide services that are targeted to
the individual patient. It is important to
recognise, however, that different
hospitals operate and require different
hospital models. Just as doctors will no
longer be able to apply the same forms of
treatment to a group of patients, not all
hospitals will be able to apply the same
approach to addressing the challenges
brought on by personalised medicine.
Fortunately, there are many ways for

                                                                                      Personalised Medicine in European Hospitals      17
Part II. Hospitals in focus
   List of Participating Hospitals
   Herlev Hospital / Copenhagen University Hospital at Herlev, Denmark
   Kuopio University Hospital, Finland
   University Hospital of Dijon, France
   Medical and Health Science Center University of Debrecen, Hungary
   University Medical Centre Ljubljana (UMCL), Slovenia
   Hospital Clinic de Barcelona, Spain

18     Personalised Medicine in European Hospitals
Copenhagen, Denmark.

Herlev Hospital/
Copenhagen
University
Hospital at Herlev
Denmark

Herlev Hospital (HEH) has for              treatment with trastuzumab.                     Clinical Biochemistry, Pathology,
several years focused on research for      Several units at HEH provide                    Radiology and Clinical Physiology.
better personalised medicine and           technical and logistical support to             HEH has several PET/CT, CT, MRI
has included new biomarkers in             research in personalised medicine.              and ultrasound scanners used in
routine clinical practice, e.g. analysis   These units help to improve the                 projects related to personalised
of KRAS mutation status in patients        effectiveness of the logistics                  medicine, e.g. early evaluation of
with colorectal cancer before              processes and research activities in            treatment response to new biologics
treatment with cetuximab and               the field of oncology, hematology,              for cancer patients.
analysis of HER2 protein expression        medicine, surgery and gynecology.
in patients with breast cancer before      The units include Departments of

                                            Type of Hospital       Public/Academic

                                                                   425,000 (700,000 in
                                            Reference Population
                                                                   certain specialities)

                                            Nº Beds                624

                                            Nº Employees           4,141

                                            Nº Physicians          768

                                            Nº Inpatient
                                                                   131,123
                                            Admissions
                                            Nº Day-Hospital
                                                                   426,379
                                            Admissions
                                            Nº Surgery
                                                                   20,400
                                            Procedures
                                            Hospital Annual
                                                                   3,008 mil DKR
                                            Revenues

                                           Interview with Julia S. Johansen,
                                           Professor, Senior Consultant, DMSc, Herlev Hospital

		                                                                                                         Hospitals in focus     19
Interview with Julia S. Johansen

   What do you believe to be the key trends related to the                What are the top five value propositions that
   implementation of personalised medicine within the                     personalised medicine may provide?
   hospital environment?
                                                                                                                 Feasibility/ Ease of             Time Horizon
   Danish patients and healthy subjects are willing to participate                Value Proposition
                                                                                                                  Implementation1
   in translational studies concerning improved personalised              Better clinical response                          1                         10 years
   medicine. The infrastructure and logistics are established for         Better survival                                   1                         15 years
   translational research at HEH. We mainly need further                  Reduce treatment failures                         1                         10 years
   support for hospital staff, researchers and operational costs          Reduce side effects                               1                         10 years
   for analysis studies in translational research.                        Decrease cost                                     1                         10 years
                                                                          1
                                                                              Each proposal is rated within a scale 1: high complexity and 5: low complexity

   How should the health system in your country lay the
   groundwork for the next steps in personalised                          What are the main barriers for the implementation of
   medicine?                                                              personalised medicine within the hospital
   Increase the amount of funding for specific studies related to         environment?
   translational medicine with a main focus on better                     Lack of research funding for better personalised medicine.
   personalised medicine.

