An Overview of Marshfield Clinic’s Research Program
Exploring Opportunities for Collaboration
in the “Real” World
Dr. Humberto Vidaillet
Director of Medical Research, Marshfield Clinic
Director, Marshfield Clinic Research Foundation
Clinical Professor of Medicine, UW SMPH
September 14, 2011
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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.
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”
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Marshfield Clinic
Mission: To serve patients through
accessible, high quality health care,
research and education
501(c)(3) organization
Largest 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/year
Marshfield Labs (Human & Veterinary)
Lakeview Medical Center, Rice Lake, WI
Security Health Plan (HMO)
Why Marshfield Clinic Engages in Research & Education
● Core elements of Marshfield Clinic’s Mission, its status as a nationally
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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 scientists
Major external sponsors: NIH, CDC, NIOSH, AHRQ, Industry, Philanthropy
Academic 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
St. Joseph’s
Hospital
Lawton Center
for Research
& Education
Main Clinic
Building
East Wing
Laird Center for
Medical Research
Research Program Structure
Marshfield Clinic Research Foundation
Humberto Vidaillet, MD, Director
Steve Wesbrook, PhD, Deputy Director
Research Support
Offices/Services
Core Laboratory
Research Centers
Sponsored Programs
& Fiscal Affairs
Center for Human Genetics
Murray Brilliant, Ph.D.
Biomedical Informatics
Research Center (BIRC)
Simon Lin, M.D.
Clinical Research Center
Steven Yale, M.D.
Epidemiology Research Center
Edward A. Belongia, M.D.
Associate Director
Adedayo Onitilo, M.D.
National Farm Medicine Center
(Rural, Agricultural Health & Safety)
Barbara Lee, RN, PhD
Research Integrity &
Protections
Scientific Writing
& Publications
Health Systems
Research
MCRF Board of Trustees
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
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
Mark Nook, PhD
UW System,
Interim
Senior Vice President
for Academic Affairs
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.
Other Capacities
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Publish Clinical Medicine & Research
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With Clinic Information System, develop
new clinical medical informatics tools
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
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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)
Institute for Clinical and Translational Research (ICTR)
● 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
PARTNERSHIP
Schools of
Medicine and Public Health
Pharmacy
Nursing
Veterinary Medicine and
College of Engineering
Strength of the Marshfield Clinic - UW Research Partnership
Collaboration & 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
KL2 Review Committee
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
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
The Marshfield-UW Partnership
Foster Collaborations
Leverage unique resources
& shared Interests
To Conduct research
not otherwise possible
…
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
2. Access to Unique MC Resources
- Its Intellectual Capital: Depth & Breath
of UW investigators (Number, Expertise
and Diversity of Potential Collaborators)
- Biomedical Informatics Research Center
- Personalized Medicine Research Project
- Marshfield Epidemiology Research Center
3. Research & Training Programs
3. Access MC Population & Programs
- National Primate Center, Waisman Center
- KL2 Scholars, ICTR Pilots, etc.
- Rural Population plus HMORN
- Expansive Clinical Research Program
4. Leverage MC Led Initiatives
4. Leverage Unique UW Resources
- Wisconsin Genomics Initiatives
- Oral Systemic Health Research Network
- Wisconsin Network for Health Research
- Survey of the Health of Wisconsin
Synergy!
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Wisconsin IRB Consortium (WIC)
Purpose
Facilitate 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 Agreement
Allows 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
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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
The Role of Pharmacist Evaluation in Asthma
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.
Local PI
Suzanne N. Havican,
RN, RPh, BCPS
PI
Henry N. Young, PhD
UW Madison
Type-2 Translational Research
Tailored Approach to Genetic Counseling for Cystic Fibrosis
Newborn Screening: A New Model
Project
Principal Investigator
Marshfield Collaborators
Audrey Tluczek, PhD, RN
UW School of Nursing
Christina Zaleski, MS
Pediatric Infectious Disease
Wisconsin Model of
Family-Centered
Genetic Counseling
Received additional/outside funding
Type-2 Translational Research
Creating Healthy Workplaces: An intervention to
Improve Outcomes for Providers and Patients
Study Goal
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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
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Increase clinician and staff interest in participating in QIIs by
Local PI
addressing primary care work conditions
Steven H. Yale, MD
● Improve care quality in hypertension and diabetes by improving work
conditions
● Improve clinician and staff satisfaction, decrease stress, and reduce
intention to leave
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)
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 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
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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
25,000 people
60,000 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:
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a UW Shapiro scholar,
an ICTR scholar,
UW Population-Health students,
UW faculty and medical residents, &
Marshfield faculty and medical residents.
Collaborations: MESA
“Mortality & Cardiovascular Events Among Rural
Systemic Lupus Erythematosus Patients”
Goal: To examine the actual mortality burden and rates of cardiovascular
events among a rural population-based cohort of lupus 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
• 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.
• 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
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speaker.
