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that leverage data sets being created during the course of standard-of-care
activities
;
The rapid and cyclical feedback of observations, fi ndings, and evidence between
clinical care and research teams, utilizing the aforementioned capabilities
;
and
The rationalization of regulatory frameworks and policies so as to maximize the
balance between clinical, research, and patient privacy/confi dentiality needs in
an equitable, transparent, resource effi cient, and timely manner.
When viewed collectively, these dimensions that serve to characterize LHCs are
predicated on an emerging model in which research and clinical care are both inexo-
rably and desirably intertwined, and where barriers between such activities are miti-
gated or removed. Further, in the LHC construct, there is a fundamental transition
away from a unidirectional model in which research informs practice (evidence
based practice or EBM), and towards a bi-directional or cyclical model in which
practice informs research that in turn informs practice (which can be described as
evidence generating medicine or EGM). This new approach can be thought of as
enabling a model in which every patient encounter is an opportunity to improve the
care of that patient, their family, and their community, by bringing together health
and wellness care with the best possible and appropriately contextualized science,
and by recognizing and valuing the role of clinicians, researchers, patients, and their
communities as equal partners in such an endeavor.
1.3.2
The Evolution of Precision or Personalized Medicine
The objective of precision medicine is to ensure that each patient has the best clini-
cal outcome by tailoring both preventative measures and treatments to meet his or
her unique needs and characteristics. Achieving such a vision requires not only the
collection and application of the best possible data, information, and knowledge
during each patient encounter, but also, learning from each encounter and engaging
patients and their families in the healthcare process, as has been described previ-
ously in the context of the emerging LHC model. An innovative and paradigm-
shifting approach to conceptualizing precision medicine has been described by
Weston and Hood using the moniker of “P4 Medicine” - where it was proposed that
our fundamental approach to disease prevention, diagnosis, and treatment must
transition from being a primarily reactive model to one that is predictive, personal-
ized, preventive and participatory [
11
]. In this model, it is envisioned that our fun-
damental approach to the delivery of healthcare will be shifted from an emphasis on
treating illness to the early and continuous prevention of disease and the promotion
of wellness. Furthermore, under this paradigm, the patient becomes an integral part
of the healthcare delivery ecosystem, taking an active role in the identifi cation and
modifi cation of disease-related risk factors, while also assuming responsibility for
critical aspects of their ongoing care (moving from being a passive consumer of
clinical care to an active member of the overall healthcare team). Unfortunately, it
is widely noted that the current healthcare delivery workfl ows (including essential
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