Synthetic Patient Populations: Challenges and

Opportunities
Philip R.O. Payne, Ph.D.
Associate Professor & Chair, Biomedical Informatics
Executive Director, Center for IT Innovation in Healthcare
Co-Director, Biomedical Informatics Program, Center for Clinical and Translational Science
Co-Director, Biomedical Informatics Shared Resource, Comprehensive Cancer Center
Overview

1. Motivation
• Barriers to secondary use
• The role of synthetic patient populations
1. Challenges and Opportunities
• Creating synthetic patient populations
• Use cases
• Challenges
1. Discussion
Overview

1. Motivation
• Barriers to secondary use
• The role of synthetic patient populations
1. Challenges and Opportunities
• Creating synthetic patient populations
• Use cases
• Challenges
1. Discussion
Significant Barriers to Secondary Use

If Successfully
Overcome
The Alternative: Synthetic Populations
 Multiple types of synthesis
 De-identified
 Anonymous Hybrid Approaches
 Imputed
 Computer-generated

 Potential use cases

 Research
 Education
 Software Development
 Many others…
Asking and Answering Questions:
Leveraging Synthetic Populations

 Given representative population

characteristics, what is the
feasibility of a given study design?
 How do changing demographics
effect the quality or costs of care?
 What is the potential impact on
clinical outcomes of a planned
decision support intervention?
 What types of data are critical to
supporting care coordination
across multi-disciplinary teams?
Overview

1. Motivation
• Barriers to secondary use
• The role of synthetic patient populations
1. Challenges and Opportunities
• Creating synthetic patient populations
• Use cases
• Challenges
1. Discussion
Building Synthetic Populations

Demonstrate
Conformance

Satisfy
Requirements

Inform
Requirements
Methodological Approaches
 Derivation from “real world” data
 De-identification or Anonymization
 “Scrubbing”
 Regulatory and/or statistical de-identification principles
 White space vs. black space
 Quantitative imputation
 Discrete data types
 Multi-modal approaches
 Simulation(s)
 Multiple computational methods
 Derivation of parameters?
Use Case: Creating a Virtual EHR @ OSUMC
Exemplary Use Cases @ OSUMC
Use Case Description
Education Development of clinical case studies for training
multi-disciplinary teams of medical, nursing, and
allied-health students. Case study exercises include
both individual and population-level scenarios.

Research Iterative modeling of clinical trial structure (e.g.,

eligibility criteria, experimental design) in a
representative patient population in order to assess
feasibility and project accrual/completion timelines.

Software Development Design, implementation, and testing of knowledge

discovery pipeline, allowing for full access to “EHR-
like” data by software engineers without risks to
patient confidentiality.
Town of Mirror Lake
 Representative
virtual community
 Population equivalent
to 1Y of patient
encounters
 Familial cohorts
 Iterative updates
 Maintains temporal
interviews
 Delivery via OSUMC
New Applications:
EHR platform •Feasibility Analyses
 Interfaces •Simulated Trials (Hypothesis Generation)
 Query and reporting • Pharmacogenomics
tools • Outcomes Research
Challenges
 Regulatory approval for extraction and
anonymization of data set from EDW
• Ability to refresh data on a regular basis
 Omission of clinical narrative text
 Homogeneity of imputed “patients” in synthetic
population
 Costs of duplicate EHR environment
• Use of low-cost alternative to operational EHR
• Dependent on extramural funding
• Creates complex ownership and stake-holder engagement
issues
 Efficacy of use cases is currently unknown
• Funded initially to support educational use case
Lessons Learned @ OSUMC
 Need for champions
 Close coordination of clinical care providers,
researchers, educators, and informaticians is critical
 Detailed use cases are central to project success
 Using the right tool for the right job
 Synthetic populations are not the right tool for every job
 Selection of appropriate methods are critical
 Costs of large-scale efforts in this area are
significant and ongoing
 The use of synthetic populations simplifies but does
note eliminate regulatory barriers
Overview

1. Motivation
• Barriers to secondary use
• The role of synthetic patient populations
1. Challenges and Opportunities
• Creating synthetic patient populations
• Use cases
• Challenges
1. Discussion
The Big Picture: Informatics, Personalized
Medicine, and Evidence Generation
 Challenges:
• Capture, representation and
management of high-throughput,
multi-dimensional data
• Phenotype
• Bio-molecular markers
• Environmental factors
• Patient-reported data
• Reasoning
• Hypothesis generation
• Decision support
• Rapid execution of research

Common Theme: Comprehensive Access to Large Scale Data

 Informatics as The Engine for Evidence Generation
 Gender
 Ethnicity Synthetic
 Age Data ?
 Biological Models  Weight
 Technologies  Diagnosis
 Algorithms  Medical History

Synthetic Integration, Management,

Data ? Analysis, and Dissemination  Literature
 Databases
 Lab Tests  Terminologies
 Genes  Ontologies
 Proteins

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Questions or comments?

Getting in touch:
•philip.payne@osumc.edu
•http://bmi.osu.edu/~payne