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Ontology-Driven Clinical Intelligence
A Path from the Biobank to Cross-Disease Research	
  
Bruce Pharr | Vice President, Bioinformatics Systems
Molecular Medicine Tri-Conference | February 11, 2014
1	
  
Data Barriers to Clinical Research
Critical Data is Dispersed in Separate Systems

Disease A

Disease B

Considering the vast stores of clinical data available to potential
investigators, the actual amount of clinical research performed has
been quite modest. At many medical centers, the data are dispersed in
separate systems that have evolved independently of one another.

Source: Obstacles and Approaches to Clinical Database Research: Experience at the University of California, San Francisco
Removing the Data Barriers
Structured Digital Data with Standardized Metadata and Ontology

Disease A

Disease B

The discovery of scientific insights through
effective management and reuse of data
requires several conditions to be optimized:
•  Data need to be digital;
•  Data need to be structured;
•  Data need to be standardized in terms of metadata and ontology.
Source: Anne E. Thessen and David J. Patterson, Data issues in life sciences, PMC (NIH/NLM) (November 28, 2011).
Ontology-Driven Clinical Intelligence
Structured Data with Standardized Metadata and Ontology
New Patient

Biobank

Lab Test & Analysis
Disease
Registry

Pre-analytical Data

Analytical Data

Mosaic™ Ontology-Based Platform
Legacy Data

Patient
Data

Legacy Disease Database

Patient
Data

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The document discusses two scientific journals - the Journal of Laboratory Automation (JALA) and the Journal of Biomolecular Screening (JBS). It provides information on their editors, impact factors, indexing in databases, scientific advisors and editorial boards. The goal of both journals is to publish research applying technological advances to scientific exploration and discovery of new therapeutics. Authors are encouraged to submit their work to these peer-reviewed, MEDLINE-indexed journals.

slasjalascientific journals
2016 CRI Year-in-Review
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2016 CRI Year-in-Review

This paper describes the methods of the Treatment In Morning versus Evening (TIME) study, a large prospective randomized open-label blinded endpoint study comparing morning versus evening dosing of antihypertensive medications. The TIME study recruits participants through advertising, primary and secondary care, and patient databases in the UK. Participants self-enroll and consent on a secure website, and are randomized to morning or evening dosing. Follow-ups are conducted by automated email at 1 month and every 3 months thereafter. The study uses a prospective randomized open-label blinded endpoint design to establish if evening dosing is more cardioprotective than morning dosing.

biomedical informaticshealth informaticsclinical research
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The document discusses Peter Embi's approach to presenting on clinical and translational research informatics literature from the past year. It provides an overview of Embi's search strategy and categorization of papers, which involved searching literature databases and recommendations from colleagues. The presentation will focus on summarizing representative papers within categories like data sharing/reuse, methods and systems, recruitment and eligibility, and trends in clinical research informatics.

clinical researchbiomedical informaticstranslational science
Ontology-Driven Clinical Intelligence
Remedy Informatics Architecture
Patient
Data

New
Data

Patient
Data

Remedy Bioinformatics

RemedyAMH™

Biobank Management Informatics

Aggregate, Map & Harmonize

	
  

Legacy
Data

	
  

Mosaic Builder Applications

Patient
Data

Content and Registry Development

	
  
Mosaic Engine
Functional Layers: Physical, Data Model, Information Model, Ontology, Representation Model

Mosaic™ Platform
Remedy Informatics

	
  

Disease
Registry
Next-Gen Biobank
A Path from the Biobank to Cross-Disease Research
Patient
Data

New
Data

Remedy Bioinformatics
Biobank Management Informatics

	
  

Remedy Informatics
Biobank Growth and Upgrade Cycle
Drivers for Next-Gen Biobanks
Growth
33% of all biobanks have been installed since the early 2000s (HGP)
• 
• 
• 

Increase in population genetics studies
Personalized medicine
Genetic information in food safety, forensics and disease surveillance

