learning health systems

May 6, 2020: EHR Workshop Grand Rounds Series Continues With Future Directions in Real-World Evidence

Posted on by Damon Seils

The NIH Collaboratory is using its ePCT Grand Rounds platform for a special webinar series on electronic health records (EHRs). The series, Advances at the Intersection of Digital Health, Electronic Health Records and Pragmatic Clinical Trials, is highlighting advances in digital health, new approaches and evolving standards for EHRs, and implications for researchers conducting pragmatic trials.

In this week’s EHR workshop session, Dr. Jacqueline Corrigan-Curay of the US Food and Drug Administration and Dr. Joshua Denny of the National Institutes of Health will discuss “Real World Evidence: Contemporary Experience and Future Directions.” NIH Collaboratory investigator Dr. Patrick Heagerty of the University of Washington School of Public Health will facilitate the discussion. The Grand Rounds session will be held on Friday, May 8, at 1:00 pm eastern. Join the online meeting.

Other upcoming sessions in the EHR workshop series include:

  • May 29, 2020: Experiences From the Collaboratory PCTs (Jeffrey [Jerry] G. Jarvik, MD, MPH; Lynn DeBar, PhD; Doug Zatzick, MD; Vince Mor, PhD; Moderator: Wendy Weber, ND, PhD, MPH)
  • June 26, 2020: Keys to Success in the Evolving EHRs Environment (Teresa Zayas-Cabán, PhD; George [Holt] Oliver, MD, PhD; Christopher A. Longhurst, MD, MS; Rachel Richesson, PhD, MPH; Moderator: Keith Marsolo, PhD)
  • Recording June 30, Available July 7, 2020: Podcast: Summary Expert Panel Discussion (Patrick J. Heagerty, PhD; Keith Marsolo, PhD; Wendy Weber, ND, PhD, MPH; Moderator: Lesley H. Curtis, PhD)

May 5, 2020: Dr. Robert Califf Discusses Next Steps for Reforming the Evidence Generation Ecosystem After COVID-19

Posted on by Gina Uhlenbrauck

In case you missed the May 1 keynote address by Robert M. Califf, MD, MACC, you can now listen to the recorded webinar and Q&A. Dr. Califf, head of strategy and policy for Verily Life Sciences and Google Health, kicked off the Collaboratory’s Grand Rounds workshop series, Advances at the Intersection of Digital Health, Electronic Health Records, and Pragmatic Clinical Trials.

His presentation outlined several opportunities to drive change and rebuild clinical research in the aftermath of COVID-19, including:

  • Evaluate what has and has not worked in the changes that have been made in response to the crisis
  • Allocate a significant part of recovery funding to transition issues in evidence generation, especially at the interface of medicine and public health
  • Do everything possible to fix the “purposefulness issue”:
    • Create methods for deciding the most important questions
    • Reward behavior that gets important questions answered quickly
  • Develop inclusive networks driven by people with the health problems of interest; increase incentives for clinicians and investigators that lead to reliable and faster evidence generation (balance financial focus with purpose); and automate mapping of EHR data beyond individual systems

“The effective use of digital information such as electronic health records, telehealth, applications, and patient-reported outcomes should free up effort to fix the human components that are holding us back.” – Dr. Robert Califf

View the full presentation for more insights from Dr. Califf.

Stay tuned for these upcoming presentations in the series:

May 1, 2020: Advances at the Intersection of Digital Health, Electronic Health Records, and Pragmatic Clinical Trials: Keynote-Can the COVID-19 Crisis Lead to Reformation of the Evidence Generation Ecosystem? (Robert Califf, MD, MACC)

Posted on by Gina Uhlenbrauck

Speaker

Robert Califf, MD, MACC
Head of Strategy and Policy
Verily Life Sciences and Google Health

Topic

Advances at the Intersection of Digital Health, Electronic Health Records, and Pragmatic Clinical Trials: Keynote-Can the COVID-19 Crisis Lead to Reformation of the Evidence Generation Ecosystem?