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 Group
The 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
Phil Boehning
Sharon Bredl
Margaret Brubaker
Margy Frey
Pat Gall
Jodie Gardner
Nancy Kaster
Colleen Kelly
Mike Kobs
Norm Kommer
Darlene Krake
Rev. Mark Krueger
Julie Levelius
Jerry Minor
Noreen Moen
Representative Marlin Schneider
Scott Schultz
Jean Schwanebeck
Liz Welter
UW Marshfield
Loyal, WI Resident
Harmony-Ho Holsteins
Certified Municipal Clerk
Coldwell Banker, Brenizer Realtors
Financial Services Professional
Catalog Marketing Services
Pulaski, WI Resident
Marshfield, WI Resident
WDLB Radio Station
Community Bank of Central Wisconsin
Figi Inc, Senior Management Retiree
Christ Lutheran Church
Stratford, WI Public Schools
Pittsville, WI, Volunteer Fire Department
Marshfield Resident
WI State Government
Wisconsin Farmer's Union
Board of the Family Health Center
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
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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
Wisconsin Genomics Initiative
Marshfield
MCRF
• Rural
Cohort
Comprised of 20,000
Adults
•Biomedical Informatics
• Phenotyping
UWSMPH
• Regenerative Medicine
•Statistical &
Computational Analysis
• Super-Computing
Capability
Madison
MCW
•Genetic & Genomic Analysis
• Diverse Urban & Pediatric
Patient Populations
•High Through-Put Genotyping
UW-Milwaukee
• Urban & Environmental Health
• Community Engagement
• School of Nursing
Milwaukee
Building Accurate Predictive Models
G
Genetic
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+
1,000,000 SNPs will hit
or be close to most
medically relevant
genetic markers
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(
&
E
(Environmental Factors & Clinical Attributes)
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Smoking
Diet
Exercise
Alcohol
Residence
Occupation
Socio-economic status
Chemical exposure
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)=
C
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
=
P
Phenotype
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Cardiovascular diseases
Diabetes
Obesity
Stroke
Cancer
Allergies and Asthma
Alzheimer’s
Childhood illnesses &
developmental disorders
Eye diseases
Other
 Complex combinations of variables are required for accurate prediction
 The more we know about individual patients, greater the probability of prediction
WGI Funded Demonstration Projects (1)
Integrating Genomic Data into a Computational Model for Improved Breast Cancer Diagnosis
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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
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PI: Humberto Vidaillet, MD1
Collaborators: Bess Berg, MS4; David Page, PhD4; Peggy Peissig, MBA1; Percy Karanjia, MD1
Feasibility of Modular High Throughput Electronic Phenotyping
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PI: Peggy Peissig, MBA1
WGI Infrastructure Project Proposal: Expand the Current Informatics Architecture in Order to
Capitalize on the Available EMR and Genetic Data
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PI: Justin Starren, MD, PhD1
WGI Exome Sequencing to Identify Coding Variants for Myocardial Infarction
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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
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PI: Steve Yale, MD1
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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
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PIs: Aaron Buseh PhD, MPH3; Sandra Underwood, PhD, RN, FAAN 3
Development of a Predictive Algorithm for Age-related Macular Degeneration
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PI: Murray Brilliant, PhD1
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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
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PI: Nancy Sweitzer, MD, PhD4
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Collaborators: Cathy McCarty, PhD, MPH1; Orly Vardeny, PharmD4; Zhan Ye, PhD1
Membrane Metaloproteinase-9 Genotype and Aortic Aneurysm
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PI: Jay Yang, MD, PhD4
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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 Degeneration
Investigators
Murray Brilliant, PhD (PI)
Senior Research Scientist & Director Center Human Genetics
James Weber Endowed Chair in Human Genetics (MCRF)
Marshfield Clinic
Other Marshfield Clinic Co-Investigators
Cathy McCarty, PhD, MPH (Co-I)
Gary Pesicka, MD (Co-I)
Robert Valenzuela (Co-I)
C. David Page, PhD (Co-I)
Professor, Departments of Biostatistics & Medical Informatics
Professor, Department of Computer Science
UWSMPH
Joseph Carroll, PhD (Co-I)
Associate Professor of Ophthalmology
Assistant Professor of Biophysics
Assistant Professor of Cell Biology, Neurobiology & Anatomy
Medical College of Wisconsin
Contribution
 Hereditary pigmentation disorders.
His work led to the identification of
three genes that cause albinism:
- Hermansky-Pudlak syndrome 1
- Oculocutaneous albinism type 2 & 4
 Epidemiologist (Genetics & Eye Dz)
 Clinical Ophthalmologist (MC)
 Graduate Research Assistant (CHG)
 Algorithms for data mining and
machine learning, special interest
in applications to clinical and highthroughput genetic & molecular data
 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 Buseh
UW Milwaukee
Collaboration with UW Waisman Center
Genetic/Complex Disorders
1) 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.
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Marsha Seltzer, PhD
Waisman Center
Murray H. Brilliant, PhD
MCRF
Group Health Cooperative
Dementia
Mayo Clinic
Peripheral artery disease
Marshfield Clinic
Cataracts
Northwestern
Type II diabetes
Coordinating
center
Vanderbilt
QRS duration
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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MCRF’s Oral & Systemic Health Research Project (2)
● 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
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Planned Transition to Personalized Health Care
Plans for 2011 and 2012
Goals for the next 5 years
Improve user interface for PMRP
Searchable PMRP database
Sequence 10 subjects
Sequence all 20,000 subjects in PMRP
Stakeholders plan incorporation of
genetic data in EHR
Sequence genetic data linked to iEHR
with decision making tools
Pilot/Develop a clinically actionable
predictive algorithm (Age-related
Macular Degeneration - AMD)
Pilot Personalized Health Care to clinical
standard of care (AMD)
Pilot/Develop Oral-Systemic Health
Research Project (OHRP) and plan
recruitment of a large OSRP cohort
Create enhanced Personalized Health
Care Resource Networks
Current cost $4K
“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 Lohr
Published: 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
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● Organizational Structure:
● Administrative Informatics
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Support
Biostatistics
Usability/ICDI (Interactive
Clinical Design Institute)
Informatics Research
Infrastructure & Central
Resource
Research Data & Analytics
Management
BIRC: Multiple Missions
External Funders
Design
Data
Analysis
BIRC
Strategy
Prototyping
Evaluation
IT Planning
Infrastructure
Backoffice
Foundation Administration
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Clinic IS
Researchers
Research
Outcomes
BIRC Personnel Growth
Does not include short term students
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BIRC Expansion
• 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
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
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•
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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.