An Overview of Marshfield Clinics Research Program Exploring Opportunities for Collaboration in the Real World Dr. Humberto Vidaillet Director of Medical.

An Overview of Marshfield Clinic’s Research Program

Exploring Opportunities for Collaborationin the “Real” World

Dr. Humberto VidailletDirector of Medical Research, Marshfield ClinicDirector, Marshfield Clinic Research Foundation

Clinical Professor of Medicine, UW SMPH

September 14, 2011

Objectives: Purpose of Forum

• Provide an opportunity for research networks and other research groups to learn about each other and the projects they conduct.

• Learn about operational and project barriers, and successful methods to overcome barriers.

• Facilitate networking and connections between people and groups with similar interests.

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Welcome to Marshfield Clinic*

*Ranked by Forbes in 2010 as the “5th best small city in the country to raise a family.” Designated in 2008 by Demographics Daily as

one of the nation’s top 20 “Dream Towns”

Marshfield ClinicMission: To serve patients through

accessible, high quality health care, research and education

501(c)(3) organizationLargest private group practice in WI:

● 52 centers in >35 communities● >770 physicians (102 family practice

physicians) in >85 specialties● 6,600 additional personnel● ~3.5 million patient encounters/year

~365,000 unique patients/yearMarshfield Labs (Human & Veterinary)Lakeview Medical Center, Rice Lake, WISecurity Health Plan (HMO)

Why Marshfield Clinic Engages in Research & Education● Core elements of Marshfield Clinic’s Mission, its status as a nationally

recognized Academic Medical Center, and its Charitable Trust● Contribute to knowledge leading to advances in patient care, quality

metrics and public health, improves the quality of human existence and the lives of our patients and their loved ones

● Contribute to recruitment of high quality physicians and other professionals who want to work in an academic environment

● Differentiate Marshfield Clinic from competitors; patients rightly conclude that care is better at centers involved in research & education

● For clinicians who do research and teach, it adds another dimension to their contributions to medicine and improves their clinical practice; for virtually all Marshfield Clinic employees, a sense of shared pride!

Research and Education have been integral to the Clinic’s culture, sustained growth and quality of care since 1916!

Research Program at Marshfield Clinic~400 active studies~125-150 clinical investigators and 30 MD/PhD scientistsMajor external sponsors: NIH, CDC, NIOSH, AHRQ, Industry, PhilanthropyAcademic structure: IRB, Research Comm., Research Compliance,

Conflict of Interest, Biosafety, etc.Tenure program and Endowed positions

Marshfield Clinic Research Foundation (MCRF) Mission: To discover and communicate scientific knowledge that

substantially improves human health and well-being- 200 staff

Main ClinicBuilding

East Wing

St. Joseph’s Hospital Laird Center for

Medical ResearchLawton Center for Research & Education

Research Program Structure

Marshfield Clinic Research FoundationHumberto Vidaillet, MD, Director

Steve Wesbrook, PhD, Deputy Director

Clinical Research CenterSteven Yale, M.D.

Biomedical InformaticsResearch Center (BIRC)

Simon Lin, M.D.Center for Human Genetics

Murray Brilliant, Ph.D.

Epidemiology Research CenterEdward A. Belongia, M.D.

National Farm Medicine Center(Rural, Agricultural Health & Safety)

Barbara Lee, RN, PhD

Research Centers

Research SupportOffices/Services

Core Laboratory

Research Integrity &Protections

Scientific Writing& Publications

Sponsored Programs& Fiscal Affairs

Health SystemsResearch

Associate DirectorAdedayo Onitilo, M.D.

Oversees MCRF, providing policy direction, financial oversight, and counsel to MCRF leadership in a wide range of areas associated with research structure, process, and resources

MCRF Board of Trustees

Physician Members• Jaime Boero, MD. Vice - Chair • Michael Caldwell, MD, PhD • Christopher Cold, MD • Rezwan Islam, MD • Ram Pathak, MD • Kent Ray, DO • Shereif Rezkalla, MD, Treasurer • Karl Ulrich, MD • Matthias Weiss, MD

Scientist Member • Po-Huang Chyou, Ph.D.

