Shawnee Mission South
Mark Hoffman, Ph.D.
Director – Translational Medicine
Aug 24, 2007
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
• Software developer for Microbiology team
– Respond to issues
– Write programs
• Team leader
– Responsibilities above + lead team
• Architect
• Solution Manager
• Begin where
you
want to end:
– Automate
enterprise
workflow
– Connect the
community
– Structure and
analyze
– Create
executable
knowledge
• The objective:
close the loop
Our Vision
Critical Decisions
Cerner Millennium Solutions Portfolio
10 Solution Groups – 54 Solutions
Community &
Consumer Systems
Access Systems
Specialty
Care Systems
Direct
Care Systems
Physician
Portal
PowerLink
Consumer
Relationship
Management
Condition
Centers
Call Center
Registration
Scheduling
Benefits Mgmt.
Eligibility &
Med. Necessity
Enterprise
Master Person
Index
Enterprise
Registration Mgmt.
Enterprise
Scheduling Mgmt.
Cardiology
Oncology
Bio-Surveillance
HealthSentry
PowerChart
Oncology
Women’s
Health
Children’s
Orthopedics
Pulmonology
Home Health
CVNet
EMR
Ambulatory
Care
Emergency
Critical Care
INet
Surgery &
Anesthesia
Acute Care
FirstNet
Plans &
Protocol Mgmt.
Image
Management
Pharmacy
PharmNet
Clinical Trials
Millennium
Helix™
Health
Info. Mgmt.
Workforce
Management
Outcomes
Measurement
Comparative
Data
ProFile
PowerInsight
HealthFacts
Executable
Knowledge
PowerChart
CDR
PowerChart Office
Clinical
Center Systems
Laboratory
Radiology
PathNet
RadNet
Financial & Operational
Systems
Patient
Accounting
Cost
Accounting
Supply Chain
Reporting
Outcomes &
Benchmarking
Drug
Database
Referential
Knowledge
Cerner APACHE
Cerner Multum
Zynx
HIPAA
Compliance
Clinical
Decision
Support
Clinically
Driven Revenue
Cycle
Clinically Driven
Resource
Planning
Interface
Engine
Interface
Library
Open Engine
OpenPort
Medical Device
Interfaces
Application
Dev. Kit
Mobile
Solutions
Distributed
Database EMPI
Distributed
Database EMR
Key
Industrial
Strength
Knowledge-Driven
Care Solutions
Inherent Solutions
Connectivity
Technologies
Health Economy
ProFit
Decision
Support Engine
Discern Expert
Closed Loop
Med. Process
Meds Integration
Discern Explorer
PowerVision
Cerner ProVision
ProCure
Early Maturity
SurgiNet
2003
CareNet
PowerOrders
2004
ProCall
PowerPlan
2005
Multi-Contributor
Documentation
PowerNote &
PowerForms
Future
©2003 Cerner Corporation. All rights reserved. This document contains confidential information which may not be reproduced or transmitted without the expressed written consent of Cerner.
.
Version
3.0
Innovation You Can Trust™
Automatic Reporting - HealthSentry
Lab Result
Fill Out Forms
by Hand
Fill out Log for
HIM – HIPAA
Compliance
Fax to DOH
Preparation of
Internal IC Reports by
hand using multiple
systems
Public Health
Daily Reports for Lab
and IC “Pushed” to
HealthSentry users
Follow Up from
DOH
HealthSentry Architecture
Public Health
Daily Result Trending
2006
HealthSentry – Proven Results
DATA COMPLETENESS
Reportable cases (non-STD): March-Sept 2002
*Average over 6 key data fields
80%
60%
40%
TIMELINESS
20%
0%
Conventional
HealthSentry
UNDER-REPORTING
400%
200%
3.0
*Average over all reportables
2.5
2.0
1.5
1.0
0.5
0.0
Conventional
100%
C
ep
H
nf
lu
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S
A
rp
G
H
tr
ep
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S
al
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S
am
p
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0%
C
% Increase
300%
Days to receive report
% Fields Complete
100%
*Increased overall reporting by 96%
HealthSentry
Present role
• Director of Translational Medicine at
Cerner Corporation
– Genomics
– Biobanking
– Clinical Trials
– Registries
– HIV Insights
• Lead group that is developing:
– New software module(s)
– Controlled vocabulary
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
The Clinical Bioinformatics Ontology (CBO)
•
Scope:
•
•
•
•
•
•
Molecular pathology
Clinical Genetics
Infectious disease
Cytogenetics
Cell surface markers
Current state (Jun 2008):
•
•
•
•
•
12,063
29,355
761
1,239
6,923
•
5,516
Concepts
Relationships
Genes
Nucleotide variants
Terms
Facets
•
Available from: www.clinbioinformatics.org
•
Included in the NCI Metathesaurus
Registered Users
Registered Users - Global
Unified ReportDocument Results
Default- uneditable
Protocol
MultiMedia
Foundation (MMF)
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
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
Cap of 10 associates for 2008
Tier 3: Student Associate


3.0 cumulative GPA or above in High School or College
Cap of 35 associates/summer
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