Leveraging Electronic Health Care Records To Improve Public Policy
How many fully vaccinated people still develop COVID-19 infections? How did the 2020 spike in firearm injuries affect minorities? What impact did the pandemic have on hospitalizations for teens with eating disorders?
Electronic health records (EHRs) are a treasure trove of data to answer such question. And one company—Epic—has made that information available to researchers across the country through Cosmos, a clinical and public health research platform.
Private data for public benefit
Epic launched Cosmos in 2017, but its full opportunity was first realized in the early days of the COVID-19 pandemic, when clinicians were desperate for any information they could find on treating this novel disease. Seeing that need for solid data, Epic’s founder and CEO, the irrepressible Judy Faulkner, pushed her team to launch what was then called the Epic Health Research Network (since renamed simply Epic Research).
“The Network was intended to be a new kind of journal to fill the need for good, actionable insights—fast,” Faulkner said.
While it does not replace the role of peer-reviewed clinical research, Epic Research uses Cosmos to provide public health officials quick, accurate answers to important health questions. Cosmos combines electronic health record data from over 140 million U.S. patients, refreshed every 14 days, from over 700 hospitals and 10,000 clinics, an event base of some 4.5 billion patient encounters including 2.2 billion visits with health care providers. The data covers patients from rural and urban areas as well as healthcare paid for by individuals, Medicare, and commercial health plans. Before data enters Cosmos, it is de-identified in 16 categories to protect patient privacy.
Indeed spillover benefits of clinical and public health information mined from such databases—provided it is privacy-preserved, normalized, historical, integrated, and representative–has long been a goal of EHR implementation. “The game changer has been the incorporation of artificial intelligence (AI) applied to these giant databases”, explain Walter Wieners, consultant and EHR expert. “Artificial intelligence provides new tools for analyzing clinical data to inform current policy decisions and public health planning.”
Epic Research teams work collaboratively with clinicians, data scientists, and public health experts. For example, two years ago Epic Research found that weekly volumes for preventive cancer screenings for breast, colon, and cervical cancer fell as much as 90 percent from 2017-2019 U.S. historical averages, presumably because of COVID-19 disruptions. Without detection, cancer can go misdiagnosed or diagnosed at a later stage. Epic Research published the information so individuals and health care providers could schedule screenings or seek alternative test options.
COVID-19 use cases for the CDC and FDA
Epic Research has used Cosmos to help the Centers for Disease Control (CDC) track adverse events and the efficacy of vaccines for COVID-19. The CDC also presented Cosmos data to the FDA on myocarditis, a rare but serious inflammation of the heart. This data was used in the approval process for COVID-19 vaccinations in kids ages 5-11. The CDC collaborated with the Epic Research teams who used Cosmos to compare the efficacy of the Moderna, Johnson & Johnson, and Pfizer COVID-19 vaccines against breakthrough infections and hospital admissions across age groups and to manage efficacy declines over time, an important factor when determining whether booster shots are appropriate and for which populations.
Epic and healthcare organizations that contribute data to Cosmos can use the platform to track, model, and visualize the impact of illnesses over time; study clinical interventions that have worked best for similar patients; and examine Look-Alikes, which helps physicians connect with other doctors on diagnosis and care for rare cases. The addition of the Cosmos research platform is likely a key value proposition for Epic’s customers, which include America’s top-rated hospitals and medical research universities.
Epic’s contrarian success story is par for the course for Faulkner, 78, who eschewed Wall Street and M&A for family ownership and in-house design of computer systems for humans. With Cosmos’s more than 6 million cancer patient records, Faulkner expects more improvements for prevention and treatment in this domain and when appropriate, bringing genomic perspectives to healthcare, naturally with appropriate privacy protections. Faulkner touts Epic’s forthcoming innovation, Best Care for My Patient, which takes clinical patient care to the next level of personalization. Best Care for My Patient enables providers to search Epic’s vast database to find other patients with symptoms or ailments like a patient they are currently treating and compare and modify treatment plans as such. For example, a clinician might research how other Epic users are treating young adult females with Lyme Disease and respiratory issues to find the best outcomes for treating the patient.
Epic’s passion for health extends beyond patients to include Epic’s employees and the planet. Epic’s 8.5 million-square-foot campus in Verona, WI, includes 43 acres of green roofs, nature walks, ponds, bioswale, and stormwater structures. The company is recognized nationally for its sustainability and for having one of America’s largest green heating/cooling systems with thousands of miles of underground geothermal pipes. The software giant also helps power its data centers with 6 wind turbines and 18 acres of solar panels.
Many media peddle healthcare startup and the politicization of medicine, Epic stands out as a legacy player at the forefront of innovation and committed to making a positive impact on the world.