Keywords

Electronic health records; Digital health; Mobile health; Coronavirus; COVID-19; Ecosystem; Clinical trials; Evidence generation

Key Points

  • The HERO Registry and RECOVERY Trial are good examples of a rapid clinical research response to the urgent COVID-19 health crisis.
  • Among the essential steps to move the evidence generation system in the right direction:
    • Evaluate what has and has not worked in the changes made in response to the crisis
    • Allocate a significant part of recovery funding to transition issues in evidence generation, especially at the interface of medicine and public health
    • Increase purposefulness by creating methods for deciding the most important questions and rewarding behavior that gets those questions answered quickly

Discussion Themes

The COVID-19 pandemic has shone a spotlight on disparities in our current healthcare delivery system. How can we avoid leaving the most vulnerable of society behind?

Telemedicine can be a framework for the integration of research and clinical care. But the digital element must be integrated with the human element. The routine and effective use of digital information should free up effort to fix the human components that are holding us back.

We’ve been trying to modernize clinical trial design for decades (factorial/sequential/adaptive designs for example). While some positive movement in the past month has been made, the research enterprise remains largely conservative when it comes to design modernization. How do we make more rapid progress?

Tags

#pctGR, #COVID19, @Collaboratory1, @Califf001

April 29, 2020: Dr. Robert Califf Will Give Keynote Address to Launch EHR Workshop Grand Rounds Series

Posted on by Damon Seils

The NIH Collaboratory will use its ePCT Grand Rounds platform on Friday, May 1, to launch a special workshop series on electronic health records (EHRs). The webinar series, Advances at the Intersection of Digital Health, Electronic Health Records and Pragmatic Clinical Trials, will highlight advances in digital health, new approaches and evolving standards for EHRs, and implications for researchers conducting pragmatic trials.

In this week’s series kickoff, Dr. Robert Califf will present a keynote address, “Can the COVID-19 Crisis Lead to Reformation of the Evidence Generation Ecosystem?” Dr. Califf is head of strategy and policy for Verily Life Sciences and Google Health. The Grand Rounds session will be held on Friday, May 1, at 1:00 pm eastern. Join the online meeting.

Other upcoming sessions in the EHR workshop series include:

April 29, 2020: Materials from the Collaboratory Steering Committee’s Virtual Meeting Now Available

Posted on by Gina Uhlenbrauck

On April 22 and 23, 2020, more than 90 participants joined the online Steering Committee meeting to hear about the evolution of the embedded PCT (ePCT) ecosystem, discuss how to strengthen partnerships across the ecosystem, and identify approaches and lessons that will help inform and broaden the ecosystem. All presentations are available for downloading.

April 17, 2020: The HERO Program: PCORnet® at Work to Create a Healthcare Worker Community for Rapid Cycle Evidence (Nakela Cook, MD, MPH; Josie Briggs, MD; Susanna Naggie, MD; Emily O’Brien, PhD; Russell Rothman, MD; Chris Forrest, MD, PhD)

Posted on by Gina Uhlenbrauck

Speakers

Nakela Cook, MD, MPH
Executive Director
PCORI

Josie Briggs, MD
Acting Chief Science Director
PCORI

Susanna Naggie, MD
Principal Investigator, HERO-HCQ Clinical Trial
Duke University

Emily O’Brien, PhD
Principal Investigator, HERO-Registry
Duke University

Russell Rothman, MD, MPP
Chair, HERO Steering Committee
Vanderbilt University

Chris Forrest, MD, PhD
Chair, HERO Registry
Children’s Hospital of Pennsylvania

Topic

The HERO Program: PCORnet® at Work to Create a Healthcare Worker Community for Rapid Cycle Evidence

Keywords

Coronavirus; Virus pandemic; COVID-19; PCORI; Patient-Centered Outcomes Research Institute; Frontline health workers; Hydroxychloroquine; Healthcare systems; HERO-HCQ

Key Points

  • With the onset of the coronavirus pandemic, the U.S. healthcare system faces an unprecedented stress test to adapt to meet new demands.
  • Those on the frontline of caring for patients—healthcare workers—are at risk of developing or transmitting COVID-19. Evidence is urgently needed to keep healthcare workers and their families safe and healthy, which ultimately will help protect us all.
  • The HERO (Healthcare Worker Exposure Response & Outcomes) Program has three broad focus areas to develop rapid evidence around healthcare workers’ outcomes related to COVID-19:
    • Emphasis on the adaptations in how healthcare is delivered
    • Emphasis on vulnerable populations
    • Emphasis on the well-being of the healthcare worker
  • HERO will consist of a registry study of healthcare workers and a randomized controlled trial called HERO-HCQ that will evaluate the safety and efficacy of hydroxychloroquine to prevent COVID-19 clinical infections in healthcare workers.

