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Fleurence RL, Kent S, Adamson B, Tcheng J, Balicer R, Ross JS, Haynes K, Muller P, Campbell J, Bouée-Benhamiche E, García Martí S, Ramsey S. Assessing Real-World Data From Electronic Health Records for Health Technology Assessment: The SUITABILITY Checklist: A Good Practices Report of an ISPOR Task Force. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:692-701. [PMID: 38871437 PMCID: PMC11182651 DOI: 10.1016/j.jval.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 01/23/2024] [Indexed: 06/15/2024]
Abstract
This ISPOR Good Practices report provides a framework for assessing the suitability of electronic health records data for use in health technology assessments (HTAs). Although electronic health record (EHR) data can fill evidence gaps and improve decisions, several important limitations can affect its validity and relevance. The ISPOR framework includes 2 components: data delineation and data fitness for purpose. Data delineation provides a complete understanding of the data and an assessment of its trustworthiness by describing (1) data characteristics; (2) data provenance; and (3) data governance. Fitness for purpose comprises (1) data reliability items, ie, how accurate and complete the estimates are for answering the question at hand and (2) data relevance items, which assess how well the data are suited to answer the particular question from a decision-making perspective. The report includes a checklist specific to EHR data reporting: the ISPOR SUITABILITY Checklist. It also provides recommendations for HTA agencies and policy makers to improve the use of EHR-derived data over time. The report concludes with a discussion of limitations and future directions in the field, including the potential impact from the substantial and rapid advances in the diffusion and capabilities of large language models and generative artificial intelligence. The report's immediate audiences are HTA evidence developers and users. We anticipate that it will also be useful to other stakeholders, particularly regulators and manufacturers, in the future.
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Affiliation(s)
| | - Seamus Kent
- Erasmus School of Health & Policy Management, Erasmus University, Rotterdam, The Netherlands
| | | | | | | | - Joseph S Ross
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Kevin Haynes
- Janssen Research and Development, Titusville, NJ, USA
| | - Patrick Muller
- Centre for Guidelines, National Institute for Health and Care Excellence, Manchester or London, England, UK
| | - Jon Campbell
- National Pharmaceutical Council, Washington, DC, USA
| | - Elsa Bouée-Benhamiche
- Public Health and Healthcare Division, Institut National du Cancer, Boulogne-Billancourt, France
| | - Sebastián García Martí
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Scott Ramsey
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, WA, USA.
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Thokagevistk K, Coppo C, Rey L, Carelli A, Díez V, Vaselenak S, Oliveira L, Patel A, Sicari E, Ramos T, Schach S, Schirghuber E, Simpson A, Choquet R, Le Lay K. Real-World Evidence to Reinforce Clinical Trial Evidence in Health Technology Assessment: A Critical Review of Real-World Evidence Requirements from Seven Countries and Recommendations to Improve Acceptance. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2024; 12:105-117. [PMID: 38808313 PMCID: PMC11130860 DOI: 10.3390/jmahp12020009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 02/22/2024] [Accepted: 04/18/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Real-world evidence (RWE) can reinforce clinical trial evidence in health technology assessment (HTA). OBJECTIVES Review HTA bodies' (HTAbs) requirements for RWE, real uses, and acceptance across seven countries (Brazil, Canada, France, Germany, Italy, Spain, and the United Kingdom) and outline recommendations that may improve acceptance of RWE in efficacy/effectiveness assessments and appraisals processes. METHODS RWE requirements were summarized based on HTAbs' guidelines. Acceptance by HTAbs was evaluated based on industry experience and case studies. RESULTS As of June 2022, RWE methodological guidelines were in place in three of the seven countries. HTAbs typically requested analyses based on local data sources, but the preferred study design and data sources differed. HTAbs had individual submission, assessment, and appraisal processes; some allowed early meetings for the protocol and/or results validation, though few involved external experts or medical societies to provide input to assessment and appraisal. The extent of submission, assessment, and appraisal requirements did not necessarily reflect the degree of acceptance. CONCLUSION All the countries reviewed face common challenges regarding the use of RWE. Our proposals address the need to facilitate collaboration and communication with industry and regulatory agencies and the need for specific guidelines describing RWE design and criteria of acceptance throughout the assessment and appraisal processes.
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Affiliation(s)
| | - Céline Coppo
- IQVIA, 17 bis Tsse. des Reflets, 92400 Courbevoie, France
| | - Laetitia Rey
- IQVIA, 17 bis Tsse. des Reflets, 92400 Courbevoie, France
| | - Amanda Carelli
- Roche, Rua Dr. Rubens Gomes Bueno, 691—Várzea de Baixo, São Paulo 04730-903, Brazil
| | - Veronica Díez
- F. Hoffmann-La Roche Ltd., C/Ribera del Loira 50, 28042 Madrid, Spain
| | | | - Liana Oliveira
- Roche, Rua Dr. Rubens Gomes Bueno, 691—Várzea de Baixo, São Paulo 04730-903, Brazil
| | - Ajay Patel
- Roche Products Ltd., Hexagon Place, Shire Park, Falcon Way, Welwyn Garden City AL7 1TW, UK
| | - Emilia Sicari
- Roche SpA, Viale Gian Battista Stucchi, 110, 20900 Monza, Italy
| | - Teresa Ramos
- F. Hoffmann-La Roche Ltd., C/Ribera del Loira 50, 28042 Madrid, Spain
| | - Susanne Schach
- Roche, Emil-Barell-Straße 1, 79639 Grenzach-Wyhlen, Germany
| | - Erika Schirghuber
- F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070 Basel, Switzerland
| | - Alex Simpson
- F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070 Basel, Switzerland
| | - Remy Choquet
- Roche, 4 Cr de l’Île Seguin, 92100 Boulogne-Billancourt, France
| | - Katell Le Lay
- Roche, 4 Cr de l’Île Seguin, 92100 Boulogne-Billancourt, France
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Gomes M, Turner AJ, Sammon C, Dawoud D, Ramagopalan S, Simpson A, Siebert U. Acceptability of Using Real-World Data to Estimate Relative Treatment Effects in Health Technology Assessments: Barriers and Future Steps. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:623-632. [PMID: 38369282 DOI: 10.1016/j.jval.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 01/19/2024] [Accepted: 01/24/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVES Evidence about the comparative effects of new treatments is typically collected in randomized controlled trials (RCTs). In some instances, RCTs are not possible, or their value is limited by an inability to capture treatment effects over the longer term or in all relevant population subgroups. In these cases, nonrandomized studies (NRS) using real-world data (RWD) are increasingly used to complement trial evidence on treatment effects for health technology assessment (HTA). However, there have been concerns over a lack of acceptability of this evidence by HTA agencies. This article aims to identify the barriers to the acceptance of NRS and steps that may facilitate increases in the acceptability of NRS in the future. METHODS Opinions of the authorship team based on their experience in real-world evidence research in academic, HTA, and industry settings, supported by a critical assessment of existing studies. RESULTS Barriers were identified that are applicable to key stakeholder groups, including HTA agencies (eg, the lack of comprehensive methodological guidelines for using RWD), evidence generators (eg, avoidable deviations from best practices), and external stakeholders (eg, data controllers providing timely access to high-quality RWD). Future steps that may facilitate future acceptability of NRS include improvements in the quality, integration, and accessibility of RWD, wider use of demonstration projects to highlight the value and applicability of nonrandomized designs, living, and more detailed HTA guidelines, and improvements in HTA infrastructure relating to RWD. CONCLUSION NRS can represent a crucial source of evidence on treatment effects for use in HTA when RCT evidence is limited.
