Intelligent Health Lab

Next-Generation Registries: Fusion of Data for Care and Research

Kenneth D. Mandl, MD, MPH Director, Intelligent Health Laboratory Childrens Hospital Informatics Program Center for Biomedical Informatics, Harvard

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US Spending per capita vs. Life Expectancy

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Rapid Learning Network: Evidence Generated from a Well-Instrumented Health System

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As per the previous National Coordinator . . . l New England Journal of Med 2008: Low uptake of HIT in ambulatory setting l New England Journal of Med 2009 Low uptake in of HIT in hospitals

Conclusion: $48B
investment, pushing the technology

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Yearly trends in MI Partners Healthcare (1997-2005)

PLoS One 2007

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Monthly trends in Myocardial Infarction: Sudden Increase

Introduction of COX-2 Inhibitors

18.5% Increase

PLoS One 2007

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Signal Detection

First signal: l 1 year after Celecoxib l 8 months after Rofecoxib

PLoS One 2007

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l For every million prescriptions, 0.5% increase in MI (95%CI 0.1 to 0.9) l 50.3% of the deviance explained

PLoS One 2007

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What do we not know? l Full medication list l Complete history from across sites of care l Symptoms/effects not resulting in a healthcare visit l Functional status improvement for patients on COX-2 l Pain relief for patients on COX-2

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Intelligent Health Laboratory | Childrens Hospital Informatics Program

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l Ambient data from the health care system l Data acquired directly from patients l Meticulously collected data

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Stephen Edge, MD Roswell Park Cancer Center Marc D. Natter, MD, MPH Boston Childrens Hospital Chad Malone, MD Remedy Informatics Keith Marsolo, PhD Cincinnati Childrens Hospital Medical Center