April 19, 2011
Closing the Loop
In discussing the ultimate objectives of Cerner solutions, the phrase “closing the loop” is often mentioned. In research circles, this “loop” usually starts with the electronic capture of health information during the course of patient care. This information is then used to improve the management of that patient’s care. In some instances, the information is collected and de-identified in order to be used for research purposes. Research using these health data drives medical progress, from accelerating development of new therapies to informing point of care decisions. These changes are identified, their outcomes documented and evaluated for effectiveness in further research, and so on. In short, in this system, patient care drives discovery, and discovery drives patient care.
Since 2001, Cerner has worked with the Centers for Disease Control and Prevention to manage and analyze longitudinal de-identified health data collected on HIV-infected patients in two separate cohorts (research groups): HOPS (HIV Outpatient Study) and SUN (Study of the Natural History of HIV/AIDS in the Era of Effective Therapy). These data were collected through government-mandated public health reporting regulations. Cerner plays a significant role in the HOPS study, collecting data using Discovere®, Cerner’s research platform that manages sites, manages data processing and quality assurance, and conducts analyses. Although the clinic sites involved in collecting these data are currently populating the cohort databases by manual abstraction of medical records, the resulting data have already provided the basis for many scientific publications, some which reveal epidemiological trends among HIV-infected persons, effects of treatment, and most recently, higher risks for fractures (broken bones) associated with their HIV status*.
This fracture analysis among HIV-infected patients in the HOPS cohort not only revealed higher rates of fracture compared with the general U.S. population, but that rates of fracture in this cohort appeared to be increasing since 2000. Given these findings, the authors recommended that routine care of HIV-infected persons should include screening for, and correcting, causes of low mineral bone density and fall risk. This analysis was recently published in Clinical Infectious Diseases, featured on The Doctor's Channel, and should certainly have an impact on the care HIV-infected persons receive with regard to their bone health. This is a perfect example of “closing the loop.”
The successes of the HOPS and SUN studies in identifying trends in the progression of HIV disease and outcomes of treatment have come at a fairly high cost, given that data have been manually abstracted from medical records. Cerner is currently moving the data collection at these sites from a PC-based data collection tool to the web-based Discovere system. Once all cohort data reside in Discovere, the opportunities for downloading data from sites’ electronic health record systems to the cohort database increase dramatically. This movement from electronic capture of patient care to electronic transfer of data to a de-identified cohort database enables more rapid and efficient updates to the cohort database. Such efficiencies will allow the limited funds set aside for maintaining such cohorts to go further in increasing the size of the cohort and thoroughness of data collection, resulting in more important insights for improving patient care and identifying risks to their health.
* Benjamin Young; Christine N. Dao; Kate Buchatz; Rose Baker; John T Brooks; the HIV Outpatient Study (HOPS) Investigators. Increased Rates of Bone Fracture among HIV-Infected Persons in the HIV Outpatient Study (HOPS) Compared with the US General Population, 2000-2006. Clinical Infectious Diseases 2011; doi: 10.1093/cid/ciq242