Community Members•Rene Daniels •John Hutchinson •Brian Kief •Patricia Kleine, Ph.D. •John Laird •Scott Larson, Secretary •Mark T. Nelson •Mark Nook, Ph.D., Chair •Jim Schuh •James Weber, PhD

UW System,Interim

Senior Vice President for

Academic Affairs

Mark Nook, PhD

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• Publish Clinical Medicine & Research• Publish Journal of Agromedicine• With Division of Lab Medicine, part of

State Laboratory Response Network and CDC’s Select Agent Program; provide Laboratory Medicine facilities for its R&D

• With Clinic Information System, develop new clinical medical informatics tools

Other Capacities

Research Strategy and Guiding Principles● Integration of research into clinical practice and

clinical practice into research.

● Collaboration with other top-tier medical centers, especially UWSMPH (now ICTR) and MCW.

● Dedication to achieving excellence in translational research, which requires close collaboration among physicians and scientists to bring scientific advances into clinical care and public health.

Select Research Collaborations at MCRF (1)

Select Research Collaborations at MCRF (2)

● Founded jointly in 2007 by UW and MC● Has become framework of strengthening

research ties between the two institutions● Awarded a Clinical and Translational Science

Award by NIH; now waiting for renewal● Unprecedented level of collaboration:

14 funded pilot projects with UW-Madison investigators working together with 23 Clinic investigators from 16 different departments

● Likely to impact Clinic’s clinical and translational research for decades

Institute for Clinical and Translational Research (ICTR)

PARTNERSHIP

Schools of Medicine and Public Health

PharmacyNursing

Veterinary Medicine and College of Engineering

Strength of the Marshfield Clinic - UW Research PartnershipCollaboration & Integration of Administrative Activities

ICTR Committee / Core Marshfield Representative Board of Governors Karl Ulrich, MD, MMM

President, Marshfield Clinic

ICTR Management Team Humberto Vidaillet, MD Director, Marshfield Clinic Research Foundation (MCRF)

Associate Director (ICTR)

Biomedical Informatics Core (BMIC) Simon Lin, MD, CSDP Research Scientist & Director, Biomedical informatics Research (MCRF)

Director, BMIC (MCRF)

Faculty Governance Committee

Graduate Program in Clinical Investigation

Robert Greenlee, PhD, MPH Associate Research Scientist, Epidemiology Research Center (MCRF)

CAP Steering Committee & Director, CAP Core (MCRF) Vice-Chair, UW Faculty Governance Committee in Clinical Investigation

KL2 Review Committee Steven Yale, MD Director, Clinical Research Center (MCRF)

Director, CTRC and REC (MCRF)

Pilot Grant Review Committees Murray Brilliant, PhD Senior Research Scientist & Director, Center Human Genetics (MCRF)

Director, TTRC (MCRF)

Evaluation Group Bobbi Bradley, MPH ICTR Project Coordinator (MCRF)

CAP - Northern Regional Research Council Comm. Health Connections

Ronda Kopelke Director, Center Community Outreach, Marshfield Clinic

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What was each partner looking for when we started? What did MC want from UW? What did UW want from MC?

1. MCRF Strategic Priorities → CTSA 1. Wisconsin Idea and Beyond

2. Access UW’s Greatest Resource - IIttss IInntteelllleeccttuuaall CCaappiittaall:: Depth & Breath of UW investigators (Number, Expertise and Diversity of Potential Collaborators)

2. Access to Unique MC Resources - Biomedical Informatics Research Center - Personalized Medicine Research Project - Marshfield Epidemiology Research Center

3. Research & Training Programs - National Primate Center, Waisman Center - KL2 Scholars, ICTR Pilots, etc.

3. Access MC Population & Programs - Rural Population plus HMORN - Expansive Clinical Research Program

4. Leverage MC Led Initiatives - Wisconsin Genomics Initiatives - Oral Systemic Health Research Network

4. Leverage Unique UW Resources - Wisconsin Network for Health Research - Survey of the Health of Wisconsin

Synergy!

The Marshfield-UW PartnershipFoster Collaborations

Leverage unique resources & shared Interests

To Conduct research not otherwise possible …

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PurposeFacilitate collaboration among member institutions'

Institutional Review Boards (IRBs) in order to provide more effective and efficient oversight of multi-site human subject research protocols In Wisconsin and reduce costs and duplication of effort among the Member institutions and affiliated investigators.

One AgreementAllows any member institution to serve as the IRB of record

for another, eliminating the need to draft individual, study-specific IRB authorization agreements for each study reviewed.