   Description of personalised medicine approach in your hospital:

    Core Activity
    Diagnostics and           Many departments at HEH have a high focus on better diagnostics and therapeutics, e.g. cancer patients are
    Therapeutics              discussed at multidisciplinary team conferences (surgeons, oncologist, pathologists and radiologists).
    Personalised Medical Care
    EMR/Clinical
                              Conducted between departments and at multidisciplinary team conferences.
    Decision Support
                              Disease management is used in several departments, such as oncology, haematology, intensive care, surgery
    Disease Management
                              and medicine, paediatrics, and gynaecology. Personalised medical care is used in disease management.
    Telemedicine/Remote
                        Multidisciplinary teleconferences with other hospitals.
    Patient Monitoring
                              HEH participates in many research projects related to better personalised medicine that is funded by public
                              and private agencies.
                              The Copenhagen General Population Study is located at the Department of Clinical Biochemistry. This is
                              a blood biobank and research study which will follow about 100,000 volunteers, aged 20 years to 100 years,
                              from the Copenhagen area in Denmark. Today more than 60,000 volunteers are included. Initial enrolment
    Research/Expansion
                              is taking place at HEH, and the participants are followed yearly in the Danish Health registries thereafter.
    of Science-Base
                              The secretarial office of the Danish CancerBiobank is located at the Molecular Unit, Department of Pathology,
                              HEH. The objective of this biobank nationally is to collect blood and tissues optimal for translational research
                              from patients with primary cancer in order to, for example, improve personalised medicine. The project started
                              in January 2010, which included biological material from 5,281 patients in its first year. There is a connection
                              with the Danish nationwide clinical databases and other national registries.
                              The Experimental Cancer Therapy Unit, Department of Oncology at HEH has been involved in clinical
                              trials for more than 25 years. The department has broad experience with cytostatic drugs, biological and
                              anti-hormonal agents, dendritic cells, and intrahepatic chemotherapy. The Experimental Cancer Therapy
                              Unit was founded in 2004. Its core competency focuses on the planning, preparation and conduct of phase I
                              clinical trials in cancer patients as well as early phase II trials.
                              • The unit offers complete project and clinical trial management systems.
    Others
                              • The unit operates with ICH GCP and standards of the pharmaceutical industry, including standard
                                 operating procedures (SOP’s) covering all aspect of clinical trials.
                              • The unit complies with all current legal requirements and the EU Directive on Clinical Trials (Directive
                                 2001/20/EC & Directive 2005/28/EF).
                              • The unit has experience in design and administration of databases and the development of computerised
                                 trial management software.

20     Personalised Medicine in European Hospitals
Interview with Julia S. Johansen

                       •T he unit has experience in incorporation of health economics and quality-of-life measures.
                       •T he unit has a network of leading scientists and oncologists and collaborates with other phase I units in
                         Denmark and Europe.
                       A dedicated team, including research nurses, oncologists, and statisticians staffs the unit. The staff members
                       have a comprehensive experience in developing, planning, implementing and running a clinical trial, as well
Others
                       as conducting data management and statistical analysis. The staff members are trained in handling blood
                       samples for pharmacokinetics, pharmadynamics and translational research. Additionally, tissue sampling
                       may be added to the unit through the collaboration with the Department of Diagnostic Radiology and
                       various surgical departments. Furthermore, the unit has access to MRI, CT and PET-scans, and a variety of
                       other interventional diagnostic radiology and clinical physiological assessments.
Nutrition & Wellness
Nutrition/Organic      Several departments have focused on nutrition and physical activity to improve wellness and treatment of
Care                   patients.
Complementary &
                       N/A
Alternative Medicine