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Affiliation(s)
- Manuel Gomes
- Department of Applied Health Research, University College London, London, England, UK
| | | | | | - Dalia Dawoud
- Science, Policy and Research Programme, National Institute for Health and Care Excellence, London, England, UK; Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | | | - Alex Simpson
- Global Access, F. Hoffmann-La Roche Ltd, Grenzacherstrasse, Basel, Switzerland.
| | - Uwe Siebert
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Hall in Tirol, Austria; Center for Health Decision Science and Department of Health Policy and Management, Harvard T.H Chan School of Public Health, Boston, MA, USA; Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Haug M, Oja M, Pajusalu M, Mooses K, Reisberg S, Vilo J, Giménez AF, Falconer T, Danilović A, Maljkovic F, Dawoud D, Kolde R. Markov modeling for cost-effectiveness using federated health data network. J Am Med Inform Assoc 2024; 31:1093-1101. [PMID: 38472144 PMCID: PMC11031209 DOI: 10.1093/jamia/ocae044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/19/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024] Open
Abstract
OBJECTIVE To introduce 2 R-packages that facilitate conducting health economics research on OMOP-based data networks, aiming to standardize and improve the reproducibility, transparency, and transferability of health economic models. MATERIALS AND METHODS We developed the software tools and demonstrated their utility by replicating a UK-based heart failure data analysis across 5 different international databases from Estonia, Spain, Serbia, and the United States. RESULTS We examined treatment trajectories of 47 163 patients. The overall incremental cost-effectiveness ratio (ICER) for telemonitoring relative to standard of care was 57 472 €/QALY. Country-specific ICERs were 60 312 €/QALY in Estonia, 58 096 €/QALY in Spain, 40 372 €/QALY in Serbia, and 90 893 €/QALY in the US, which surpassed the established willingness-to-pay thresholds. DISCUSSION Currently, the cost-effectiveness analysis lacks standard tools, is performed in ad-hoc manner, and relies heavily on published information that might not be specific for local circumstances. Published results often exhibit a narrow focus, central to a single site, and provide only partial decision criteria, limiting their generalizability and comprehensive utility. CONCLUSION We created 2 R-packages to pioneer cost-effectiveness analysis in OMOP CDM data networks. The first manages state definitions and database interaction, while the second focuses on Markov model learning and profile synthesis. We demonstrated their utility in a multisite heart failure study, comparing telemonitoring and standard care, finding telemonitoring not cost-effective.
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Affiliation(s)
- Markus Haug
- Institute of Computer Science, University of Tartu, Tartu 51009, Estonia
| | - Marek Oja
- Institute of Computer Science, University of Tartu, Tartu 51009, Estonia
| | - Maarja Pajusalu
- Institute of Computer Science, University of Tartu, Tartu 51009, Estonia
| | - Kerli Mooses
- Institute of Computer Science, University of Tartu, Tartu 51009, Estonia
| | - Sulev Reisberg
- Institute of Computer Science, University of Tartu, Tartu 51009, Estonia
| | - Jaak Vilo
- Institute of Computer Science, University of Tartu, Tartu 51009, Estonia
| | | | - Thomas Falconer
- Columbia University Irving Medical Center, New York, NY 10032, United States
| | | | - Filip Maljkovic
- Department of Health Information Systems, Heliant, Belgrade 11000, Serbia
| | - Dalia Dawoud
- National Institute for Health and Care Excellence, London WC1V 6NA, United Kingdom
| | - Raivo Kolde
- Institute of Computer Science, University of Tartu, Tartu 51009, Estonia
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Ward R, Hallinan CM, Ormiston-Smith D, Chidgey C, Boyle D. The OMOP common data model in Australian primary care data: Building a quality research ready harmonised dataset. PLoS One 2024; 19:e0301557. [PMID: 38635655 PMCID: PMC11025850 DOI: 10.1371/journal.pone.0301557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/15/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND The use of routinely collected health data for secondary research purposes is increasingly recognised as a methodology that advances medical research, improves patient outcomes, and guides policy. This secondary data, as found in electronic medical records (EMRs), can be optimised through conversion into a uniform data structure to enable analysis alongside other comparable health metric datasets. This can be achieved with the Observational Medical Outcomes Partnership Common Data Model (OMOP-CDM), which employs a standardised vocabulary to facilitate systematic analysis across various observational databases. The concept behind the OMOP-CDM is the conversion of data into a common format through the harmonisation of terminologies, vocabularies, and coding schemes within a unique repository. The OMOP model enhances research capacity through the development of shared analytic and prediction techniques; pharmacovigilance for the active surveillance of drug safety; and 'validation' analyses across multiple institutions across Australia, the United States, Europe, and the Asia Pacific. In this research, we aim to investigate the use of the open-source OMOP-CDM in the PATRON primary care data repository. METHODS We used standard structured query language (SQL) to construct, extract, transform, and load scripts to convert the data to the OMOP-CDM. The process of mapping distinct free-text terms extracted from various EMRs presented a substantial challenge, as many terms could not be automatically matched to standard vocabularies through direct text comparison. This resulted in a number of terms that required manual assignment. To address this issue, we implemented a strategy where our clinical mappers were instructed to focus only on terms that appeared with sufficient frequency. We established a specific threshold value for each domain, ensuring that more than 95% of all records were linked to an approved vocabulary like SNOMED once appropriate mapping was completed. To assess the data quality of the resultant OMOP dataset we utilised the OHDSI Data Quality Dashboard (DQD) to evaluate the plausibility, conformity, and comprehensiveness of the data in the PATRON repository according to the Kahn framework. RESULTS Across three primary care EMR systems we converted data on 2.03 million active patients to version 5.4 of the OMOP common data model. The DQD assessment involved a total of 3,570 individual evaluations. Each evaluation compared the outcome against a predefined threshold. A 'FAIL' occurred when the percentage of non-compliant rows exceeded the specified threshold value. In this assessment of the primary care OMOP database described here, we achieved an overall pass rate of 97%. CONCLUSION The OMOP CDM's widespread international use, support, and training provides a well-established pathway for data standardisation in collaborative research. Its compatibility allows the sharing of analysis packages across local and international research groups, which facilitates rapid and reproducible data comparisons. A suite of open-source tools, including the OHDSI Data Quality Dashboard (Version 1.4.1), supports the model. Its simplicity and standards-based approach facilitates adoption and integration into existing data processes.
