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Intelligent Health Lab

Kenneth D. Mandl, MD, MPH

Director, Intelligent Health LaboratoryChildrens Hospital Informatics Program

Center for Biomedical Informatics, Harvard

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

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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 ofHIT in ambulatory setting

l New England Journal of Med 2009 Low uptake in ofHIT in hospitals

Conclusion: $48Binvestment, pushingthe technology

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Yearly trends in MI

Partners Healthcare (1997-2005)

PLoS One 2007

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Intelligent Health Lab

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 afterCelecoxib

l 8 months afterRofecoxib

PLoS One 2007

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l For every millionprescriptions, 0.5%

increase in MI(95%CI 0.1 to 0.9)

l 50.3% of thedeviance explained

PLoS One 2007

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What do we not know?

l Full medication listl Complete history from across sites of carel Symptoms/effects not resulting in a healthcare visitl Functional status improvement for patients on COX-2l Pain relief for patients on COX-2

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Intelligent Health Laboratory | Childrens Hospital Informatics

Program

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lAmbient data from the health care systemlData acquired directly from patientslMeticulously collected data

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Intelligent Health Lab

Stephen Edge, MDRoswell Park Cancer Center

Marc D. Natter, MD, MPH

Boston Childrens Hospital

Chad Malone, MD

Remedy Informatics

Keith Marsolo, PhD

Cincinnati Childrens Hospital Medical Center