WIC is in its development/pilot phase ,and as such, is limited to the following participants:

Aurora Health Care IRB, Milwaukee Marshfield Clinic IRB, Marshfield Medical College of Wisconsin IRB, Milwaukee University of Wisconsin-Madison Health Sciences IRB,

Madison

Wisconsin IRB Consortium (WIC)

Clinical Research Center● Established in 1998 to provide centralized

research support for clinician-led research throughout system

● Built on a strategy of integrating research and clinical practice

● More than 350 active clinical trials● 125-150 clinician investigators● >40 research coordinators and research

nurses as well as other administrative support staff

● Community Clinical Oncology Program (CCOP) is the longest-running clinical research project

Type-2 Translational Research

Study Goal● To conduct a pilot test of a telepharmacy-based intervention to

improve asthma control through medications and disease management in an underserved, rural patient population.

Aims● To assess the feasibility of providing a telepharmacy intervention ● To determine whether a telepharmacy intervention is acceptable ● To assess the intervention’s impact on patients’ asthma control,

adherence to medications, and patient activation● To examine the facilitators and barriers associated with

implementing the intervention.

The Role of Pharmacist Evaluation in Asthma

Local PI Suzanne N.

Havican, RN, RPh, BCPS

PI Henry N. Young,

PhDUW Madison

Type-2 Translational Research Tailored Approach to Genetic Counseling for Cystic Fibrosis

Newborn Screening: A New Model

Project Principal Investigator Marshfield Collaborators

Wisconsin Model of Family-Centered

Genetic Counseling

Audrey Tluczek, PhD, RN

UW School of Nursing

Christina Zaleski, MS

Pediatric Infectious Disease

Received additional/outside funding

Type-2 Translational Research Creating Healthy Workplaces: An intervention to

Improve Outcomes for Providers and PatientsStudy Goal

● Test the impact of a novel quality improvement strategy on care quality. The quality improvement intervention (QIIs) will create “healthy workplaces” by addressing adverse primary care work conditions (workflow, work control, and organizational culture).

Aims● Increase clinician and staff interest in participating in QIIs by

addressing primary care work conditions ● Improve care quality in hypertension and diabetes by improving

work conditions● Improve clinician and staff satisfaction, decrease stress, and reduce

intention to leave

Local PI Steven H. Yale,

MD

Epidemiology Research Center● Consequential epidemiology: focus on applied research

questions that make a difference in the lives of people Vaccine safety & effectiveness Antibiotic resistance Cancer surveillance Cardiovascular care and outcomes

● Unique resources & network collaborations: Marshfield Epidemiology Study Area (MESA) HMO Research Network (HMORN)

Cancer Research Network (NCI) Cardiovascular Disease Research Network (NHLBI)

Vaccine Safety Datalink (CDC)

• In 2011, Dr. Laura Coleman joined as tenure-track scientist

Marshfield Epidemiologic Study Area (MESA)Key Features:● Defined geographic region (24 zip codes)● Nearly all residents choose to receive health care

from Marshfield Clinic and affiliated hospitals● Dynamic cohort tracked since 1991● Links to sophisticated electronic medical record

system and data warehouse archive● Low population mobility● High population coverage and health event

capture, in MESA Central: 97% population coverage 99% deaths captured 95% hospitalizations captures 90% outpatient visits captured

60,000 people 25,000 people

Marshfield Epidemiologic Study Area (MESA)

There are more than 25 active consults in the current year, with many early and mid-career stage recipients, including:

• a UW Shapiro scholar, • an ICTR scholar, • UW Population-Health students, • UW faculty and medical residents, & • Marshfield faculty and medical residents.

Collaborations: MESA

Goal: To examine the actual mortality burden and rates of cardiovascular events among a rural population-based cohort of lupus patients

“Mortality & Cardiovascular Events Among RuralSystemic Lupus Erythematosus Patients”

UW Marshfield Christie Bartels, MD

(KL2 Scholar) Rheumatologist, Principal Investigator

Robert Greenlee, PhD, MPH Epidemiologist , Co-Investigator

Chris Sorkness, PharmD ICTR Associate Director

Jerry Goldberg, MD Rheumatologist, Clinical Collaborator

Carolyn Bell, MD Rheumatologist, Clinical Collaborator

Mark Hennick, MD Marshfield Internal Medicine Residency

Director, Clinical Collaborator

Frank Graziano, MD, PhD Immunologist, Clinical Collaborator

Maja Visekruna, MD Resident

Kevin Buhr, PhD Biostatistician

Swapna Nekkanti, MD Resident

HMO Research Network

• Focus is on cancer, cardiovascular disease, diabetes, genomics, vaccine safety, medical product surveillance, health care quality, and comparative effectiveness.