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Affiliation(s)
- Roger Ward
- Health & Biomedical Research Information Technology Unit (HaBIC R2), Department of General Practice and Primary Care, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Christine Mary Hallinan
- Health & Biomedical Research Information Technology Unit (HaBIC R2), Department of General Practice and Primary Care, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - David Ormiston-Smith
- Health & Biomedical Research Information Technology Unit (HaBIC R2), Department of General Practice and Primary Care, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Christine Chidgey
- Health & Biomedical Research Information Technology Unit (HaBIC R2), Department of General Practice and Primary Care, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Dougie Boyle
- Health & Biomedical Research Information Technology Unit (HaBIC R2), Department of General Practice and Primary Care, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
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Claire R, Elvidge J, Hanif S, Goovaerts H, Rijnbeek PR, Jónsson P, Facey K, Dawoud D. Advancing the use of real world evidence in health technology assessment: insights from a multi-stakeholder workshop. Front Pharmacol 2024; 14:1289365. [PMID: 38283835 PMCID: PMC10811058 DOI: 10.3389/fphar.2023.1289365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 12/29/2023] [Indexed: 01/30/2024] Open
Abstract
Introduction: Real-world evidence (RWE) in health technology assessment (HTA) holds significant potential for informing healthcare decision-making. A multistakeholder workshop was organised by the European Health Data and Evidence Network (EHDEN) and the GetReal Institute to explore the status, challenges, and opportunities in incorporating RWE into HTA, with a focus on learning from regulatory initiatives such as the European Medicines Agency (EMA) Data Analysis and Real World Interrogation Network (DARWIN EU®). Methods: The workshop gathered key stakeholders from regulatory agencies, HTA organizations, academia, and industry for three panel discussions on RWE and HTA integration. Insights and recommendations were collected through panel discussions and audience polls. The workshop outcomes were reviewed by authors to identify key themes, challenges, and recommendations. Results: The workshop discussions revealed several important findings relating to the use of RWE in HTA. Compared with regulatory processes, its adoption in HTA to date has been slow. Barriers include limited trust in RWE, data quality concerns, and uncertainty about best practices. Facilitators include multidisciplinary training, educational initiatives, and stakeholder collaboration, which could be facilitated by initiatives like EHDEN and the GetReal Institute. Demonstrating the impact of "driver projects" could promote RWE adoption in HTA. Conclusion: To enhance the integration of RWE in HTA, it is crucial to address known barriers through comprehensive training, stakeholder collaboration, and impactful exemplar research projects. By upskilling users and beneficiaries of RWE and those that generate it, promoting collaboration, and conducting "driver projects," can strengthen the HTA evidence base for more informed healthcare decisions.
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Affiliation(s)
- Ravinder Claire
- National Institute for Health and Care Excellence, Manchester, United Kingdom
| | - Jamie Elvidge
- National Institute for Health and Care Excellence, Manchester, United Kingdom
| | | | | | | | - Páll Jónsson
- National Institute for Health and Care Excellence, Manchester, United Kingdom
| | - Karen Facey
- University of Edinburgh, Member Scottish Health Technologies Group Council, Edinburgh, United Kingdom
| | - Dalia Dawoud
- National Institute for Health and Care Excellence, London, United Kingdom
- Clinical Pharmacy Department, Faculty of Pharmacy, Cairo University, Cairo, Egypt
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Cai CX, Halfpenny W, Boland MV, Lehmann HP, Hribar M, Goetz KE, Baxter SL. Advancing Toward a Common Data Model in Ophthalmology: Gap Analysis of General Eye Examination Concepts to Standard Observational Medical Outcomes Partnership (OMOP) Concepts. OPHTHALMOLOGY SCIENCE 2023; 3:100391. [PMID: 38025162 PMCID: PMC10630664 DOI: 10.1016/j.xops.2023.100391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/16/2023] [Accepted: 08/21/2023] [Indexed: 12/01/2023]
Abstract
Purpose Evaluate the degree of concept coverage of the general eye examination in one widely used electronic health record (EHR) system using the Observational Health Data Sciences and Informatics Observational Medical Outcomes Partnership (OMOP) common data model (CDM). Design Study of data elements. Participants Not applicable. Methods Data elements (field names and predefined entry values) from the general eye examination in the Epic foundation system were mapped to OMOP concepts and analyzed. Each mapping was given a Health Level 7 equivalence designation-equal when the OMOP concept had the same meaning as the source EHR concept, wider when it was missing information, narrower when it was overly specific, and unmatched when there was no match. Initial mappings were reviewed by 2 graders. Intergrader agreement for equivalence designation was calculated using Cohen's kappa. Agreement on the mapped OMOP concept was calculated as a percentage of total mappable concepts. Discrepancies were discussed and a final consensus created. Quantitative analysis was performed on wider and unmatched concepts. Main Outcome Measures Gaps in OMOP concept coverage of EHR elements and intergrader agreement of mapped OMOP concepts. Results A total of 698 data elements (210 fields, 488 values) from the EHR were analyzed. The intergrader kappa on the equivalence designation was 0.88 (standard error 0.03, P < 0.001). There was a 96% agreement on the mapped OMOP concept. In the final consensus mapping, 25% (1% fields, 31% values) of the EHR to OMOP concept mappings were considered equal, 50% (27% fields, 60% values) wider, 4% (8% fields, 2% values) narrower, and 21% (52% fields, 8% values) unmatched. Of the wider mapped elements, 46% were missing the laterality specification, 24% had other missing attributes, and 30% had both issues. Wider and unmatched EHR elements could be found in all areas of the general eye examination. Conclusions Most data elements in the general eye examination could not be represented precisely using the OMOP CDM. Our work suggests multiple ways to improve the incorporation of important ophthalmology concepts in OMOP, including adding laterality to existing concepts. There exists a strong need to improve the coverage of ophthalmic concepts in source vocabularies so that the OMOP CDM can better accommodate vision research. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Cindy X. Cai
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - William Halfpenny
- Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, California
| | - Michael V. Boland
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Harold P. Lehmann
- Division of Health Sciences Informatics, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Biomedical Informatics and Data Science, Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michelle Hribar
- Office of Data Science and Health Informatics, National Eye Institute, National Institute of Health, Bethesda, Maryland
- Department of Ophthalmology, Casey Eye Institute, Portland, Oregon
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon
| | - Kerry E. Goetz
- Office of Data Science and Health Informatics, National Eye Institute, National Institute of Health, Bethesda, Maryland
| | - Sally L. Baxter
- Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, California
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California
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Oja M, Tamm S, Mooses K, Pajusalu M, Talvik HA, Ott A, Laht M, Malk M, Lõo M, Holm J, Haug M, Šuvalov H, Särg D, Vilo J, Laur S, Kolde R, Reisberg S. Transforming Estonian health data to the Observational Medical Outcomes Partnership (OMOP) Common Data Model: lessons learned. JAMIA Open 2023; 6:ooad100. [PMID: 38058679 PMCID: PMC10697784 DOI: 10.1093/jamiaopen/ooad100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 11/15/2023] [Indexed: 12/08/2023] Open
Abstract
Objective To describe the reusable transformation process of electronic health records (EHR), claims, and prescriptions data into Observational Medical Outcome Partnership (OMOP) Common Data Model (CDM), together with challenges faced and solutions implemented. Materials and Methods We used Estonian national health databases that store almost all residents' claims, prescriptions, and EHR records. To develop and demonstrate the transformation process of Estonian health data to OMOP CDM, we used a 10% random sample of the Estonian population (n = 150 824 patients) from 2012 to 2019 (MAITT dataset). For the sample, complete information from all 3 databases was converted to OMOP CDM version 5.3. The validation was performed using open-source tools. Results In total, we transformed over 100 million entries to standard concepts using standard OMOP vocabularies with the average mapping rate 95%. For conditions, observations, drugs, and measurements, the mapping rate was over 90%. In most cases, SNOMED Clinical Terms were used as the target vocabulary. Discussion During the transformation process, we encountered several challenges, which are described in detail with concrete examples and solutions. Conclusion For a representative 10% random sample, we successfully transferred complete records from 3 national health databases to OMOP CDM and created a reusable transformation process. Our work helps future researchers to transform linked databases into OMOP CDM more efficiently, ultimately leading to better real-world evidence.
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Affiliation(s)
- Marek Oja
- Institute of Computer Science, University of Tartu, 51009 Tartu, Estonia
| | - Sirli Tamm
- Institute of Computer Science, University of Tartu, 51009 Tartu, Estonia
| | - Kerli Mooses
- Institute of Computer Science, University of Tartu, 51009 Tartu, Estonia
| | - Maarja Pajusalu
- Institute of Computer Science, University of Tartu, 51009 Tartu, Estonia
| | - Harry-Anton Talvik
- Institute of Computer Science, University of Tartu, 51009 Tartu, Estonia
- STACC, 51009 Tartu, Estonia
| | - Anne Ott
- Institute of Computer Science, University of Tartu, 51009 Tartu, Estonia
| | - Marianna Laht
- Institute of Computer Science, University of Tartu, 51009 Tartu, Estonia
| | - Maria Malk
- Institute of Computer Science, University of Tartu, 51009 Tartu, Estonia
| | - Marcus Lõo
- Institute of Computer Science, University of Tartu, 51009 Tartu, Estonia
| | - Johannes Holm
- Institute of Computer Science, University of Tartu, 51009 Tartu, Estonia
| | - Markus Haug
- Institute of Computer Science, University of Tartu, 51009 Tartu, Estonia
| | - Hendrik Šuvalov
- Institute of Computer Science, University of Tartu, 51009 Tartu, Estonia
| | - Dage Särg
- Institute of Computer Science, University of Tartu, 51009 Tartu, Estonia
- STACC, 51009 Tartu, Estonia
| | - Jaak Vilo
- Institute of Computer Science, University of Tartu, 51009 Tartu, Estonia
- STACC, 51009 Tartu, Estonia
| | - Sven Laur
- Institute of Computer Science, University of Tartu, 51009 Tartu, Estonia
| | - Raivo Kolde
- Institute of Computer Science, University of Tartu, 51009 Tartu, Estonia
| | - Sulev Reisberg
- Institute of Computer Science, University of Tartu, 51009 Tartu, Estonia
- STACC, 51009 Tartu, Estonia
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Tamuhla T, Lulamba ET, Mutemaringa T, Tiffin N. Multiple modes of data sharing can facilitate secondary use of sensitive health data for research. BMJ Glob Health 2023; 8:e013092. [PMID: 37802544 PMCID: PMC10565310 DOI: 10.1136/bmjgh-2023-013092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/12/2023] [Indexed: 10/10/2023] Open
Abstract
Evidence-based healthcare relies on health data from diverse sources to inform decision-making across different domains, including disease prevention, aetiology, diagnostics, therapeutics and prognosis. Increasing volumes of highly granular data provide opportunities to leverage the evidence base, with growing recognition that health data are highly sensitive and onward research use may create privacy issues for individuals providing data. Concerns are heightened for data without explicit informed consent for secondary research use. Additionally, researchers-especially from under-resourced environments and the global South-may wish to participate in onward analysis of resources they collected or retain oversight of onward use to ensure ethical constraints are respected. Different data-sharing approaches may be adopted according to data sensitivity and secondary use restrictions, moving beyond the traditional Open Access model of unidirectional data transfer from generator to secondary user. We describe collaborative data sharing, facilitating research by combining datasets and undertaking meta-analysis involving collaborating partners; federated data analysis, where partners undertake synchronous, harmonised analyses on their independent datasets and then combine their results in a coauthored report, and trusted research environments where data are analysed in a controlled environment and only aggregate results are exported. We review how deidentification and anonymisation methods, including data perturbation, can reduce risks specifically associated with health data secondary use. In addition, we present an innovative modularised approach for building data sharing agreements incorporating a more nuanced approach to data sharing to protect privacy, and provide a framework for building the agreements for each of these data-sharing scenarios.