Others                 N/A

Other Related Products and Services

Stem Cells             N/A

                       The Clinical Research Unit, Department of Oncology, HEH has been involved in clinical trials for more than
                       25 years. The department has broad experience with cytostatic drugs, biological and anti-hormonal agents,
                       dendritic cells, and intrahepatic chemotherapy.
                       Clinical Research Unit was founded in 1992. The main objective of the unit is to conduct high-quality
                       research to achieve patient benefits. Its core competencies focus on the planning, preparation and
                       performance of phase I–III clinical trials in cancer patients.
                       •T he unit offers complete project and clinical trial management systems.
                       •T he unit operates with ICH GCP and standards of the pharmaceutical industry, including standard
                         operating procedures covering all aspect of clinical trials.
                       •T he unit complies with all current legal requirements and the EU Directive on Clinical Trials (Directive
                         2001/20/EC & Directive 2005/28/EF).
                       •T he unit has experience in the design and administration of databases and the development of
                         computerised trial management software.
                       •T he unit has experience in incorporation of health economics and quality-of-life measures.
Others                 •T he unit has expertise and computing facilities required to coordinate multicentre clinical trials.
                       •T he unit organises educational activities, including training courses and workshops.
                       •T he unit has a network of leading scientists and oncologists, including collaboration with other phase I
                         units in Denmark and Europe.
                       The unit collaborates closely with the Experimental Cancer Therapy Unit, a dedicated unit for
                       experimental cancer therapy and phase I trials. Furthermore, the unit has easy access to a basic science
                       laboratory and all facilities of a large centre.
                       A dedicated team, including research nurses, oncologists and statisticians staff the unit. The staff members
                       have comprehensive experience in developing, planning, implementing and running a clinical trial, as well
                       as conducting data management and statistical analysis. The staff members are trained to handle blood
                       samples for pharmacokinetics, pharmadynamics and translational research. Additionally, tissue sampling
                       may be added to the unit through the collaboration with the Department of Diagnostic Radiology and
                       various surgical departments. Lastly, the unit has access to MRI, CT and PET-scans, and a variety of other
                       interventional diagnostic radiology and clinical physiological assessments.

		                                                                                                              Hospitals in focus    21
Interview with Julia S. Johansen

   Where does your hospital stand on the                                      Which service lines, including clinical services as well
   implementation level of each activity?                                     as non-clinical services, related to personalised
                                                                              medicine are more developed in your hospital?
                                   Diagnostics and
                                    Therapeutics
                                                                              • Clinical chemistry: e.g. SNPs, genes, mRNA, microRNA,
                                       5
                                                                                 protein biomarkers
                                       4
                                                                              • Pathology: e.g. SNPs, genes, mRNA, microRNA, protein
       Nutrition / Organic                                  EMR / Clinical
               Care                                        Decision Support
                                                                                 biomarkers
                                       3
                                                                              • Radiology: CT, MRI, ultrasound
                                       2
                                                                              • Clinical Physiology: PET/CT
                                       1

                                       0                                      Policies and programs play an important role as an
       Other: The                                                  Disease    accelerator and regulator. What are the key
      Experimental                                               Management   personalised medicine enablers in your hospital
                                                                              environment?
                                                                              Herlev Hospital has for several years focused on research for
                   Research /
                                                     Telemedicine /           better personalised medicine and has rapidly incorporated
                  Expansion of
                                                     Remote Patient
                  Science-Base
                                                       Monitoring
                                                                              new biomarkers in routine clinical practice, e.g. analysis of
                                                                              KRAS and BRAF mutation status in patients with colorectal
    (0: Not applicable; 5: High development).
                                                                              cancer and melanoma before treatment with biologics and
                                                                              analysis of HER2 protein and FISH expression in patients with
   Do you have relationships or affiliations with other                       breast cancer before treatment with trastuzumab.
   sector organisations as it relates to personalised
   medicine (such as universities, IT companies,                              HEH participates in many research projects related to better
   government, biotech, etc.)? How do these                                   personalised medicine funded by the Hospital, and also by,
   relationships work?                                                        e.g. the Danish government, the Danish Cancer Society, the
   HEH is collaborating with several institutions for research                Danish Heart Association, the Danish Rheumatism
   purposes and treatment of patients. These institutions                     Association, Biotech Companies like Novo Nordisk, Roche,
   include:                                                                   Merck/Serono, Novartis and private foundations.
   • Other University Hospital in Denmark
   • Other universities in Denmark, the European Union, and the              The “Copenhagen General Population Study” is located at the
      United States                                                           Department of Clinical Biochemistry, HEH. This is a blood
   • T he Danish Technical University                                        biobank and research study which will follow 100,000
   • R ISØ, National Laboratory for Sustainable Energy                       volunteers, aged 20 years to 100 years, from the Copenhagen
   • Many biotech and pharmaceutical companies                               area in Denmark. Today more than 60,000 volunteers are
                                                                              included. Initial enrolment is taking place at HEH, and the
   Have you built a research centre that encompasses                          participants are followed yearly in the Danish Health
   personalised medicine?                                                     registries thereafter. Some of the expenses (e.g. salaries to
   The Clinical Research Unit, Department of Oncology, has a                  technicians and doctors, biomarker analysis) for this unique
   close collaboration with the Experimental Cancer Therapy                   biobank are paid by HEH.
   Unit, a dedicated unit for experimental cancer therapy and
   phase I trials. Furthermore, the unit has easy access to a basic           The secretarial office of the “Danish CancerBiobank” is
   science laboratory and all facilities of a large centre.                   located at the Molecular Unit, Department of Pathology, HEH.
                                                                              The objective of this biobank is to nationally collect blood and
   The units have access to MRI, CT and PET-scans, and a variety              tissues optimal for translational research from patients with
   of other interventional diagnostic radiology and clinical                  primary cancer in order to, for example, improve personalised
   physiological assessments.                                                 medicine. The project started in January 2010, and during the
                                                                              first year, biological material from 5,281 patients was
   Current status report on the integration of                                included. There is a connection with the Danish nationwide
   personalised medicine into actual clinical practice                        clinical databases and other national registries. Some of the
   within your hospital:                                                      expenses (e.g. salaries to technicians and doctors) for this
   Several tests for personalised medicine are used in daily                  unique biobank are paid by HEH.
   clinical practice (e.g. KRAS mutations, HER2 expression,
   molecular profiling in haematological disease).                            Several units at HEH provide technical and logistic support to
                                                                              research in personalised medicine and help to improve the