Discussion Themes

The goal of the HERO registry is to understand all aspects of healthcare workers’ lives—those with direct impact and those with indirect impact.

What mechanisms are you envisioning for new study proposals that would be conducted via the HERO platform?

Serologic testing will have a significant role in understanding prior infection and potential immunity.

The HERO Registry is open to any healthcare worker to join at https://heroesresearch.org/. Enrollment takes only a few minutes; participation is free and voluntary. It is not restricted by profession. All data are kept confidential.

Tags
#HeroRegistry, #pctGR, @Collaboratory1, @PCORI, @PCORnetwork, @HeroesResearch

April 16, 2020: Why Randomized A vs B Comparisons Remain Uncommon in Clinical Trials

Posted on by Damon Seils

In an article published today in the New England Journal of Medicine, NIH Collaboratory investigators Drs. Greg Simon, Rich Platt, and Adrian Hernandez describe why it has been so challenging to meet the National Academy of Medicine’s 2020 goal for the development of a learning health system. If the goal had been met, 90% of clinical decisions would be based on accurate evidence gathered from health systems that continually learn from data collected as part of routine care.

Absent such evidence, the type of care provided is determined by the haphazard influences of financial incentives, clinicians’ anecdotal experiences, and patients’ or clinicians’ exposure to marketing messages. — Simon et al, New England Journal of Medicine, April 16, 2020

Most pragmatic trials, including the NIH Collaboratory Demonstration Projects and clinical trials conducted through the National Patient-Centered Clinical Research Network (PCORnet), have compared standard care with proposed improvements to standard care, or “A vs A-plus trials.” Trials that compare 2 alternative treatments that are in current use, or “A vs B trials,” are rarely done.

The authors describe both the barriers and the potential solutions for the development of more A vs B pragmatic clinical trials in pursuit of a learning health system.

“Achievement of the NAM’s goal of basing 90% of clinical decisions on accurate evidence remains distant, and meaningful progress will involve engagement by many parties,” write Simon and colleagues. “It will require health system leaders to consider rigorous evidence generation a core function of ordinary health care, research funders to prioritize practical questions relevant to population health and to support infrastructure for embedded research, research regulators to align consent procedures with incremental risks of research, and researchers to ask real-world questions that patients, caregivers, and clinicians want answered. But the first step is for everyone involved to honestly acknowledge the lack of evidence supporting the majority of common medical decisions and the urgent need for more relevant and efficient clinical research,” the authors continue.

The impetus for the article was an NIH Collaboratory workshop, Embedded Pragmatic Clinical Trials of Therapeutic A vs B Interventions. The workshop explored challenges and strategies for planning and implementing embedded pragmatic clinical trials that compare 2 or more therapeutic medical regimens.

The authors of the article are Adrian F. Hernandez, MD, MHS, professor of medicine and vice dean for clinical Research in the Duke University School of Medicine; Gregory E. Simon, MD, MPH, of the Kaiser Permanente Washington Health Research Institute; and Richard Platt, MD, MSc, of the Harvard Pilgrim Health Care Institute. All 3 institutions are part of the NIH Collaboratory Coordinating Center.

April 7, 2020: Support for the PRISM Embedded PCTs From the Health Care Systems Interactions Core

Posted on by Gina Uhlenbrauck

In a recent video interview, Dr. Eric Larson, chair of the Collaboratory’s Health Care Systems Interactions Core, and Leah Tuzzio, research associate, describe ways the Core is supporting the PRISM Demonstration Projects. A priority for conducting embedded PCTs (ePCTs) is establishing strong, sustainable relationships between the study team and health system leadership, clinicians, and staff.

For researchers who are evaluating pain management interventions, the Core advises remaining flexible when integrating the intervention and being mindful of documenting any adaptations made throughout the trial. Other best practices include understanding the context of the health setting, anticipating road blocks, and incorporating the intervention with minimal burden to clinicians and staff.