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Affiliation(s)
- Tsaone Tamuhla
- South African National Bioinformatics Institute, University of the Western Cape, Bellville, South Africa
| | - Eddie T Lulamba
- South African National Bioinformatics Institute, University of the Western Cape, Bellville, South Africa
| | - Themba Mutemaringa
- Provincial Health Data Centre, Health Intelligence Directorate, Western Cape Department of Health and Wellness, Cape Town, Western Cape, South Africa
- Computational Biology Division, Department of Integrative Biomedical Sciences, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Nicki Tiffin
- South African National Bioinformatics Institute, University of the Western Cape, Bellville, South Africa
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10
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Dhingra LS, Shen M, Mangla A, Khera R. Cardiovascular Care Innovation through Data-Driven Discoveries in the Electronic Health Record. Am J Cardiol 2023; 203:136-148. [PMID: 37499593 PMCID: PMC10865722 DOI: 10.1016/j.amjcard.2023.06.104] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/24/2023] [Accepted: 06/29/2023] [Indexed: 07/29/2023]
Abstract
The electronic health record (EHR) represents a rich source of patient information, increasingly being leveraged for cardiovascular research. Although its primary use remains the seamless delivery of health care, the various longitudinally aggregated structured and unstructured data elements for each patient within the EHR can define the computational phenotypes of disease and care signatures and their association with outcomes. Although structured data elements, such as demographic characteristics, laboratory measurements, problem lists, and medications, are easily extracted, unstructured data are underused. The latter include free text in clinical narratives, documentation of procedures, and reports of imaging and pathology. Rapid scaling up of data storage and rapid innovation in natural language processing and computer vision can power insights from unstructured data streams. However, despite an array of opportunities for research using the EHR, specific expertise is necessary to adequately address confidentiality, accuracy, completeness, and heterogeneity challenges in EHR-based research. These often require methodological innovation and best practices to design and conduct successful research studies. Our review discusses these challenges and their proposed solutions. In addition, we highlight the ongoing innovations in federated learning in the EHR through a greater focus on common data models and discuss ongoing work that defines such an approach to large-scale, multicenter, federated studies. Such parallel improvements in technology and research methods enable innovative care and optimization of patient outcomes.
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Affiliation(s)
| | - Miles Shen
- Section of Cardiovascular Medicine, Department of Internal Medicine; Department of Internal Medicine
| | - Anjali Mangla
- Section of Cardiovascular Medicine, Department of Internal Medicine; Department of Neuroscience, Yale School of Medicine, New Haven, Connecticut
| | - Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine; Center for Outcomes Research and Evaluation (CORE), Yale New Haven Hospital, New Haven, Connecticut; Section of Health Informatics, Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut.; Section of Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, Connecticut.
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11
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Graili P, Guertin JR, Chan KKW, Tadrous M. Integration of real-world evidence from different data sources in health technology assessment. JOURNAL OF PHARMACY & PHARMACEUTICAL SCIENCES : A PUBLICATION OF THE CANADIAN SOCIETY FOR PHARMACEUTICAL SCIENCES, SOCIETE CANADIENNE DES SCIENCES PHARMACEUTIQUES 2023; 26:11460. [PMID: 37529633 PMCID: PMC10387532 DOI: 10.3389/jpps.2023.11460] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/30/2023] [Indexed: 08/03/2023]
Abstract
Real-world evidence (RWE) is being increasingly used by a wide range of stakeholders involved in the therapeutic product lifecycle but remains underutilized in the health technology assessment (HTA) process. RWE aims to fill the current evidence gaps, reduce the uncertainty around the benefits of medical technologies, and better understand the long-term impact of health technologies in real-world conditions. Despite the minimal use of RWE in some elements of HTA, there has been a larger push to further utilize RWE in the HTA processes. HTA bodies, as other stakeholders, work towards developing more robust means to leverage RWE from various data sources in the HTA processes. However, these agencies need to overcome important challenges before the broader incorporation of RWE into their routine practice. This paper aims to explore the extensive integration of RWE utilizing diverse sources of RWD. We discuss the utilization of RWE in HTA processes, considering aspects such as when, where, and how RWE can be effectively applied. Additionally, we seek the potential challenges and barriers associated with the utilization of different data sources.
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Affiliation(s)
- Pooyeh Graili
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Quality HTA, Oakville, ON, Canada
| | - Jason R. Guertin
- Axe Santé des Populations et Pratiques Optimales en Santé, Centre de Recherche du CHU de Québec-Université Laval, Laval, QC, Canada
- Department of Social and Preventive Medicine, Université Laval, Laval, QC, Canada
- Tissue Engineering Laboratory (LOEX), Université Laval, Laval, QC, Canada
| | - Kelvin K. W. Chan
- Sunnybrook Health Science Centre, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Canadian Centre for Applied Research in Cancer Control, Toronto, ON, Canada
| | - Mina Tadrous
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
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12
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Smeltzer MP, Reeves SL, Cooper WO, Attell BK, Strouse JJ, Takemoto CM, Kanter J, Latta K, Plaxco AP, Davis RL, Hatch D, Reyes C, Dombkowski K, Snyder A, Paulukonis S, Singh A, Kayle M. Common data model for sickle cell disease surveillance: considerations and implications. JAMIA Open 2023; 6:ooad036. [PMID: 37252051 PMCID: PMC10224800 DOI: 10.1093/jamiaopen/ooad036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 02/10/2023] [Accepted: 05/23/2023] [Indexed: 05/31/2023] Open
Abstract
Objective Population-level data on sickle cell disease (SCD) are sparse in the United States. The Centers for Disease Control and Prevention (CDC) is addressing the need for SCD surveillance through state-level Sickle Cell Data Collection Programs (SCDC). The SCDC developed a pilot common informatics infrastructure to standardize processes across states. Materials and Methods We describe the process for establishing and maintaining the proposed common informatics infrastructure for a rare disease, starting with a common data model and identify key data elements for public health SCD reporting. Results The proposed model is constructed to allow pooling of table shells across states for comparison. Core Surveillance Data reports are compiled based on aggregate data provided by states to CDC annually. Discussion and Conclusion We successfully implemented a pilot SCDC common informatics infrastructure to strengthen our distributed data network and provide a blueprint for similar initiatives in other rare diseases.
