Public Health

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Feb 21, 2013 (4 years and 8 months ago)

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Mark Hoffman, Ph.D.

Vice President Research Solutions

Cerner Corporation

Sept 2, 2011


Shawnee Mission South

Bio
-
sketch


Raytown South High School 1987


BA
-

William Jewell College 1991


Oxford University 1990


Ph.D.
-

University of Wisconsin 1996


1994 internship at DNAStar


Postdoctoral training


National Animal
Disease Center (USDA) 1996
-
1997


High school


Science Honor Society


Knowledge Bowl


Equal interest in science and social
studies


William Jewell College


Oxbridge Honors Program


Molecular Biology Major


Semester in England studying bioethics


Electives in political science


Cold War politics


International relations


Undergraduate summers


UMKC


Learned how to do basic Microbiology tasks


KU


Learned biochemical techniques


Protein purification


Small research problems


Refolding of purified proteins


JC Penney commission sales

University of Wisconsin


Department of Bacteriology


Funded by biotechnology training program


NIH program provides tuition and stipend for
first 3 years


Requires internship in industry


Coursework outside major

Graduate school


Years 1
-
2


Classes


Identify research project


Preliminary exams


Years 3


x


Research


Publications


Write thesis


Defend thesis

Staphylococcal enterotoxin A


Causes food poisoning


Activates immune system through unusual
mechanism


Are the two related?


Rhesus monkey umbilical cord

blood stimulation assay

Molecular modeling


Sites associated with vomiting

Sites associated with


immune activity

Internship


DNAStar


Developed programs that perform DNA
and protein sequence analysis


Immunology related algorithms to predict
immunogenic epitopes in proteins


Rational vaccine design



NADC


National Animal Disease Center


USDA


Ames, Iowa


Research on diseases of importance to
agriculture and human food safety


Biosecurity level 2 and 3 barns


EC 0157:H7


E. coli

O157:H7


Causes enterohemorrhagic colitis


7% of cases progress to hemolytic uremic
syndrome


Live oral vaccination



Clin. Diag. Immun. 1998 5:242
-
246

Cerner


Early Career


Software developer for Microbiology team


Respond to issues


Write programs


Team leader


Responsibilities above + lead team


Architect


Design complex solutions


Solution Manager

Our Vision


Begin where
you

want to end:


Automate
enterprise
workflow


Connect the
community


Structure and
analyze


Create
executable
knowledge



The objective:


close the loop



Critical Decisions

.

Cerner Solutions Portfolio

©2003 Cerner Corporation. All rights reserved. This document contains confidential information which may not be reproduced o
r t
ransmitted without the expressed written consent of Cerner.

Version 3.0


Community &

Consumer Systems

Physician

Portal

PowerLink

Consumer

Relationship

Management


Condition

Centers


Call Center

Bio
-
Surveillance

HealthSentry

Specialty

Care Systems



Cardiology

CVNet



Oncology

PowerChart

Oncology


Women’s

Health

Children’s

Orthopedics

Pulmonology

Home Health

ProCall

Clinical

Center Systems

Clinical Trials

Laboratory

PathNet

Radiology

RadNet


Image

Management

Cerner ProVision


Pharmacy

PharmNet

Financial & Operational

Systems

Patient

Accounting

ProFit

Cost

Accounting

Supply Chain

ProCure

Health

Info. Mgmt.

ProFile

Workforce

Management

Outcomes

Measurement

PowerInsight

Comparative

Data

HealthFacts

Knowledge
-
Driven

Care Solutions


Decision

Support Engine

Discern Expert



Reporting

Discern Explorer

PowerVision


Outcomes &

Benchmarking

Cerner APACHE

Drug

Database

Cerner Multum

Referential

Knowledge

Zynx


Executable

Knowledge


Direct

Care Systems



EMR

PowerChart

CDR



Ambulatory

Care

PowerChart Office


Emergency

FirstNet




Critical Care

INet



Surgery &

Anesthesia

SurgiNet



Acute Care

CareNet

PowerOrders




Plans &

Protocol Mgmt.

PowerPlan


Multi
-
Contributor

Documentation

PowerNote &

PowerForms

Connectivity

Technologies

Interface

Engine

Open Engine

Interface

Library

OpenPort

Medical Device

Interfaces

Application

Dev. Kit

Mobile

Solutions

Health Economy

Distributed

Database EMPI

Distributed

Database EMR

Access Systems


Enterprise

Master Person

Index


Registration

Enterprise

Registration Mgmt
.


Scheduling

Enterprise

Scheduling Mgmt.


Benefits Mgmt.