“Pain is a complicated area. It’s not a specific disease, it’s a state, and it’s a state that everybody experiences.”

For additional suggestions from the Core, read the new chapter in the Living Textbook on how to monitor intervention fidelity and adaptations. Learn more about the Health Care Systems Interactions Core and view interviews with the PRISM Demonstration Projects:

April 3, 2020: Innovative Support for Patients with SARS-COV-2 Infections Registry (INSPIRE): Participant-Centered, Rapidly-Deployed, Digitally-Enabled Research (Harlan Krumholz, MD; Bala Hota, MD, MPH; Graham Nichol, MD, MPH)

Posted on by Gina Uhlenbrauck

Speakers

Harlan M. Krumholz, MD
Harold H. Hines Jr. Professor of Medicine, Yale University
Director, Yale New Haven Hospital Center for Outcomes Research and Evaluation
Co-Founder Hugo Health

Bala Hota, MD, MPH
Professor of Internal Medicine, Rush University
Chief Analytics Officer, Rush University Medical Center

Graham Nichol, MD, MPH
Medic One Foundation Endowed Chair for Pre-hospital Emergency Care
Professor of Emergency Medicine
University of Washington

Other Panelists:

Jacqueline Rollin, Administrative Fellow
Rush University Medical Center

Wade Schulz, MD, PhD
Assistant Professor of Laboratory Medicine
Director, CORE Center for Computational Health

Matthew J. Thompson, MB, ChB, DPhil
Helen D. Cohen Endowed Professorship in Family Medicine
Professor of Global Health and Medicine, University of Washington

Deb R. Chromik, Participant Experience
Hugo Health

Dave Hutton, Product Lead
Hugo Health

Topic

Innovative Support for Patients with SARS-COV-2 Infections Registry (INSPIRE): Participant-Centered, Rapidly-Deployed, Digitally-Enabled Research

Keywords

Coronavirus; Virus pandemic; INSPIRE Registry; COVID-19 directed research program; SARS-COV-2; Longitudinal data; Hugo Health digital research platform

Key Points

  • In the face of the coronavirus pandemic, there is an urgent need for rapid knowledge generation and actionable insights. Evidence needed includes:
    • The number of cases, including milder ones
    • Risk factors and timing of transmission
    • Severity and attack rate
    • Risk factors for infection and severe outcomes, including death
    • Infectiousness timing and intensity
  • Patients must be considered part of the team; involved, engaged, and respected, with agency over their data.
  • To better understand the experience of people with COVID-19, Rush University Medical Center and Hugo health are piloting the COVID INSPIRE registry. INSPIRE is a rapidly-deployed, digitally-enabled, participant-centered platform to collect longitudinal data and facilitate observational and experimental studies.

Discussion Themes

Even with social distancing, the coronavirus is in a rapid escalation phase; this rapid pace has our attention.

People are interested in participating in research now more than ever. The call to action is to build a human-connected system that treats patients compassionately and supports patients in real time.

Are there existing systems that could be built on or adapted for COVID-19? Are there potential for linkages to other systems?

Tags
#pctGR, @Collaboratory1, @HMKYale, @BalaHota, @GrahamNichol

April 6, 2020: Convening Pain Management Expertise in the Patient-Centered Outcomes Core: An Interview With Dr. Kevin Weinfurt

Posted on by Gina Uhlenbrauck

The Collaboratory recently interviewed Kevin Weinfurt, PhD, co-chair of the Patient-Centered Outcomes Core working group, to hear about the Core’s plans for supporting the PRISM Demonstration Projects. In this video, Dr. Weinfurt says one challenge for embedded trials of pain is in obtaining high-quality, complete patient-reported outcome data on pain intensity and functioning. Along with other national initiatives focused on pain research, such as the NIH-DoD-VA Pain Management Collaboratory, a chief task of the Core will be to look at efforts to harmonize pain outcomes across studies.

“The Core serves as a convener of expertise in pain management within the Collaboratory. We keep an eye on issues across the Demonstration Projects that might also be of interest to the broader pragmatic trial community.”

Read more about the work of the Patient-Centered Outcomes Core, and view other interviews about the HEAL Initiative and PRISM Demonstration Projects.