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Affiliation(s)
- Matthew P Smeltzer
- Corresponding Author: Matthew P. Smeltzer, PhD, MStat, Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, 222 Robison Hall, Memphis, TN 38152, USA;
| | - Sarah L Reeves
- Department of Pediatrics, Susan B Meister Child Health Evaluation and Research (CHEAR) Center, University of Michigan, Ann Arbor, Michigan, USA
| | - William O Cooper
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Brandon K Attell
- Georgia Health Policy Center, Georgia State University, Atlanta, Georgia, USA
| | - John J Strouse
- Department of Hematology, Duke University, Durham, North Carolina, USA
| | - Clifford M Takemoto
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Julie Kanter
- Division of Hematology-Oncology, University of Alabama Birmingham, Birmingham, Alabama, USA
| | - Krista Latta
- Department of Pediatrics, Susan B Meister Child Health Evaluation and Research (CHEAR) Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Allison P Plaxco
- Division of Epidemiology, Biostatistics, and Environmental Health School of Public Health, University of Memphis, Memphis, Tennessee, USA
| | - Robert L Davis
- Department of Bioinformatics, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Daniel Hatch
- Duke University School of Nursing, Durham, North Carolina, USA
| | - Camila Reyes
- Duke Office of Clinical Research, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kevin Dombkowski
- Department of Pediatrics, Susan B Meister Child Health Evaluation and Research (CHEAR) Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Angela Snyder
- Georgia Health Policy Center, Georgia State University, Atlanta, Georgia, USA
| | - Susan Paulukonis
- Tracking California, Public Health Institute, Oakland, California, USA
| | - Ashima Singh
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Mariam Kayle
- Duke University School of Nursing, Durham, North Carolina, USA
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13
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Németh B, Kamusheva M, Mitkova Z, Petykó ZI, Zemplényi A, Dimitrova M, Tachkov K, Balkányi L, Czech M, Dawoud D, Goettsch W, Hren R, Knies S, Lorenzovici L, Maravic Z, Piniazhko O, Zerovnik S, Kaló Z. Guidance on using real-world evidence from Western Europe in Central and Eastern European health policy decision making. J Comp Eff Res 2023; 12:e220157. [PMID: 36861458 PMCID: PMC10402755 DOI: 10.57264/cer-2022-0157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 02/14/2023] [Indexed: 03/03/2023] Open
Abstract
Aim: Real-world data and real-world evidence (RWE) are becoming more important for healthcare decision making and health technology assessment. We aimed to propose solutions to overcome barriers preventing Central and Eastern European (CEE) countries from using RWE generated in Western Europe. Materials & methods: To achieve this, following a scoping review and a webinar, the most important barriers were selected through a survey. A workshop was held with CEE experts to discuss proposed solutions. Results: Based on survey results, we selected the nine most important barriers. Multiple solutions were proposed, for example, the need for a European consensus, and building trust in using RWE. Conclusion: Through collaboration with regional stakeholders, we proposed a list of solutions to overcome barriers on transferring RWE from Western Europe to CEE countries.
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Affiliation(s)
| | - Maria Kamusheva
- Department of Organization & Economics of Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Sofia, BG 1000, Bulgaria
| | - Zornitsa Mitkova
- Department of Organization & Economics of Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Sofia, BG 1000, Bulgaria
| | | | - Antal Zemplényi
- Syreon Research Institute, Budapest, HU 1142, Hungary
- Center for Health Technology Assessment & Pharmacoeconomics Research, Faculty of Pharmacy, University of Pécs, Pécs, Hungary
| | - Maria Dimitrova
- Department of Organization & Economics of Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Sofia, BG 1000, Bulgaria
| | - Konstantin Tachkov
- Department of Organization & Economics of Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Sofia, BG 1000, Bulgaria
| | - László Balkányi
- Medical Informatics R&D Center, Pannon University, Veszprém, HU 8200, Hungary
| | - Marcin Czech
- Department of Pharmacoeconomics, Institute of Mother & Child, Warsaw, PL 01-211, Poland
| | - Dalia Dawoud
- Science Policy & Research Programme, Science Evidence & Analytics Directorate, National Institute for Health & Care Excellence (NICE), London, United Kingdom
- Cairo University, Faculty of Pharmacy, Cairo, Egypt
| | - Wim Goettsch
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
- National Health Care Institute, Diemen, NL 1120 AH, The Netherlands
| | - Rok Hren
- Faculty of Mathematics & Physics, University of Ljubljana, Ljubljana, Slovenia
| | - Saskia Knies
- National Health Care Institute, Diemen, NL 1120 AH, The Netherlands
| | - László Lorenzovici
- Syreon Research Romania, Tirgu Mures, RO 540004, Romania
- G. E. Palade University of Medicine, Pharmacy, Science & Technology, Tirgu Mures, RO 540142, Romania
| | | | - Oresta Piniazhko
- HTA Department of State Expert Centre of the Ministry of Health of Ukraine, Kyiv, Ukraine
| | | | - Zoltán Kaló
- Syreon Research Institute, Budapest, HU 1142, Hungary
- Centre for Health Technology Assessment, Semmelweis University, Budapest, HU 1091 Hungary
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14
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Junior EPP, Normando P, Flores-Ortiz R, Afzal MU, Jamil MA, Bertolin SF, Oliveira VDA, Martufi V, de Sousa F, Bashir A, Burn E, Ichihara MY, Barreto ML, Salles TD, Prieto-Alhambra D, Hafeez H, Khalid S. Integrating real-world data from Brazil and Pakistan into the OMOP common data model and standardized health analytics framework to characterize COVID-19 in the Global South. J Am Med Inform Assoc 2023; 30:643-655. [PMID: 36264262 PMCID: PMC9619798 DOI: 10.1093/jamia/ocac180] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/16/2022] [Accepted: 09/29/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The aim of this work is to demonstrate the use of a standardized health informatics framework to generate reliable and reproducible real-world evidence from Latin America and South Asia towards characterizing coronavirus disease 2019 (COVID-19) in the Global South. MATERIALS AND METHODS Patient-level COVID-19 records collected in a patient self-reported notification system, hospital in-patient and out-patient records, and community diagnostic labs were harmonized to the Observational Medical Outcomes Partnership common data model and analyzed using a federated network analytics framework. Clinical characteristics of individuals tested for, diagnosed with or tested positive for, hospitalized with, admitted to intensive care unit with, or dying with COVID-19 were estimated. RESULTS Two COVID-19 databases covering 8.3 million people from Pakistan and 2.6 million people from Bahia, Brazil were analyzed. 109 504 (Pakistan) and 921 (Brazil) medical concepts were harmonized to Observational Medical Outcomes Partnership common data model. In total, 341 505 (4.1%) people in the Pakistan dataset and 1 312 832 (49.2%) people in the Brazilian dataset were tested for COVID-19 between January 1, 2020 and April 20, 2022, with a median [IQR] age of 36 [25, 76] and 38 (27, 50); 40.3% and 56.5% were female in Pakistan and Brazil, respectively. 1.2% percent individuals in the Pakistan dataset had Afghan ethnicity. In Brazil, 52.3% had mixed ethnicity. In agreement with international findings, COVID-19 outcomes were more severe in men, elderly, and those with underlying health conditions. CONCLUSIONS COVID-19 data from 2 large countries in the Global South were harmonized and analyzed using a standardized health informatics framework developed by an international community of health informaticians. This proof-of-concept study demonstrates a potential open science framework for global knowledge mobilization and clinical translation for timely response to healthcare needs in pandemics and beyond.
