Fostering innovation in medicine and health care: what must academic health centers do?

There is a real need for innovation in health care delivery, as well as in medicine, to address related challenges of access, quality, and affordability through new and creative approaches. Health care environments must foster innovation, not just allowing it but actively encouraging it to happen anywhere and at every level in health care and medicine-from the laboratory, to the operating room, bedside, and clinics. This paper reviews the essential elements and environmental factors important for health-related innovation to flourish in academic health systems.The authors maintain that innovation must be actively cultivated by teaching it, creating "space" for and supporting it, and providing opportunities for its implementation. The authors seek to show the importance of these three fundamental principles and how they can be implemented, highlighting examples from across the country and their own institution.Health innovation cannot be relegated to a second-class status by the urgency of day-to-day operations, patient care, and the requirements of traditional research. Innovation needs to be elevated to a committed endeavor and become a part of an organization's culture, particularly in academic health centers.

Perspective: Prospective health care and the role of academic medicine: lead, follow, or get out of the way.

The authors contend that the crisis facing the U.S. health care system is in large part a consequence of that system's disease-oriented, reactive, and sporadic approach to care, and they suggest that a prospective approach to health care, which emphasizes personalized medicine and strategic health planning, would be a more rational way to prevent disease and maximize health. During recent years, personalized, predictive, preventive, and participatory medicine--that is, prospective care--has been receiving increasing attention as a solution to the U.S. health care crisis. Advocacy has been mainly from industry, government, large employers, and private insurers. However, academic medicine, as a whole, has not played a leading role in this movement. The authors believe that academic medicine has the opportunity and responsibility to play a far greater role in the conception and development of better models to deliver health care. In doing so, it could lead the transformation of today's dysfunctional system of medical care to that of a prospective approach that emphasizes personalization, prediction, prevention, and patient participation. Absent contributing to improving how care is delivered, academic medicine's leadership in our nation's health will be bypassed.

Proposal for a new health record to support personalized, predictive, preventative and participatory medicine.

Today's approach to patient care and the medical record that directs and documents it is largely focused on identifying and treating the patient's disease. This has resulted in a sporadic, reactive healthcare system. Shifting medicine's focus to personalized strategic health planning will require a new approach to the patient 'work-up', a new relationship between the patient and the provider and a new medical record to support it. A prospective health record should be developed to enable personalized and preventative strategies, including assessment of health risks, evaluation of current health status, tracking of disease pathogenesis, prediction of disease events and long-term planning for maintaining wellness and limiting disease. The record should utilize emerging technologies to track predictive clinical risk factors, thereby enabling preventative responses and personalized medicine.