Upgrade
The Cancer Genome Atlas (TCGA) project (2006-8) exposed deficiencies
• 

Many biobank managers didn’t know exactly what was in their freezers

• 

Some specimens were unfit for analysis

• 
• 

Others had been obtained from patients without adequate consent
The rate of unacceptable shipments from some institutions was 99%

Source:	
  The	
  Future	
  of	
  Biobanking,	
  Laboratory	
  Focus,	
  January	
  2013	
  
Next-Gen Biobank Management
Best Practices Model Mapped to Applicable Global Standards
Patient

Biobank

Manage all information about:
1.  Specimens,
2.  Patients, and
3.  Operations throughout:
•  Collection
•  Processing
•  Storage and Inventory
•  Distribution

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secondary useresearchanalytics
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biomedical text miningradiology image
Clinical & Molecular Epidemiology
Clinical & Molecular EpidemiologyClinical & Molecular Epidemiology
Clinical & Molecular Epidemiology

The Clinical and Molecular Epidemiology Shared Resource (CMESR) provides services including the collection, processing, and storage of biological samples and clinical data from various cancer patient populations. It assists with IRB protocols, questionnaire data entry and analysis, and sample and data requests for cancer research. The CMESR is located at the Lombardi Cancer Center and houses samples and data on prostate, head and neck, colon, lung, and breast cancers.

Best Practices
Biobank Management Informatics Requirements
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 

Metadata
Entity Types
Sample Acquisition
Sample and Data Management
Sample Retention and Distribution
Support of Laboratory Processes
User Management
Search
Presentation of Entities
Printing
Reports and Audits
Non-functional Requirements
External Interface Requirements
Best Practices
Applicable International Standards and Guidelines
ISBER

International Society for Biological and Environmental Repositories. Best Practices for Repositories:
Collection, Storage, Retrieval, and Distribution of Biological Materials for Research.

NCI National Cancer Institute. First-generation guidelines for NCI-supported Biorepositories.
BAP Biorepository Accreditation Program (BAP) Checklist – College of American Pathologists (CAP)
21 CFR Part 11 US FDA – Guidelines on electronic records and electronic signatures.
45 CFR § 164.514 US HHS – Other requirements relating to uses and disclosures of protected health information.
ISO 15189 Medical laboratories – Particular requirements for quality and competence.
ISO 17025 General requirements for the competence of testing and calibration laboratories.
MoReq2 European Commission. Model Requirements for the management of electronic records.
OECD Best Practice Guidelines for biological resource centres.
Rec(2006)4

Council of Europe, Committee of Ministers. Recommendation of the Committee of Ministers to
member states on research on biological materials of human origin.
Mosaic Ontology
Purpose-Specific Structured Data Model
1.  Predefined, Standardized Terminology
2.  Domain-Specific Mapped Relationships
3.  Permissible Values and Validation Rules

Patient
Data

Legacy
Data

RemedyAMH™
Aggregate, Map & Harmonize

	
  
Mosaic Builder Applications

Patient
Data

Content and Registry Development

	
  
Mosaic Engine
Functional Layers: Physical, Data Model, Information Model, Ontology, Representation Model

Mosaic Platform
Remedy Informatics

	
  

Disease
Registry
Mosaic Ontology
Predefined, Standardized Terminology
Lab Result
LOINC
Subject
Units
High End of Normal
Low End of Normal
Confidentiality
Validation Status
Validator
Supplier of Data

LOINC Medical Laboratory and Clinical Observations

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The document discusses the importance of standardized practices and quality control for biobanks in order to facilitate research using human biosamples. It notes that the UC system's biobanks currently use diverse practices. The UC Biobanking and Research Integration Across Disciplines (BRAID) working group aims to establish standards to recognize high-quality biobanks within the UC system and help them share samples.

uc braid
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Discussion of provenance usage in the Learning Health System paradigm, as implemented in the TRANSFoRm project, with focus on security requirements and how they can be addressed using provenance graph abstraction.