Eligibility &

Med. Necessity

Inherent Solutions

Closed Loop

Med. Process


Meds Integration

HIPAA

Compliance

Clinical

Decision

Support

Clinically

Driven Revenue

Cycle

Clinically Driven

Resource

Planning

Industrial

Strength

Early Maturity

2003

2004

2005

Future

Key

10 Solution Groups


54 Solutions

Millennium

Helix™

Cerner Solution Portfolio

Public Health

Lab Result

Fill Out Forms
by Hand

Fax to DOH

Fill out Log for
HIM


HIPAA
Compliance

Follow Up
from

DOH

Preparation of
Internal IC Reports by
hand using multiple
systems

Automatic Reporting
-

HealthSentry

Daily Reports for Lab
and IC “Pushed” to
HealthSentry users

Public Health

HealthSentry Architecture

Daily Result Trending


DATA COMPLETENESS



Reportable cases (non
-
STD): March
-
Sept 2002

*Average over 6 key data fields

UNDER
-
REPORTING

0%
100%
200%
300%
400%
Campy
Salm
Shig
Grp A Strep
H. Influ
Hep C
% Increase

0%
20%
40%
60%
80%
100%
Conventional
HealthSentry
0.0
0.5
1.0
1.5
2.0
2.5
3.0
Conventional
HealthSentry
TIMELINESS


% Fields Complete


*Average over all reportables


*Increased overall reporting by 96%

Days to receive report

HealthSentry



Proven Results

Public Health Network: Influenza
itiative



Opt
-
in at project level



850+ facilities, 48 States


57 million cases processed


Positive influenza A results, ILI, ED
utilization



Worked with CDC, state and local public
health

Present role


Vice President of Research Solutions


Genomics


Biobanking


Clinical Trials


HIV Insights


Public Health


Safety solutions


Adjunct faculty appointments


UMKC Dept. of Computer Science


KU School of Nursing

Cerner Genomics Journey

2000


Whitepaper

2001


AHQR grant
HIV decision
support

2002


Begin
Millennium
Helix design

2003


Begin CBO

2004


First site live
on Helix

2005


CBO
incorporated
into NCBI
Metathesaurus

2006



Genomed

Enabled EMR”
published

2007


Data
visualization
with Hong
Kong
University

2008


Warfarin

decision
support project
with
Univ

of
Utah


Karyotype
functionality


Image
integration

2009


Begin
personalized
medicine
initiative


First non
-
US
sites live on
Helix

2010


Improved
integration
with pathology
workflow


Severe
adverse event
consortium

Blood Center of

Wisconsin

Cairo Children’s

Cancer Hospital

© Cerner Corporation 2010

Interoperability


“You say tomato, I say tomato”



Same meaning, different pronunciation


Clinical example:


Na, Sodium, Sod = same meaning


EC,
E. coli
,
Escherichia coli


Variant of like concept


E. coli
O157:H7


E. coli
O111:H11


Bacillus


Bacillus anthracis



Scope:


Molecular pathology


Clinical Genetics


Infectious disease


Cytogenetics


Cell surface markers



Current state (Jun 2008):



12,063

Concepts


29,355

Relationships



761

Genes



1,239

Nucleotide variants




6,923

Terms




5,516

Facets





Available from:
www.clinbioinformatics.org



Included in the NCI Metathesaurus


The Clinical Bioinformatics Ontology (CBO)

Unified Report

Default
-

uneditable

MultiMedia

Foundation (MMF)

Document Results

Protocol

Policy Issues
-

Genetic Testing


SACGHS


Ordering


Reporting


Interpretation


Reimbursement


American Health Information Community (AHIC)


Standardization


Data exchange


Family history

Clinical Utility of Genetic Testing


Evaluating Genomics in Practice and Prevention


Working group


generates reports


Stakeholder group


guides priorities/communication of WG


Example: CYP2D6 genotyping in non
-
psychotic depression treated
with SSRI



Encourage to extend literature review model to incorporate data and
other analytical methods

Pharmacogenomics


Use of genetic information in
the selection of therapy.


Sometimes used to describe
the use of Genomics to identify
drug targets.


Mutations that affect ability to
metabolize drugs


Adverse Reactions


Halothane
-
> Malignant
Hyperthermia
-

RYR1


Dosage effects


Coumadin
-

CYP2C9


No benefit


Codeine
-

CYP2D6

Clinical Data

The Connection between Science and Engineering

“To the individual who devotes his or
her life to science, nothing can give
more happiness than when results
immediately find practical
application. There are
not

two
sciences. There is science and the
application of science and these two
are linked as the fruit is to the tree.”

Louis Pasteur

When the research is complete …. a 17 year wait

50% use in
clinical
practice

Inclusion in
reviews,
textbooks

Inclusion in
bibliographic
databases

Publication

Acceptance

Submission to journal

50%

17 years

Balas, E.;Boren, S. “Managing clinical knowledge for health care improvement”
Yearbook of Medical Informatics 2000 p. 65
-
70

Early use
in clinical
practice

9 years

6
-
11 years

Opportunities


Internships (High School or College)


Clinical roles


Nurse


Medtech


Physician


Technical roles



Software engineer


Systems engineer

Options during High School

Tier 2: Velocity Academic
Interns (High School)


Summer following Sophomore year in high school


3.0 cumulative GPA or above


Technical career interest or previous
experience

Tier 3: Student Associate


㌮〠捵c畬u瑩te 䝐䄠A爠a扯be 楮i䡩H栠卣Soo氠o爠䍯C汥来


Cap of 35 associates/summer

Mandy Nickell


mandy.nickell@cerner.com

Decisions


Seemingly small decisions can have
lasting impact


Try to open doors and avoid closing them


A career in science doesn’t rule out:


Business


Policy


Management


Never say “just”


about yourself or others


Learn what you do well and what you don’t
and then accept both