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Using Big Data to Shift from Evidence-based
Practice to Practice-based Evidence
Christopher Longhurst, MD, MS
Chief Medical Information Officer, Stanford Children’s Health
Associate Professor of Pediatrics and Medicine, Stanford University
2
Stanford Children’s Health
• Opened in 1991
• Mission: To provide extraordinary family-centered care
• 311 bed pediatric/obstetric tertiary-care facility
• Hospital stats
• 4200 Deliveries
• 13k Discharges
• 300k Clinic visits
3
Pediatrics, December 2005
4
Pediatrics, May 2010
5
Pediatrics, May 2010
6
AMIA Proceedings, 2009
7
New England Journal of Medicine, Nov 2011
9
Big Data and the Gartner Hype Cycle
10
“Big Data” Signals in Biomedicine & Healthcare
• Physiologic signals (remote monitoring, quantified self)
• Images (radiology, pathology, dermatology, ophthalmology)
• Omics (genomics, microbiomics, proteonomics)
• Social data (network analysis, crowdsourced)
• EMR data (structured and unstructured)
11
“Big Data” Signals in Biomedicine & Healthcare
• Physiologic signals (remote monitoring, quantified self)
• Images (radiology, pathology, dermatology, ophthalmology)
• Omics (genomics, microbiomics, proteonomics)
• Social data (network analysis, crowdsourced)
• EMR data (structured and unstructured)
12
Physiologic Data – Stanford (Science, 2010)
13
Physiologic Data – Silicon Valley
14
“Big Data” Signals in Biomedicine & Healthcare
• Physiologic signals (remote monitoring, quantified self)
• Images (radiology, pathology, dermatology, ophthalmology)
• Omics (genomics, microbiomics, proteonomics)
• Social data (network analysis, crowdsourced)
• EMR data (structured and unstructured)
15
Images – Stanford (AMIA Annu Symp Proc, 2008)
16
Images – Silicon Valley
17
“Big Data” Signals in Biomedicine & Healthcare
• Physiologic signals (remote monitoring, quantified self)
• Images (radiology, pathology, dermatology, ophthalmology)
• Omics (genomics, microbiomics, proteonomics)
• Social data (network analysis, crowdsourced)
• EMR data (structured and unstructured)
18
Omics – Stanford (Lancet, May 2010)
19
“Big Data” Signals in Biomedicine & Healthcare
• Physiologic signals (remote monitoring, quantified self)
• Images (radiology, pathology, dermatology, ophthalmology)
• Omics (genomics, microbiomics, proteonomics)
• Social data (network analysis, crowdsourced)
• EMR data (structured and unstructured)
20
Social Data – Stanford (JAMIA, 2013)
Social Data – Silicon Valley
Full disclosure: I serve on
the medical advisory
board for Doximity.
This infographic shows a
snapshot of Northern
California doctors and their
referrals, where each doctor
is represented by a blue dot
and the connecting lines
represent a referral.
US primary care connections
70% of PCP Colleagues
are within 100 miles
US specialist connections
are more regional
25
AHRQ, 2007
“Information technology must be deployed
and reengineered to overcome growing
problems associated with information
overload. Finally, and most importantly,
patients will have to be engaaged on
multiple levels to become ‘coproducers’
in a safer practice of medical diagnosis.”
26
“Big Data” Signals in Biomedicine & Healthcare
• Physiologic signals (remote monitoring, quantified self)
• Images (radiology, pathology, dermatology, ophthalmology)
• Omics (genomics, microbiomics, proteonomics)
• Social data (network analysis, crowdsourced)
• EMR data (structured and unstructured)
28
EMR Data – Stanford (AMIA Proceedings, 2009)
29
Finding Labs and Events that
Predict Harm
2
True Positive Rate
and False Positive
Rate
Best performing labs
and events
 Best sensitivity: urea nitrogen
 Best specificity: feeding tube
response
 Best overall: indirect bilirubin
30
IEEE Intelligent Systems, April 2009
“The first lesson of web-scale learning is
to use available large-scale data rather
than hoping for annotated data that
isn’t available.”
31
EMR Data – Stanford (Nature Pharmacology 2013)
32
2012 IOM Report on “Learning
Healthcare System”
33
Science Translational Medicine, Nov 2010
How do we ensure our healthcare system learns
from every patient, at every visit, every time?
Christopher Longhurst, MD, MS
clonghurst@stanfordchildrens.org
"We make a living by what we get, we make a life
by what we give." - Winston Churchill
Upon this gifted age, in its dark hour,
Rains from the sky a meteoric shower
Of facts…they lie unquestioned, uncombined.
Wisdom enough to leech us of our ill
Is daily spun, but there exists no loom
To weave it into fabric…
Edna St. Vincent Millay, Upon this age, that never speaks its mind.
In: Colleted Sonnets, 1939.