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Affiliation(s)
- Elzo Pereira Pinto Junior
- Center of Data and Knowledge Integration for Health (Cidacs), Fiocruz-Brazil, Parque Tecnológico da Edf, Tecnocentro, R. Mundo, Salvador, BA 41745-715, Brazil
| | - Priscilla Normando
- Center of Data and Knowledge Integration for Health (Cidacs), Fiocruz-Brazil, Parque Tecnológico da Edf, Tecnocentro, R. Mundo, Salvador, BA 41745-715, Brazil
| | - Renzo Flores-Ortiz
- Center of Data and Knowledge Integration for Health (Cidacs), Fiocruz-Brazil, Parque Tecnológico da Edf, Tecnocentro, R. Mundo, Salvador, BA 41745-715, Brazil
| | - Muhammad Usman Afzal
- Shaukat Khanum Memorial Cancer Hospital and Research Centre, Johar Town, Lahore, 54840, Pakistan
| | - Muhammad Asaad Jamil
- Shaukat Khanum Memorial Cancer Hospital and Research Centre, Johar Town, Lahore, 54840, Pakistan
| | - Sergio Fernandez Bertolin
- Fundació Institut, Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, 587 08007, Spain
| | - Vinícius de Araújo Oliveira
- Center of Data and Knowledge Integration for Health (Cidacs), Fiocruz-Brazil, Parque Tecnológico da Edf, Tecnocentro, R. Mundo, Salvador, BA 41745-715, Brazil
| | - Valentina Martufi
- Center of Data and Knowledge Integration for Health (Cidacs), Fiocruz-Brazil, Parque Tecnológico da Edf, Tecnocentro, R. Mundo, Salvador, BA 41745-715, Brazil
| | - Fernanda de Sousa
- Center of Data and Knowledge Integration for Health (Cidacs), Fiocruz-Brazil, Parque Tecnológico da Edf, Tecnocentro, R. Mundo, Salvador, BA 41745-715, Brazil
| | - Amir Bashir
- Shaukat Khanum Memorial Cancer Hospital and Research Centre, Johar Town, Lahore, 54840, Pakistan
| | - Edward Burn
- Centre for Statistics in Medicine, Botnar Research Centre, University of Oxford, Oxford, OX3 7LD, United Kingdom
| | - Maria Yury Ichihara
- Center of Data and Knowledge Integration for Health (Cidacs), Fiocruz-Brazil, Parque Tecnológico da Edf, Tecnocentro, R. Mundo, Salvador, BA 41745-715, Brazil
| | - Maurício L Barreto
- Center of Data and Knowledge Integration for Health (Cidacs), Fiocruz-Brazil, Parque Tecnológico da Edf, Tecnocentro, R. Mundo, Salvador, BA 41745-715, Brazil
| | - Talita Duarte Salles
- Fundació Institut, Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, 587 08007, Spain
| | - Daniel Prieto-Alhambra
- Centre for Statistics in Medicine, Botnar Research Centre, University of Oxford, Oxford, OX3 7LD, United Kingdom
| | - Haroon Hafeez
- Shaukat Khanum Memorial Cancer Hospital and Research Centre, Johar Town, Lahore, 54840, Pakistan
| | - Sara Khalid
- Centre for Statistics in Medicine, Botnar Research Centre, University of Oxford, Oxford, OX3 7LD, United Kingdom
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15
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Shweikh Y, Sekimitsu S, Boland MV, Zebardast N. The Growing Need for Ophthalmic Data Standardization. OPHTHALMOLOGY SCIENCE 2023; 3:100262. [PMID: 36691643 PMCID: PMC9860145 DOI: 10.1016/j.xops.2022.100262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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16
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Zemplényi A, Tachkov K, Balkanyi L, Németh B, Petykó ZI, Petrova G, Czech M, Dawoud D, Goettsch W, Gutierrez Ibarluzea I, Hren R, Knies S, Lorenzovici L, Maravic Z, Piniazhko O, Savova A, Manova M, Tesar T, Zerovnik S, Kaló Z. Recommendations to overcome barriers to the use of artificial intelligence-driven evidence in health technology assessment. Front Public Health 2023; 11:1088121. [PMID: 37181704 PMCID: PMC10171457 DOI: 10.3389/fpubh.2023.1088121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 04/03/2023] [Indexed: 05/16/2023] Open
Abstract
Background Artificial intelligence (AI) has attracted much attention because of its enormous potential in healthcare, but uptake has been slow. There are substantial barriers that challenge health technology assessment (HTA) professionals to use AI-generated evidence for decision-making from large real-world databases (e.g., based on claims data). As part of the European Commission-funded HTx H2020 (Next Generation Health Technology Assessment) project, we aimed to put forward recommendations to support healthcare decision-makers in integrating AI into the HTA processes. The barriers, addressed by the paper, are particularly focusing on Central and Eastern European (CEE) countries, where the implementation of HTA and access to health databases lag behind Western European countries. Methods We constructed a survey to rank the barriers to using AI for HTA purposes, completed by respondents from CEE jurisdictions with expertise in HTA. Using the results, two members of the HTx consortium from CEE developed recommendations on the most critical barriers. Then these recommendations were discussed in a workshop by a wider group of experts, including HTA and reimbursement decision-makers from both CEE countries and Western European countries, and summarized in a consensus report. Results Recommendations have been developed to address the top 15 barriers in areas of (1) human factor-related barriers, focusing on educating HTA doers and users, establishing collaborations and best practice sharing; (2) regulatory and policy-related barriers, proposing increasing awareness and political commitment and improving the management of sensitive information for AI use; (3) data-related barriers, suggesting enhancing standardization and collaboration with data networks, managing missing and unstructured data, using analytical and statistical approaches to address bias, using quality assessment tools and quality standards, improving reporting, and developing better conditions for the use of data; and (4) technological barriers, suggesting sustainable development of AI infrastructure. Conclusion In the field of HTA, the great potential of AI to support evidence generation and evaluation has not yet been sufficiently explored and realized. Raising awareness of the intended and unintended consequences of AI-based methods and encouraging political commitment from policymakers is necessary to upgrade the regulatory and infrastructural environment and knowledge base required to integrate AI into HTA-based decision-making processes better.