• MCRF co-hosted the National HMORN meeting in 2008, at which the NCRR Director was a plenary keynote speaker.

• Mission: Use collective scientific capabilities to integrate research and practice for the improvement of health and health care among diverse populations.

• Consortium of 16 HMO organizations

• MCRF leveraged the MESA cohort and Security Health Plan enrollees to facilitate membership in the HMORN.

• MCRF investigators are currently leading efforts on more than 20 active collaborative research projects within the HMORN.

Survey of the Health of Wisconsin • First statewide research survey to systematically gather data on health

status and health disparities among Wisconsin adults.

• Marshfield Clinic became the home of a new, third recruitment and enrollment center for SHOW, joining Madison (Middleton) and Milwaukee.

• MCRF assists SHOW data collection, including: face-to face interviews, self administered questionnaires, and physical exams.

• In the first year of the MCRF, 30 scheduled weeks of rural Wisconsin data collection were completed in three months due to Marshfield Clinic’s presence in rural WI communities.

• The data collected from SHOW will address critical and novel research questions to accelerate translation into evidence-based policies and health care practices, and improve health and reduce health disparities in Wisconsin.

Center for Human Genetics● A long history of important discoveries in human genetics (short

tandem repeat polymorphisms, Marshfield linkage maps)● Mission: “To conduct translational research in medical genetics that

substantially improves patient care”● In 2009, recruited Dr. Murray Brilliant (Center Director, tenured

Senior Research Scientist and James Weber Endowed Chair)● in 2010, recruited Dr. Steve Schrodi and

Dr. Deana Cross as tenure-track scientists● In 2011, joint recruitment of Dr. Brautbar● Major programs and unique resources:

Personalized Medicine Research Project (PMRP) Wisconsin Genomics Initiative (WGI) Electronic Medical Records and Genomics (eMERGE) Network

Personalized Medicine Research Project (PMRP)● In September 2002, Governor McCallum and the leadership of MC

and MCRF announced enrollment of the first research subject● Initial funds: State government ($2 million), Federal government

($800K), and Marshfield Clinic ($1 million)● Ultimate Goal: Translate genetic data into specific knowledge about

disease that is clinically relevant & will enhance patient care● Key Features:

Nation’s largest population-based biobank Stable population of approximately 20,000 adults DNA, plasma and serum samples on each subject Access to longitudinal electronic health record 99% of PMRP cohort has agreed to be re-contacted All genotyped for 50 medically relevant markers, ~5K high-density genotyped samples

PMRP Community Advisory GroupThe Community Advisory Group (CAG) provides advice and guidance from the

community perspective on the continued development, implementation and on-going operations of the Personalized Medicine Research Project

Members Affiliation Mat Bartkowiak UW Marshfield Phil Boehning Loyal, WI Resident Sharon Bredl Harmony-Ho Holsteins

Margaret Brubaker Certified Municipal Clerk Margy Frey Coldwell Banker, Brenizer Realtors

Pat Gall Financial Services Professional Jodie Gardner Catalog Marketing Services Nancy Kaster Pulaski, WI Resident Colleen Kelly Marshfield, WI Resident

Mike Kobs WDLB Radio Station Norm Kommer Community Bank of Central Wisconsin Darlene Krake Figi Inc, Senior Management Retiree

Rev. Mark Krueger Christ Lutheran Church Julie Levelius Stratford, WI Public Schools Jerry Minor Pittsville, WI, Volunteer Fire Department

Noreen Moen Marshfield Resident Representative Marlin Schneider WI State Government

Scott Schultz Wisconsin Farmer's Union Jean Schwanebeck Board of the Family Health Center

Liz Welter Marshfield News Herald

Ongoing Studies

Pharmacogenetics●Efficacy and safety of statins●Efficacy of metformin in patients with type II diabetes●Pharmacogenetics of tamoxifen for breast cancer●Pharmacogenetics underlying response to beta blockers in

patients with glaucoma●Pharmacogenetics of warfarin metabolism●Sulfa hypersensitivity●ACE and angioedema

Genetic Basis of Disease● Atrial fibrillation/flutter● Cataracts● Endometriosis● Hypertensive heart disease● Low HDL● Macular degeneration● Multiple sclerosis● Myocardial infarction● Obesity, genetics and risk of

diabetes and abnormal lipids● Prostate cancer● Venousthromboembolism Dz.

