The Discipline of Informatics Brian J Wells, MD, PhD Wake Forest Baptist Medical Center Who are you? Participant Demographics, Goals and Ideas for Future Research Wake Forest Baptist Medical Center Demographics 35 enrolled 9 junior faculty (Instructors, Assistant Professors) 1 KL2 Scholar 2 Translational Research Academy Scholars 16 PhDs 11 MDs 3 Wake Forest Baptist Medical Center Roster 4 NameDepartment Ralph DAgostinoBiostatistical Sciences Angie AlmondPediatrics Walter AmbrosiusBiostatistical Sciences Peter AntinozziBiochemistry Don BabcockEnterprise Information Management Rita BakhruPulmonary Brian HiestandEmergency Medicine Cheryl BushnellNeurology Claudia CamposInternal Medicine Arjun ChatterjeePulmonary Wei ChenDiagnostic Radiology Clancy ClarkSurgical Oncology NameDepartment Pamela DuncanNeurology Chuan GaoGenomics & Personalized Medicine Dianne JohnsonLibrary Kristen JordanWake Forest Innovations Mark McKoneLibrary Akiva MintzDiagnostic Radiology Shadi QasemPathology Thomas ReeveResident Lindsay ReynoldsEpidemiology Julia RobertsonPHS Scott RushingPHS Georgia SaylorCardiology Wake Forest Baptist Medical Center Roster (cont.) 5 NameDepartment Beverly SnivelyBiostatistical Sciences Eunyoung SongSocial Sciences Jing SuDiagnostic Radiology Keri TabbBiochemistry Umit TopalogluCancer Biology Becca UrResident Jillian UrbanBiomedical Engineering Nadeem WajihMicrobiology & Immunology Steve WalkerWFIRM Kathryn WeaverSocial Sciences Wesley WillefordInternal Medicine Wake Forest Baptist Medical Center What do you want to gain from this course? An understanding of the clinical informatics field today Use of Big Data in research Use and implementation of mobile health technology Informatics tools and resources available at WFBMC Developing Clinical Decision Support tools 6 Wake Forest Baptist Medical Center What ideas do you have for using clinical informatics in future research? Develop CDS tool for early mobilization of critically ill patients Analyze cohort data with high degrees of data error and missing data to model healthcare utilization and outcomes Establish platform to include the EHR into our analysis and conducting GWAS (genome-wide association analysis) in parallel with PheWAS (phenome-wide association analysis) Develop CDS from the available gene panel data Enhance a cardiac risk factor visualization tool for use with cancer survivors. The tool will integrate with the EHR and patient portals to collect risk factor and relevant cancer information and visualize risk information for patients and providers. 7 Wake Forest Baptist Medical Center FLOPS Floating-point Operations per Second Iphone 6 = 115 GFLOPS Cost of 1 GigaFlop in 2013 USD 2013 = $ = $1 thousand 1985 = $42 million 1961 = $8.3 trillion Commodore 64 = 0.43 MIPS Intel i7 processor = 188,502 MIPS 10 11 Wake Forest Baptist Medical Center Rand Survey of Physician Satisfaction with EHRs in % felt that EHRs improved quality 1/3 had improved satisfaction 1/5 would go back to paper 85% spend more time on notes 2/3 seeing fewer patients. 12 Wake Forest Baptist Medical Center Biomedical Informatics The interdisciplinary field that studies and pursues the effective uses of biomedical data, information, and knowledge for scientific inquiry, problem solving and decision making, motivated by efforts to improve human health - American Medical Informatics Association Wake Forest Baptist Medical Center Shortliffe definition Basic Biomedical Science Primary Genomics/Proteomics Translational Studies, Animals Translational Studies, Humans Clinical Trials Epidemiology & Health Services Translating Research Findings Into Practice Practice Improvement Studies Population Health Research T1 T2 T3T4 Biomedical Informatics Clinical Informatics Affinity Group Wake Forest Baptist Medical Center Key components of Clinical Informatics Collection, processing, storage, and analysis of data Making better healthcare decisions Goal of improving human health Implementation of clinical decision support tools at the point of care. Wake Forest Baptist Medical Center Distinctions Not IT, but depends on IT Not computer repair, but requires good hardware and software Capture/processing of data Analysis of data Decision science Creation of tools Implementation Wake Forest Baptist Medical Center Why is the field of informatics necessary? Rapid, Accelerating, Expansion of data Important bridge between related fields Statistics Information Technology Decision science Library Sciences Mathematics Implementaion Science Wake Forest Baptist Medical Center World Data Storage 1 Exabyte = bytes =1 billion GB 500 EB of new data in 2015 alone YearStorage Wake Forest Baptist Medical Center Data sources EHR Structured (400 orders in 3 day admission) Unstructured Images, digital/analog data from ancillary systems, Pharmacy (12,000 meds per day at UCSF) GIS (Census) Claims Patient reported outcomes Social Media Credit