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thomson reutersanalyticstransmart
Mosaic Ontology
Predefined, Standardized Terminology
Disorder
SNOMED CT
Assertion
Subject
Severity
Stage
Response to Treatment
Active State
Onset Date
Resolved State
First Diagnosed Date
Confidentiality
Source
Date of Entry
Validation Status
Validator
Supplier of Data

LOINC Medical Laboratory and Clinical Observations
SNOMED CT Clinical Codes, Terms, Synonyms and Definitions
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Predefined, Standardized Terminology
LOINC Medical Laboratory and Clinical Observations
SNOMED CT Clinical Codes, Terms, Synonyms and Definitions
ICD Disease Classifications
Gene Ontology Gene Product Characteristics and Annotation
RxNorm Clinical Drug Classifications
CDISC Clinical Protocol, Analysis and Reporting
Mosaic Ontology
Domain-Specific Mapped Relationships
Lab Result

Disorder

Procedure

LOINC

SNOMED

SNOMED

Subject

Response to Tx

Cause

Subject

Units
High End of Normal

Assertion

Evidence for

Severity

Subject
Operator

Indication

Facility

Low End of Normal

Stage

Confidentiality

Response to Treatment

Validation Status

Active State

Intent

Onset Date

Confidentiality

Resolved State

Source

First Diagnosed Date

Date of Entry

Confidentiality

Validation Status

Source

Validator

Date of Entry

Supplier of Data

Validator
Supplier of Data

Has Result

Validation Status
Validator
Supplier of Data

Start-Stop Time

Contraindication

Urgency Status
Mosaic Ontology
Permissible Value and Validation Rules
Disorder

Procedure

SNOMED

SNOMED

Assertion

Subject

Mild

Subject

Operator

Moderate

Severity

Facility

Severe

Stage

Screening

Start-Stop Time

Response to Treatment

Diagnostic

Urgency Status

Active State

Prevention

Intent

Onset Date

Therapeutic

Confidentiality

Resolved State

Palliation

Source

First Diagnosed Date

End-of-Life

Date of Entry

Confidentiality

Validation Status

Source

Validator

Date of Entry

Supplier of Data

Validation Status
Validator
Supplier of Data

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Diagnostic criteria and clinical guidelines standardization to automate case ...
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This document discusses standardizing clinical guidelines for adverse event classification using the Adverse Event Reporting Ontology (AERO). It describes how AERO encodes guidelines like Brighton Collaboration for diagnosing conditions like anaphylaxis from vaccine reports. It also discusses how AERO can integrate data like classifying reports in the Vaccine Adverse Event Reporting System according to encoded guidelines and linking to other datasets like DrugBank. The goal is automated adverse event diagnosis and integration of reporting data.

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Bryan Soper - resume
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Bryan Soper - resume

Bryan Soper has extensive experience in pharmaceutical competitive intelligence, medical writing, and data analysis. He currently performs contract work analyzing clinical trials and assessing drug approval likelihoods for Genentech. Previously he has analyzed cancer models and clinical trials to identify correlations. He holds a PhD in Molecular Biology from Cornell University and has worked as a postdoctoral scholar at UCSF investigating drug targets.

Mosaic Ontology
Standardized, Extensible Disease Registry Implementation
Ontology-Driven Clinical Intelligence
Cross-Disease Research
Remedy Informatics
•  Founded in 2003, privately held.
•  U.S. headquarters in Salt Lake City, Utah. Development offices in
Menlo Park, California.
•  Satellite offices in London, England; Sao Paulo, Brazil; and Munich,
Germany.
•  More than 120 employees.
•  Strategic partnerships with Merck and IMS.
•  Developed proprietary Mosaic Platform, an ontology-driven clinical
intelligence system scalable to any size enterprise.
•  Delivered more than 120 registries to wide range of leading life sciences
research and healthcare delivery organizations.
Thanks! – Questions?
Bruce Pharr
Vice President, Bioinformatics Systems
bruce.pharr@remedyinformatics.com
Remedy Informatics
www.remedyinformatics.com