Wisconsin Genomics Initiative (WGI)● Announced by Governor Doyle in October 2008● Received $2 million in State FY10-11 budget● A historic collaboration of Wisconsin’s three academic

medical centers and its major urban university created to advance predictive and personalized health care

● Vision: to be able to predict for individual patients in a clinical setting the risk of disease susceptibility and treatment response using the combined power of cutting edge genetic, phenotypic, and environmental analyses

MCW•Genetic & Genomic Analysis• Diverse Urban & Pediatric

Patient Populations•High Through-Put Genotyping

UW-Milwaukee• Urban & Environmental Health

• Community Engagement• School of Nursing

Marshfield

Madison Milwaukee

UWSMPH• Regenerative Medicine

•Statistical & Computational Analysis

• Super-Computing Capability

MCRF• Rural Cohort

Comprised of 20,000 Adults

•Biomedical Informatics• Phenotyping

Wisconsin Genomics Initiative

Building Accurate Predictive Models

Complex combinations of variables are required for accurate prediction The more we know about individual patients, greater the probability of prediction

Genetic + (Environmental Factors & Clinical Attributes) = Phenotype 1,000,000 SNPs will hit

or be close to most medically relevant genetic markers

Smoking Diet Exercise Alcohol Residence Occupation Socio-economic status Chemical exposure

Disease diagnoses Exposure to:

- Viruses - Bacteria - Drugs not involved in medical

treatment Treatment (medical)

- Current medications - Past medications - Vaccinations - Other

Treatment (procedures) Physiologic parameters

- Chemical measures (e.g., HDL, cholesterol)

- Physical measures (e.g., weight, height)

- Electrical activity (e.g., ECG) - Imagining

Cardiovascular diseases Diabetes Obesity Stroke Cancer Allergies and Asthma Alzheimer’s Childhood illnesses &

developmental disorders Eye diseases Other

(+ & )=PP

EE CCGG

WGI Funded Demonstration Projects (1) Integrating Genomic Data into a Computational Model for Improved Breast Cancer Diagnosis

● PIs: Elizabeth Burnside, MD4; David Page, PhD4 ● Collaborators: Cathy McCarty, PhD, MPH1; Peggy Peissig, MBA1; Adedayo Onitilo, MD1

Improving the Predictive Modeling of Atrial Fibrillation/Flutter (AF/F) and Its Outcomes● PI: Humberto Vidaillet, MD1

● Collaborators: Bess Berg, MS4; David Page, PhD4; Peggy Peissig, MBA1; Percy Karanjia, MD1

Feasibility of Modular High Throughput Electronic Phenotyping● PI: Peggy Peissig, MBA1

WGI Infrastructure Project Proposal: Expand the Current Informatics Architecture in Order to Capitalize on the Available EMR and Genetic Data

● PI: Justin Starren, MD, PhD1

WGI Exome Sequencing to Identify Coding Variants for Myocardial Infarction● PI: Ulrich Broeckel, MD2

● Collaborators: Cathy McCarty, PhD, MPH1; David Page, PhD4

1MCRF ♦ 2MCW ♦ 3UW-Milwaukee ♦ 4UWSMPH

WGI Funded Demonstration Projects (2)Risk Modeling Post-Hospitalization Venousthromboembolism in a Population-Based Cohort

● PI: Steve Yale, MD1

● Collaborators: Mark Craven, PhD4; Deanna Cross, PhD1; Stephen Talsness, BA1; Peggy Peissig, MBA1; Joseph Mazza, MD1

Sustained Community Engagement in Genetics and Genomics Research to Improve Health and to Increase Health Equity

● PIs: Aaron Buseh PhD, MPH3; Sandra Underwood, PhD, RN, FAAN 3

Development of a Predictive Algorithm for Age-related Macular Degeneration● PI: Murray Brilliant, PhD1

