During the August Leadership Assembly at Vanderbilt University Medical Center, patients whose lives have been restored through personalized care shared their emotional stories, illustrating the Medical Center’s longtime commitment to use the latest advancements in genomic medicine as a powerful tool to tailor care to the individual.
Stephen Huff, a husband and teacher at Centennial High School, spoke passionately as he thanked physicians and staff with the Vanderbilt-Ingram Cancer Center for using genetic information about his tumor type to provide individualized treatment for a stage 4 lung cancer diagnosis he never anticipated — a therapy that allows him to get on with enjoying life.
“Because of this genetic mutation, my first treatment option was not chemo,” Huff said. “It was something I had never heard of — a targeted therapy. It’s an oral tablet that I take twice a day, with minimal side effects. It allows me to live just as normal a life as everyone else in this room here today. Each day I can wake up, drink my coffee, go on a walk with my dogs and do all those things that newly married couples do, like arguing about who’s going to fold the clothes and unload the dishwasher.
“Not only has my treatment given me the ability to live a completely normal life, it’s given me a new sense of hope. To me this is a miracle drug, and this is giving me precious time with my family and friends.”
Christine Lovly, MD, PhD, assistant professor of Medicine, began the assembly’s research focus immediately after Huff, remarking that his experience was a perfect example of the unique environment at VUMC that makes personalized care successful.
“What’s so special about working at Vanderbilt is that we have laboratory-based research that is often inspired by our patients,” Lovly said. “To be able to test a drug for the first time in the laboratory right above the clinic and then actually give that drug to patients in the clinic is amazing. There are few places that can really translate cutting-edge research right into clinical care.
“We actually developed a new precision medicine here at Vanderbilt for patients like Stephen and other patients who have this particular mutation. The drug was developed at Vanderbilt, and it was tested in a phase 1 and 2 trials here. Now, there is an international phase 3 study going on with this drug. So, it’s not just in our community to help our patients, but it’s available to patients throughout the world.”
While physician-scientists at VUMC continue to be leaders in personalized medicine, plans are also underway to build upon the successes of one of the Medical Center’s signature programs, PREDICT (Pharmacogenomic Resource for Enhanced Decisions in Care and Treatment), which uses genetic testing to predict responses to medications in order to individually target the best drugs and dosages to patients.
“We were the first medical center in the country to leverage the electronic health record to make it possible to obtain a DNA sequence and use that information to prescribe drugs in real time,” said Jeff Balser, MD, PhD, President and Chief Executive Officer of VUMC and Dean of Vanderbilt University School of Medicine.
“We were giving people a different dose or a different drug on the basis of their DNA sequence. In the past five years, we’ve actually done that for almost 15,000 patients, and we’ll be adding more drug-gene interactions for commonly used drugs, such as pain relievers like codeine and SSRIs used to treat anxiety and depression.”
Balser said that while personalized medicine can be defined as gene-targeted clinical therapies, other patients might define personalized care as the ability to easily schedule appointments in a reasonable period of time and to have convenient access to care close to home. For example, a new program called Fast Pass, available through the MyHealth at Vanderbilt online portal, sends patients a notification if an earlier clinic appointment becomes available.
The Medical Center is also adding much-needed space for both inpatient and community-based care.
“We opened the first large, new space in the adult hospital in years in June,” Balser said. “Medical Center East eighth floor opened on time and on budget just a few weeks ago with 30 inpatient beds. We’ve also done a lot of expansion in the outpatient venues. We have 27 locations now where people can go in the community for urgent care, and 14 of those are Walgreens-based clinics where we have our own staff seeing patients all over Nashville. We also have several new after hours and walk-in clinics, including ones in Belle Meade and West Meade, that people love.”
Future expansions to increase patients’ access to care include the addition of 14 new beds at Vanderbilt Psychiatric Hospital expected in June 2019, the major floor expansions opening at Monroe Carell Jr. Children’s Hospital at Vanderbilt also expected in June 2019, a pediatric outpatient surgical/specialty care facility opening in Murfreesboro in late 2019, and the opening of new clinical and procedural space at Vanderbilt Health One Hundred Oaks for pulmonary and gastrointestinal care.
During his presentation, C. Wright Pinson, MBA, MD, Deputy Chief Executive Officer and Chief Health System Officer, presented Pillar Goal performance summaries for fiscal year 2018 and introduced new fiscal year 2019 performance goals. As he reviewed goal performance during FY18, he pointed out that the launch of the eStar system had an expected negative impact, something other hospitals and health systems have experienced with similar launches.
“This was a big and tumultuous year for our health system,” he said. “While we accomplished many things in FY18, there were three daunting challenges. After more than two years of preparation, we implemented, in one day, the eStar system to all of our hospitals and clinics in multiple locations. We also had another successful Joint Commission Survey; we had 13 surveyors over five days, and well over 200 staff were actively involved.
“And we earned our third Magnet designation from the American Nurses Credentialing Center. Only the top seven percent of hospitals achieve Magnet designations, much less a three-peat. Thank you to all who turned these challenges into successes, all in just one year.”
The most impressive achievement was in the People Pillar in the areas of retention and engagement, Pinson said. Despite the year’s challenges, retention remained strong at 84 percent, and the nursing retention rate improved by 1.2 percent over last year.
In the Quality Pillar goal, Pinson singled out the 3 Round Wing team for exceptional performance in the area of hospital-acquired conditions.
“This team has gone more than five years without a catheter-associated urinary tract infection on their unit, and well over six years without a MRSA infection.”
In outlining fiscal year 2019 Pillar Goals, Pinson asked leaders to focus on three key areas: service as it relates to patient experience and access; increasing clinical volumes, especially those related to surgical and other procedures; and expense management.
“I want to thank you and your teams for your persistence and resilience during what was a very difficult year,” he added. “We faced many challenges and achieved many goals last year, and those position us well for the future.”
A surprise guest during the assembly was singer-songwriter Wade Hayes, who shared his story about being treated at VUMC not once, but twice, for stage 4 colon cancer after first being diagnosed in 2011 at age 42. One of Hayes’ physicians is oncologist Jordan Berlin, MD, who directly inspired the song Hayes performed on stage for the audience titled “Go Live Your Life.”
“I had no family history,” Hayes said. “I had no reason to have this awful disease, but I had it. After my second bout with cancer, we were sitting in Dr. Berlin’s office, and he looked at me and told me some words I will never forget as long as I live. Words that hit me like a ton of bricks. He said, ‘You need to go live your life.’ What Dr. Berlin was telling me was that I was stage 4, and now there was no evidence of the disease. That’s kind of a big deal. But he was also telling me, ‘You were stage 4, this could come back at any time, and you need to go live your life.
“I went home, and his words affected me so much that I had to write about it. I’ve learned that this life is a precious gift and to not take it for granted. We’re not guaranteed tomorrow. I will tell you like he told me, Folks, go love those ones you love, make sure they know it and appreciate this gift that you have. And go live your life.”