Booth 406

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Ontology-Driven Clinical Intelligence: A Path from the Biobank to Cross-Disease Research

  • 1. Ontology-Driven Clinical Intelligence A Path from the Biobank to Cross-Disease Research   Bruce Pharr | Vice President, Bioinformatics Systems Molecular Medicine Tri-Conference | February 11, 2014 1  
  • 2. Data Barriers to Clinical Research Critical Data is Dispersed in Separate Systems Disease A Disease B Considering the vast stores of clinical data available to potential investigators, the actual amount of clinical research performed has been quite modest. At many medical centers, the data are dispersed in separate systems that have evolved independently of one another. Source: Obstacles and Approaches to Clinical Database Research: Experience at the University of California, San Francisco
  • 3. Removing the Data Barriers Structured Digital Data with Standardized Metadata and Ontology Disease A Disease B The discovery of scientific insights through effective management and reuse of data requires several conditions to be optimized: •  Data need to be digital; •  Data need to be structured; •  Data need to be standardized in terms of metadata and ontology. Source: Anne E. Thessen and David J. Patterson, Data issues in life sciences, PMC (NIH/NLM) (November 28, 2011).
  • 4. Ontology-Driven Clinical Intelligence Structured Data with Standardized Metadata and Ontology New Patient Biobank Lab Test & Analysis Disease Registry Pre-analytical Data Analytical Data Mosaic™ Ontology-Based Platform Legacy Data Patient Data Legacy Disease Database Patient Data
  • 5. Ontology-Driven Clinical Intelligence Remedy Informatics Architecture Patient Data New Data Patient Data Remedy Bioinformatics RemedyAMH™ Biobank Management Informatics Aggregate, Map & Harmonize   Legacy Data   Mosaic Builder Applications Patient Data Content and Registry Development   Mosaic Engine Functional Layers: Physical, Data Model, Information Model, Ontology, Representation Model Mosaic™ Platform Remedy Informatics   Disease Registry
  • 6. Next-Gen Biobank A Path from the Biobank to Cross-Disease Research Patient Data New Data Remedy Bioinformatics Biobank Management Informatics   Remedy Informatics
  • 7. Biobank Growth and Upgrade Cycle Drivers for Next-Gen Biobanks Growth 33% of all biobanks have been installed since the early 2000s (HGP) •  •  •  Increase in population genetics studies Personalized medicine Genetic information in food safety, forensics and disease surveillance Upgrade The Cancer Genome Atlas (TCGA) project (2006-8) exposed deficiencies •  Many biobank managers didn’t know exactly what was in their freezers •  Some specimens were unfit for analysis •  •  Others had been obtained from patients without adequate consent The rate of unacceptable shipments from some institutions was 99% Source:  The  Future  of  Biobanking,  Laboratory  Focus,  January  2013  
  • 8. Next-Gen Biobank Management Best Practices Model Mapped to Applicable Global Standards Patient Biobank Manage all information about: 1.  Specimens, 2.  Patients, and 3.  Operations throughout: •  Collection •  Processing •  Storage and Inventory •  Distribution
  • 9. Best Practices Biobank Management Informatics Requirements •  •  •  •  •  •  •  •  •  •  •  •  •  Metadata Entity Types Sample Acquisition Sample and Data Management Sample Retention and Distribution Support of Laboratory Processes User Management Search Presentation of Entities Printing Reports and Audits Non-functional Requirements External Interface Requirements