Reports Genomic data Survey data Death Index etc Personal health devices Pedometers Glucometers Scales Sphygmomanometers Literature: 2,100 new articles per day Wake Forest Baptist Medical Center SNP Chips HumanOmni2.5-8 (Illumina) 2.5 million SNPs Axiom Genome-Wide (Affymetrix) 600k (cheaper, different versions for different ethnicities) Cost Around $500 each ~ 150,000 patients in the Vanderbilt Biovu Opt out arrangement Wake Forest Baptist Medical Center Genetic Data 1 genome contains 3.2 billion bases of DNA Single Nucleotide Polymorphisms (SNPs) single base changes in the DNA code Occur ~ every 300 bases (85 million) Genome Wide Association Study look for SNPs associated with disease SNP-chip look at several hundred thousand SNPs across the genome Wake Forest Baptist Medical Center Big Data High-volume, high-velocity and/or high-variety information assets that demand cost-effective, innovative forms of information processing that enable enhanced insight, decision making, and process automation. - Gartner Consulting 25 Wake Forest Baptist Medical Center Big Data Broad term for data sets so large or complex that traditional data processing applications are inadequate Predictive analytics Disparate data sources Requires new data storage formats Requires new hardware / software Requires interoperability Requires types of statistical analyses Wake Forest Baptist Medical Center Why has medicine been slow to harness big data? Lack of electronic record systems Lack of structured data Missing data Disparate data sources Lack of standardization Lack of interoperability Massive files Images, genetic data Analog wave forms Confidentiality concerns Unwillingness to accept predictive analytics Wake Forest Baptist Medical Center Incentives for EHR 10% of hospitals use an EHR 2014 70% of hospitals use an EHR Wake Forest Baptist Medical Center Meaningful Use Wake Forest Baptist Medical Center Argument for Govt Role in Health IT Failure of market to computerize Cost of EHR born by hospitals and providers while benefitting insurers 2/3 of the US cared for by independent physicians Interoperability is a public good Vendors and hospitals are not motivated to make things interoperable because that makes customers easier to switch 30 31 Wake Forest Baptist Medical Center Barriers to Creating a learning Healthcare system Data completeness and quality Physician resistance Difficulties with implementation of simple tools at the point of care Inadequate utilization of midlevel providers and other resources Lack of patient involvement Guidelines based on categories instead of absolute risk Lack of physician understanding Wake Forest Baptist Medical Center Lack of Structure Wake Forest Baptist Medical Center Interoperability Wake Forest Baptist Medical Center HL7 Wake Forest Baptist Medical Center Implementation 39 Wake Forest Baptist Medical Center Resistance to using Predictions Wake Forest Baptist Medical Center Missing Data Wake Forest Baptist Medical Center Missing Data Missing Information Wake Forest Baptist Medical Center Data structures Data Base Management Systems (e.g. oracle, SQL server) Normalized Hadoop (open source Apache product) Hadoop Distributed File System (HDFS) MapReduce - processing Wake Forest Baptist Medical Center Analysis of Big Data Much less case control studies Cohort studies Time-dependent analyses Dynamic Survival Models Machine Learning Hard to do backward stepwise Lasso and Elastic net are faster Wake Forest Baptist Medical Center Machine learning Sometimes what people mean when they say predictive analytics or predictive modeling Still requires some supervision Prone to overfitting Approaches ANN, decision trees, Bayesian networks Examples Spam filtering OCR Google search engine Wake Forest Baptist Medical Center Key Terms and ACRONYMS CDSS Clinical Decision Support Systems AMIA - American Medical Informatics Association EHR Electronic health records UMLS Unified Medical Language System RX NORM I2b2 Informatics for Integrating Biology and the Bedside CDM Common Data Model Wake Forest Baptist Medical Center Organizations American Medical Informatics Association (AMIA) - JAMIA Society of Medical Decision Making (SMDM) - SMDM International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Value in Health Academy Health EDM Forum Generating Evidence & Methods to improve patient outcomes (eGEMS) Healthcare Information and Management Systems (HIMSS) Agency for Healthcare Research and Quality (AHRQ) National Library of Medicine 47 Wake Forest Baptist Medical Center The END Wake Forest Baptist Medical Center EPIC Chronicles Clarity Enterprise Data Warehouse (EDW) Translational Data Warehouse (TDW) Providers patients i2b2 Registries Carolina Collaborative Harvard PCORI Shrine Vital statistics GIS PI defined Ontology mappings Self service Reporting workbench Data Team Pharmacy Labs Radiology Centricity Pulse Star Slicer Dicer