22     Personalised Medicine in European Hospitals
Interview with Julia S. Johansen

effectiveness of logistics processes and research activities in
the field of oncology, haematology, internal medicine, surgery
and gynaecology. The units include Departments of Clinical
Biochemistry, Pathology, Radiology and Clinical Physiology.
HEH has several PET/CT, CT, MRI and ultrasound scanners
used in projects related to personalised medicine, e.g. early
evaluation of treatment response to new biologics for cancer
patients. Technicians at the Department of Clinical
Biochemistry take many project-related blood samples from
healthy subjects and patients included in different projects,
without cost, at the same time as routine blood samples are
collected. This is also a benefit for the patients (they will not
have to give blood twice) with various types of diseases
included in different clinical studies (including biomarkers
studies of treatment response to, for example, biological
treatment of patients with cancer and inflammatory diseases).

What are the operational challenges you have
experienced in your hospital as it relates to
integrating personalised medicine?

              Dimension                     Challenges
Architecture and Equipment                Too little space
Services Offered                                 –
Clinical Activity                                –
Organisational Structure                         –
IT                                    Bad/slow in many areas
Financial                             Limited financial support
Research & Development                           –
Academic/Teaching activity                       –

How does personalised medicine impact on quality
measures in your hospital?
• Better survival
• Fewer side effects
• Shorter hospitalization                                          With any new technology or new initiative, there is an
• Cost                                                             adoption curve before the initial investment pays off.
• Patients are more satisfied                                      Where do you stand with personalised medicine on
                                                                    that curve?
Can you describe the basic infrastructure                           New technologies of initiatives for personalised medicine are
(technologies and tools) for the application of                     typically adopted as soon as they are introduced.
personalised medicine that exists in your hospital
today?                                                              Did personalised medicine impact the roles and
Several units at HEH provide technical and logistical support       responsibilities of your healthcare providers?
to research in personalised medicine. These units help to           Yes, very much. In recent years, the cost of new medicine, i.e.
improve the effectiveness of the logistics processes and            biologics like adalimumab and infliximab (for patients with
research activities in the field of oncology, haematology,          rheumatoid arthritis); trastuzumab (for patients with breast
medicine, surgery and gynaecology. The units include the            cancer); rituximab (for patients with lymphoma) and
Departments of Clinical Biochemistry, Pathology, Radiology          bevacizumab, cetuximab and panitumumab (for patients with
and Clinical Physiology. HEH has several PET/CT, CT, MRI            colorectal cancer) have increased dramatically during the last
and ultrasound scanners used in projects related to                 five to ten years. Unfortunately, less than 30% of the patients
personalised medicine. Early evaluation of treatment response       will benefit from the treatment since it is very expensive and
to new biologics for cancer patients is one example.                has severe side effects. The healthcare providers know very

		                                                                                                           Hospitals in focus     23
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