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iHT² CMIO & Physician & Executive Summit “Using Big Data to Shift from Evidence-based Practice to Practice-based Evidence” with Christopher Longhurst

  • 1. Using Big Data to Shift from Evidence-based Practice to Practice-based Evidence Christopher Longhurst, MD, MS Chief Medical Information Officer, Stanford Children’s Health Associate Professor of Pediatrics and Medicine, Stanford University
  • 2. 2 Stanford Children’s Health • Opened in 1991 • Mission: To provide extraordinary family-centered care • 311 bed pediatric/obstetric tertiary-care facility • Hospital stats • 4200 Deliveries • 13k Discharges • 300k Clinic visits
  • 7. 7 New England Journal of Medicine, Nov 2011
  • 8.
  • 9. 9 Big Data and the Gartner Hype Cycle
  • 10. 10 “Big Data” Signals in Biomedicine & Healthcare • Physiologic signals (remote monitoring, quantified self) • Images (radiology, pathology, dermatology, ophthalmology) • Omics (genomics, microbiomics, proteonomics) • Social data (network analysis, crowdsourced) • EMR data (structured and unstructured)
  • 11. 11 “Big Data” Signals in Biomedicine & Healthcare • Physiologic signals (remote monitoring, quantified self) • Images (radiology, pathology, dermatology, ophthalmology) • Omics (genomics, microbiomics, proteonomics) • Social data (network analysis, crowdsourced) • EMR data (structured and unstructured)
  • 12. 12 Physiologic Data – Stanford (Science, 2010)
  • 13. 13 Physiologic Data – Silicon Valley
  • 14. 14 “Big Data” Signals in Biomedicine & Healthcare • Physiologic signals (remote monitoring, quantified self) • Images (radiology, pathology, dermatology, ophthalmology) • Omics (genomics, microbiomics, proteonomics) • Social data (network analysis, crowdsourced) • EMR data (structured and unstructured)
  • 15. 15 Images – Stanford (AMIA Annu Symp Proc, 2008)
  • 17. 17 “Big Data” Signals in Biomedicine & Healthcare • Physiologic signals (remote monitoring, quantified self) • Images (radiology, pathology, dermatology, ophthalmology) • Omics (genomics, microbiomics, proteonomics) • Social data (network analysis, crowdsourced) • EMR data (structured and unstructured)
  • 18. 18 Omics – Stanford (Lancet, May 2010)
  • 19. 19 “Big Data” Signals in Biomedicine & Healthcare • Physiologic signals (remote monitoring, quantified self) • Images (radiology, pathology, dermatology, ophthalmology) • Omics (genomics, microbiomics, proteonomics) • Social data (network analysis, crowdsourced) • EMR data (structured and unstructured)
  • 20. 20 Social Data – Stanford (JAMIA, 2013)
  • 21. Social Data – Silicon Valley Full disclosure: I serve on the medical advisory board for Doximity.
  • 22. This infographic shows a snapshot of Northern California doctors and their referrals, where each doctor is represented by a blue dot and the connecting lines represent a referral.
  • 23. US primary care connections 70% of PCP Colleagues are within 100 miles
  • 25. 25 AHRQ, 2007 “Information technology must be deployed and reengineered to overcome growing problems associated with information overload. Finally, and most importantly, patients will have to be engaaged on multiple levels to become ‘coproducers’ in a safer practice of medical diagnosis.”
  • 26. 26 “Big Data” Signals in Biomedicine & Healthcare • Physiologic signals (remote monitoring, quantified self) • Images (radiology, pathology, dermatology, ophthalmology) • Omics (genomics, microbiomics, proteonomics) • Social data (network analysis, crowdsourced) • EMR data (structured and unstructured)
  • 27.
  • 28. 28 EMR Data – Stanford (AMIA Proceedings, 2009)
  • 29. 29 Finding Labs and Events that Predict Harm 2 True Positive Rate and False Positive Rate Best performing labs and events  Best sensitivity: urea nitrogen  Best specificity: feeding tube response  Best overall: indirect bilirubin
  • 30. 30 IEEE Intelligent Systems, April 2009 “The first lesson of web-scale learning is to use available large-scale data rather than hoping for annotated data that isn’t available.”
  • 31. 31 EMR Data – Stanford (Nature Pharmacology 2013)
  • 32. 32 2012 IOM Report on “Learning Healthcare System”
  • 34. How do we ensure our healthcare system learns from every patient, at every visit, every time?
  • 35. Christopher Longhurst, MD, MS clonghurst@stanfordchildrens.org "We make a living by what we get, we make a life by what we give." - Winston Churchill
  • 36. Upon this gifted age, in its dark hour, Rains from the sky a meteoric shower Of facts…they lie unquestioned, uncombined. Wisdom enough to leech us of our ill Is daily spun, but there exists no loom To weave it into fabric… Edna St. Vincent Millay, Upon this age, that never speaks its mind. In: Colleted Sonnets, 1939.