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Peter Embi: Leveraging Informatics to Create a Learning Health System

Presentación del Dr. Peter Embi, Presidente y CEO del Regenstrief Institute, en el marco del Primer Simposio Salud: Nuevas Tecnologías, Avances y Desafíos, realizado en Santiago de Chile los días 18 y 19 de julio, 2017

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Peter Embi: Leveraging Informatics to Create a Learning Health System

  1. 1. Leveraging Informatics to Create a Learning Health System Peter J. Embi, MD, MS, FACP, FACMI President and CEO, Regenstrief Institute Sam Regenstrief Professor of Medicine Associate Dean for Informatics and Health Services Research Vice-President for Learning Health Systems, IU Health July 19, 2017 Santiago, Chile
  2. 2. Applying and Generating Evidence • Goal of Health Informatics and Health IT • To improve human health • Healthcare, population health, and research • Focus of clinicians, hospitals, clinics, payors • “Research” = our evidence base • Aspects of “research” at the “point-of-care” • Two main aspects to this: • 1. Delivering knowledge to point-of-care • 2. To practice EBM, must generate evidence • Multiple initiatives in USA focused on this… • Precision Medicine, Cancer “moonshot”, Patient-centered outcomes research initiatives (PCORI), etc.
  3. 3. Data relevant to health • Data relevant to health largely beyond traditionally collected healthcare data
  4. 4. Source: What Makes Us Healthy versus What We Spend on Being Healthy. Bipartisan Policy Center. (2017, April 20). Retrieved from https://bipartisanpolicy.org/library/what-makes- us-healthy-vs-what-we-spend-on-being-healthy/
  5. 5. Exposome Inforamtics • Environment’s contribution to health has been conceptualized as the exposome. • Determinant potential of physio-pathological processes rising as data increasingly available • The growth of miniaturized sensing devices • Accessible, affordable, expanding • Biomedical informatics must provide a coherent framework for dealing with multi-scale population data including: • Phenome, Genome, Exposome, and their interconnections. From: MICHAEL WARAKSA: MAPPING THE EXPOSOME
  6. 6. Exposome informatics: considerations for the design of future biomedical research information systems (Sanchez FM, et al. JAMIA. 2014.)
  7. 7. Exposome informatics: considerations for the design of future biomedical research information systems (Sanchez FM, et al. JAMIA. 2014.)
  8. 8. Framing data sources by dimensions of “bigness” (Weber G, et al. JAMA 2014)
  9. 9. From: An informatics research agenda to support precision medicine: seven key areas J Am Med Inform Assoc. 2016;23(4):791-795. doi:10.1093/jamia/ocv213
  10. 10. Challenges to a “Learning Health System” • Leveraging existing data for research and Quality–opportunities • Clinical phenotype and outcomes • Administrative and fiscal variables • Bio-molecular markers • Patient-reported variables • Data often collected, stored for clinical care, administrative, not research purposes • Data often incomplete, unreliable • Key data often stored narratively, not discretely • Data often difficult to access • Research often requires integration across sites • Informatics efforts address some of these…
  11. 11. Efforts to address challenges – Learn as we go  Initiatives aim to leverage digital clinical data for research and improvement  EHR implementation and meaningful use  Data Warehousing Efforts  Registries and Data Networks  Health Information Exchanges  Outcomes and CER initiatives  Many engaging practitioners and leverage EHRs, data for research  Progress being made, but remains very challenging • Many, not all challenges are “technical” • Many socio-organizational, regulatory, cultural • Make leveraging existing systems for research difficult • Embedding “learning” into systems/workflow, a major challenge
  12. 12. The Current Research-Practice Paradigm and a Learning Health System • Challenge and opportunities today • Informed by EBM: • Clinical care and research are distinct activities • Activities overlap mainly at application of evidence • Information flow/influence is unidirectional • Research influences Practice (e.g. EBM) • We know this is no longer the case, but • Persistence of this paradigm impedes progress Research EBM
  13. 13. Traditional path from generation of evidence to its application Haynes, B. et al. BMJ 1998;317:273-276
  14. 14. Research-Practice Paradigm – EBM+EGM • Clinical care activities not entirely distinct from research activities • Must consider EGM when we practice to advance science and care • Many EGM activities ongoing and need support to achieve goals • Advancing EGM is critical to completing the EBM lifecycle • Multiples enabling factors and stakeholders key to making this reality Embi PJ and Payne PR. Medical Care. Aug 2013
  15. 15. National Health IT for a Learning Health System “A nationwide network. Meaningful use of EHRs, widespread participation by multiple diverse entities, and an appropriate technical architecture can spur the construction of a highly participatory rapid learning system that stretches from coast to coast.” Friedman CP et al. Sci Transl Med 2010
  16. 16. Learning Systems… Smoyer, Embi, Moffat-Bruce. JAMA 2016
  17. 17. Local Learning Health System Informatics & Health IT People & Cultural Issues Fiscal & Incentives Systems & Workflow issues Local Learning Health System Local Learning Health System Local Learning Health System Realizing Evidence Generating Medicine to Enable the Learning Health System
  18. 18. Scholarly and Operational Emphasis Areas 1) Studying linkages between molecules and populations 2) Developing tools and methods to enable “evidence generating medicine” paradigm 3) Building bridges to the health system 4) Implementing and studying solutions in the healthcare delivery environment and working with IT in order to do so Embi, Peter J., Payne, Philip R.O. "Evidence generating medicine: redefining the research-practice relationship to complete the evidence cycle." Medical care 51 (2013): S87-S91.
  19. 19. Virtuous Cycle of Evidence Generation and Application Embi, Peter J., Payne, Philip R.O. "Evidence generating medicine: redefining the research-practice relationship to complete the evidence cycle." Medical care 51 (2013): S87-S91.
  20. 20. Realizing EGM/LHS: Informatics can help enable • There are challenges to overcome • Tools for advancing point-of-care EGM limited • Work with EHRs to develop better approaches • Data quality often inadequate • Work with practitioners, patients and systems • Systems and regulations often developed and implemented with little-no concern for research implications • Informaticians, clinicians, researchers need to be involved in design/implementation • Socio-organizational…
  21. 21. Advancing EGM: Socio-organizational issues & EGM • Information issues only part of the solution • Must consider issues at several levels • Policy level • Systems level • Individual level • By valuing EGM as part of Evidence cycle, we can begin to assure proper alignment of goals and systems Policy: Local, Regulatory, Payment Alignment Systems: Hospitals, Practices, Vendors Individual/Community: Public, Patients, Physicians, Nurses
  22. 22. Leverage Informatics to Create a Learning Health System • As Informaticians, we must support EGM • Need to study how to enable EGM • Design and develop systems/approaches that facilitate practice and learning • Train informatics/healthcare workforce to do this routinely • Create a virtuous cycle of activities to advance healthcare, quality and research – powered by Informatics… Embi, Peter J., Payne, Philip R.O. "Evidence generating medicine: redefining the research-practice relationship to complete the evidence cycle." Medical care 51 (2013): S87-S91.
  23. 23. Muchas Gracias! Peter J. Embi, MD, MS pembi@regenstrief.org @embimd

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  • carolhullin

    Aug. 1, 2017

Presentación del Dr. Peter Embi, Presidente y CEO del Regenstrief Institute, en el marco del Primer Simposio Salud: Nuevas Tecnologías, Avances y Desafíos, realizado en Santiago de Chile los días 18 y 19 de julio, 2017

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