● Collaborators: David Page, PhD4; Joe Carroll, PhD4; Cathy McCarty, PhD, MPH1; Gary Pesicka, MD1; Robert Valenzuela1

Investigation of Genomic Association Between Heart Failure & Diabetes Mellitus● PI: Nancy Sweitzer, MD, PhD4

● Collaborators: Cathy McCarty, PhD, MPH1; Orly Vardeny, PharmD4; Zhan Ye, PhD1

Membrane Metaloproteinase-9 Genotype and Aortic Aneurysm● PI: Jay Yang, MD, PhD4

● Collaborators: Sijan Wang PhD4; Martha Wynn MD4; Charles Acher, MD4; Peggy Peissig, MBA1; Ulrich Broeckel, MD2

1MCRF ♦ 2MCW ♦ 3UW-Milwaukee ♦ 4UWSMPH

WGI Project: Development of a Predictive Algorithm for Age-Related Macular DegenerationInvestigators Contribution

Murray Brilliant, PhD (PI) Senior Research Scientist & Director Center Human Genetics

James Weber Endowed Chair in Human Genetics (MCRF) Marshfield Clinic

Hereditary pigmentation disorders. His work led to the identification of three genes that cause albinism:

- Hermansky-Pudlak syndrome 1 - Oculocutaneous albinism type 2 & 4

Other Marshfield Clinic Co-Investigators Cathy McCarty, PhD, MPH (Co-I)

Gary Pesicka, MD (Co-I) Robert Valenzuela (Co-I)

Epidemiologist (Genetics & Eye Dz) Clinical Ophthalmologist (MC) Graduate Research Assistant (CHG)

C. David Page, PhD (Co-I) Professor, Departments of Biostatistics & Medical Informatics

Professor, Department of Computer Science UWSMPH

Algorithms for data mining and machine learning, special interest in applications to clinical and high-throughput genetic & molecular data

Joseph Carroll, PhD (Co-I) Associate Professor of Ophthalmology

Assistant Professor of Biophysics Assistant Professor of Cell Biology, Neurobiology & Anatomy

Medical College of Wisconsin

High-resolution retinal imaging Adaptive optics fundus camera

WGI Project: Sustained Community Engagement in Genetics & Genomic Research to Improve Health & to Increase Health Equity

Study Purpose Determine effective ways to engage members of diverse urban

communities in genetic and genomics research designed to improve health and achieve health equity.

Aims Determine how characteristics of diverse ethnic, racial

urban communities are related to their potential engagement in genetics and genomics research;

Describe knowledge and attitudes of members of diverse ethnic, racial urban communities toward genetics and genomics research for health;

Identify facilitators and barriers to sustained engagement of members of diverse ethnic, racial urban communities in genetics and genomics research for health.

PI: Aaron BusehUW Milwaukee

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Collaboration with UW Waisman CenterGenetic/Complex Disorders1) To estimate the prevalence of premutation of FMR1 using the

Wisconsin longitudinal Study (WLS) cohort (PMRP in the Marshfield cohort

2) To describe natural history of premutation into adulthood and into old age (18 through 70 yrs.) with respect to family background, academic achievement, IQ, marital history, fertility, childbearing patterns, menopause, occupational stability, depression and anxiety, health and physical symptoms and cognition.

3) To compare men and women with the premutation with a closely matched comparison group of WLS unaffected age peers. Because of the small size of the sample with the permutation, this will be an exploratory aim. Murray H. Brilliant,

PhDMCRF

Marsha Seltzer, PhDWaisman Center

VanderbiltQRS duration

Group Health CooperativeDementia

Mayo ClinicPeripheral artery disease

Marshfield ClinicCataracts

NorthwesternType II diabetes

Coordinating center

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MCRF’s Oral & Systemic Health Research Project (1)

Goals:• Understand the causes of oral diseases, such as periodontal

disease and caries (e.g., determining the effect of genetics, diet, water source [well/city + fluoridation], and microbiome).

• Understand the connections between oral and systemic health, (e.g., mutual enhancement of periodontal disease and diabetes).

• Understand how improving oral health aids systemic health (comparative effectiveness) and bring PHC to the dental arena.