  • 10. Best Practices Applicable International Standards and Guidelines ISBER International Society for Biological and Environmental Repositories. Best Practices for Repositories: Collection, Storage, Retrieval, and Distribution of Biological Materials for Research. NCI National Cancer Institute. First-generation guidelines for NCI-supported Biorepositories. BAP Biorepository Accreditation Program (BAP) Checklist – College of American Pathologists (CAP) 21 CFR Part 11 US FDA – Guidelines on electronic records and electronic signatures. 45 CFR § 164.514 US HHS – Other requirements relating to uses and disclosures of protected health information. ISO 15189 Medical laboratories – Particular requirements for quality and competence. ISO 17025 General requirements for the competence of testing and calibration laboratories. MoReq2 European Commission. Model Requirements for the management of electronic records. OECD Best Practice Guidelines for biological resource centres. Rec(2006)4 Council of Europe, Committee of Ministers. Recommendation of the Committee of Ministers to member states on research on biological materials of human origin.
  • 11. Mosaic Ontology Purpose-Specific Structured Data Model 1.  Predefined, Standardized Terminology 2.  Domain-Specific Mapped Relationships 3.  Permissible Values and Validation Rules Patient Data Legacy Data RemedyAMH™ Aggregate, Map & Harmonize   Mosaic Builder Applications Patient Data Content and Registry Development   Mosaic Engine Functional Layers: Physical, Data Model, Information Model, Ontology, Representation Model Mosaic Platform Remedy Informatics   Disease Registry
  • 12. Mosaic Ontology Predefined, Standardized Terminology Lab Result LOINC Subject Units High End of Normal Low End of Normal Confidentiality Validation Status Validator Supplier of Data LOINC Medical Laboratory and Clinical Observations
  • 13. Mosaic Ontology Predefined, Standardized Terminology Disorder SNOMED CT Assertion Subject Severity Stage Response to Treatment Active State Onset Date Resolved State First Diagnosed Date Confidentiality Source Date of Entry Validation Status Validator Supplier of Data LOINC Medical Laboratory and Clinical Observations SNOMED CT Clinical Codes, Terms, Synonyms and Definitions
  • 14. Mosaic Ontology Predefined, Standardized Terminology LOINC Medical Laboratory and Clinical Observations SNOMED CT Clinical Codes, Terms, Synonyms and Definitions ICD Disease Classifications Gene Ontology Gene Product Characteristics and Annotation RxNorm Clinical Drug Classifications CDISC Clinical Protocol, Analysis and Reporting
  • 15. Mosaic Ontology Domain-Specific Mapped Relationships Lab Result Disorder Procedure LOINC SNOMED SNOMED Subject Response to Tx Cause Subject Units High End of Normal Assertion Evidence for Severity Subject Operator Indication Facility Low End of Normal Stage Confidentiality Response to Treatment Validation Status Active State Intent Onset Date Confidentiality Resolved State Source First Diagnosed Date Date of Entry Confidentiality Validation Status Source Validator Date of Entry Supplier of Data Validator Supplier of Data Has Result Validation Status Validator Supplier of Data Start-Stop Time Contraindication Urgency Status
  • 16. Mosaic Ontology Permissible Value and Validation Rules Disorder Procedure SNOMED SNOMED Assertion Subject Mild Subject Operator Moderate Severity Facility Severe Stage Screening Start-Stop Time Response to Treatment Diagnostic Urgency Status Active State Prevention Intent Onset Date Therapeutic Confidentiality Resolved State Palliation Source First Diagnosed Date End-of-Life Date of Entry Confidentiality Validation Status Source Validator Date of Entry Supplier of Data Validation Status Validator Supplier of Data
  • 17. Mosaic Ontology Standardized, Extensible Disease Registry Implementation
  • 19. Remedy Informatics •  Founded in 2003, privately held. •  U.S. headquarters in Salt Lake City, Utah. Development offices in Menlo Park, California. •  Satellite offices in London, England; Sao Paulo, Brazil; and Munich, Germany. •  More than 120 employees. •  Strategic partnerships with Merck and IMS. •  Developed proprietary Mosaic Platform, an ontology-driven clinical intelligence system scalable to any size enterprise. •  Delivered more than 120 registries to wide range of leading life sciences research and healthcare delivery organizations.
  • 20. Thanks! – Questions? Bruce Pharr Vice President, Bioinformatics Systems bruce.pharr@remedyinformatics.com Remedy Informatics www.remedyinformatics.com Booth 406