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● Microbiome contribution to heath is an NIH priority and our investigators will be among the first to utilize oral microbiome data in personalized healthcare

● Will create a unique research infrastructure to support the OSHRP: Initial cohort of 2,000 participants with electronic dental and health records coupled with a

comprehensive biobank (DNA, plasma, serum, urine and periodontal microbiome) Questionnaire data on environment, diet, etc

● OSHRP builds upon the Personalized Medicine Research Project (PMRP) >1,000 participants in PMRP who are also dental patients of Marshfield Clinic;

2 MC dental facilities in PMRP recruitment area have been operating for 1 year As the Clinic’s Electronic Health Record contains medical and dental care information, this research

sub-cohort of PMRP can be used today to study the connections between oral and systemic health in a population-based cohort

•National Institute of Dental and Craniofacial Research (NIDCR) Collaborative Grant: Data Extraction using Electronic Dental Record in Dental Practice Based Research Network Collaborating with University of Pittsburgh

MCRF’s Oral & Systemic Health Research Project (2)

Plans for 2011 and 2012

Improve user interface for PMRP

Sequence 10 subjects

Stakeholders plan incorporation of genetic data in EHR

Pilot/Develop a clinically actionable predictive algorithm (Age-related Macular Degeneration - AMD)

Pilot/Develop Oral-Systemic Health Research Project (OHRP) and plan recruitment of a large OSRP cohort

Goals for the next 5 years

Searchable PMRP database

Sequence all 20,000 subjects in PMRP

Sequence genetic data linked to iEHRwith decision making tools

Pilot Personalized Health Care to clinical standard of care (AMD)

Create enhanced Personalized Health Care Resource Networks

Planned Transition to Personalized Health Care

Current cost $4K

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“To visit the Marshfield Clinic, a longtime innovator in health information technology, is to glimpse medicine’s digital future. Across the national spectrum of health care politics there is broad agreement that moving patient records into the computer age, the way Marshfield and some other health systems have already done, is essential to improving care and curbing costs.”

By: Steve LohrPublished: December 26, 2008

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Biomedical Informatics Research Center (BIRC)

● Established in 2005● 7 PhDs and 38 other staff● Mission: to accelerate

improvements in human health and well being through informatics research while providing integrated tools, services and reliable management of information assets in support of Marshfield Clinic missions

● Organizational Structure:● Administrative Informatics

Support● Biostatistics● Usability/ICDI (Interactive

Clinical Design Institute)● Informatics Research● Infrastructure & Central

Resource● Research Data & Analytics

Management

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BIRC: Multiple Missions

BIRC

Rese

arch

ers

Foundation Administration

Clinic IS

DesignData

Analysis

StrategyPrototypingEvaluation

IT PlanningInfrastructure

Backoffice

External Funders

ResearchOutcomes

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BIRC Personnel Growth

Does not include short term students

• Cost: $980,000

• Accommodates 25 additional people in BIRC, increasing its staff to 65 by end FY 2012

• Provides enhanced Biomedical informatics infrastructure support for increased collaboration with internal & external investigators

• BIRC expansion will house personnel to support:

MCRF’s new tenure track hires & grants they will generate

Collaboration w/ MC’s IS (R&D: usability, decision support, etc.)

New Networks in Personalized Care and Population Research

Dental Informatics & Oral Systemic Health Research Networks

BIRC Expansion

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Dental Informatics Research

It is a sub-discipline of biomedical informatics. Dental informatics is the application of computer and

information science to improve dental practice, research, education and management.

* Eisner J. The future of dental informatics. Eur J Dent Educ. 1999;3 Suppl 1:61-9.

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Major Dental Informatics Research Projects• A Standard Information Model for General Dental Records

- Funded by National Institute of Dental and Craniofacial Research, NIH - Goal is to develop a comprehensive, consensus-based Electronic Dental

Record Information Model (EDRIM) as a reference standard for the content and structure of Electronic Dental Records

• Multi-institutional Consortium for Comparative Effectiveness Research in Diabetes Treatment and Prevention- Funded by Agency for Healthcare Research and Quality, DHHS- Goal is to build a national research network and a multi-system distributed database for conducting comparative effectiveness research (CER) in the treatment and prevention of diabetes mellitus

Personnel: Dr. Amit Acharya Collaboration: University of Pittsburgh

Objectives: Purpose of Forum

• Provide an opportunity for research networks and other research groups to learn about each other and the projects they conduct.

• Learn about operational and project barriers, and successful methods to overcome barriers.

• Facilitate networking and connections between people and groups with similar interests.