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Affiliation(s)
- Antal Zemplényi
- Center for Health Technology Assessment and Pharmacoeconomics Research, Faculty of Pharmacy, University of Pécs, Pécs, Hungary
- Syreon Research Institute, Budapest, Hungary
- *Correspondence: Antal Zemplényi,
| | - Konstantin Tachkov
- Department of Organization and Economics of Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | - Laszlo Balkanyi
- Medical Informatics R&D Center, Pannon University, Veszprém, Hungary
| | | | | | - Guenka Petrova
- Department of Organization and Economics of Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | - Marcin Czech
- Department of Pharmacoeconomics, Institute of Mother and Child, Warsaw, Poland
| | - Dalia Dawoud
- Science Policy and Research Programme, Science Evidence and Analytics Directorate, National Institute for Health and Care Excellence (NICE), London, United Kingdom
- Cairo University, Faculty of Pharmacy, Cairo, Egypt
| | - Wim Goettsch
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, Netherlands
- National Health Care Institute, Diemen, Netherlands
| | | | - Rok Hren
- Faculty of Mathematics and Physics, University of Ljubljana, Ljubljana, Slovenia
| | - Saskia Knies
- National Health Care Institute, Diemen, Netherlands
| | - László Lorenzovici
- Syreon Research Romania, Tirgu Mures, Romania
- G. E. Palade University of Medicine, Pharmacy, Science and Technology, Tirgu Mures, Romania
| | | | - Oresta Piniazhko
- HTA Department of State Expert Centre of the Ministry of Health of Ukraine, Kyiv, Ukraine
| | - Alexandra Savova
- Department of Organization and Economics of Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
- National Council of Prices and Reimbursement of Medicinal Products, Sofia, Bulgaria
| | - Manoela Manova
- Department of Organization and Economics of Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
- National Council of Prices and Reimbursement of Medicinal Products, Sofia, Bulgaria
| | - Tomas Tesar
- Department of Organisation and Management of Pharmacy, Faculty of Pharmacy, Comenius University in Bratislava, Bratislava, Slovakia
| | | | - Zoltán Kaló
- Syreon Research Institute, Budapest, Hungary
- Centre for Health Technology Assessment, Semmelweis University, Budapest, Hungary
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17
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Jefferson E, Cole C, Mumtaz S, Cox S, Giles TC, Adejumo S, Urwin E, Lea D, Macdonald C, Best J, Masood E, Milligan G, Johnston J, Horban S, Birced I, Hall C, Jackson AS, Collins C, Rising S, Dodsley C, Hampton J, Hadfield A, Santos R, Tarr S, Panagi V, Lavagna J, Jackson T, Chuter A, Beggs J, Martinez-Queipo M, Ward H, von Ziegenweidt J, Burns F, Martin J, Sebire N, Morris C, Bradley D, Baxter R, Ahonen-Bishopp A, Smith P, Shoemark A, Valdes AM, Ollivere B, Manisty C, Eyre D, Gallant S, Joy G, McAuley A, Connell D, Northstone K, Jeffery K, Di Angelantonio E, McMahon A, Walker M, Semple MG, Sims JM, Lawrence E, Davies B, Baillie JK, Tang M, Leeming G, Power L, Breeze T, Murray D, Orton C, Pierce I, Hall I, Ladhani S, Gillson N, Whitaker M, Shallcross L, Seymour D, Varma S, Reilly G, Morris A, Hopkins S, Sheikh A, Quinlan P. A Hybrid Architecture (CO-CONNECT) to Facilitate Rapid Discovery and Access to Data Across the United Kingdom in Response to the COVID-19 Pandemic: Development Study. J Med Internet Res 2022; 24:e40035. [PMID: 36322788 PMCID: PMC9822177 DOI: 10.2196/40035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/12/2022] [Accepted: 11/01/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND COVID-19 data have been generated across the United Kingdom as a by-product of clinical care and public health provision, as well as numerous bespoke and repurposed research endeavors. Analysis of these data has underpinned the United Kingdom's response to the pandemic, and informed public health policies and clinical guidelines. However, these data are held by different organizations, and this fragmented landscape has presented challenges for public health agencies and researchers as they struggle to find relevant data to access and interrogate the data they need to inform the pandemic response at pace. OBJECTIVE We aimed to transform UK COVID-19 diagnostic data sets to be findable, accessible, interoperable, and reusable (FAIR). METHODS A federated infrastructure model (COVID - Curated and Open Analysis and Research Platform [CO-CONNECT]) was rapidly built to enable the automated and reproducible mapping of health data partners' pseudonymized data to the Observational Medical Outcomes Partnership Common Data Model without the need for any data to leave the data controllers' secure environments, and to support federated cohort discovery queries and meta-analysis. RESULTS A total of 56 data sets from 19 organizations are being connected to the federated network. The data include research cohorts and COVID-19 data collected through routine health care provision linked to longitudinal health care records and demographics. The infrastructure is live, supporting aggregate-level querying of data across the United Kingdom. CONCLUSIONS CO-CONNECT was developed by a multidisciplinary team. It enables rapid COVID-19 data discovery and instantaneous meta-analysis across data sources, and it is researching streamlined data extraction for use in a Trusted Research Environment for research and public health analysis. CO-CONNECT has the potential to make UK health data more interconnected and better able to answer national-level research questions while maintaining patient confidentiality and local governance procedures.
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Affiliation(s)
- Emily Jefferson
- Health Informatics Centre, Division of Population and Health Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Christian Cole
- Health Informatics Centre, Division of Population and Health Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Shahzad Mumtaz
- Health Informatics Centre, Division of Population and Health Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Samuel Cox
- Digital Research Service, University of Nottingham, Nottingham, United Kingdom
| | | | - Sam Adejumo
- Digital Research Service, University of Nottingham, Nottingham, United Kingdom
| | - Esmond Urwin
- Digital Research Service, University of Nottingham, Nottingham, United Kingdom
| | - Daniel Lea
- Digital Research Service, University of Nottingham, Nottingham, United Kingdom
| | - Calum Macdonald
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Joseph Best
- Digital Research Service, University of Nottingham, Nottingham, United Kingdom
- Health Data Research UK, London, United Kingdom
| | - Erum Masood
- Health Informatics Centre, Division of Population and Health Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Gordon Milligan
- Health Informatics Centre, Division of Population and Health Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Jenny Johnston
- Health Informatics Centre, Division of Population and Health Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Scott Horban
- Health Informatics Centre, Division of Population and Health Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Ipek Birced
- Health Informatics Centre, Division of Population and Health Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Christopher Hall
- Health Informatics Centre, Division of Population and Health Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Aaron S Jackson
- Health Informatics Centre, Division of Population and Health Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Clare Collins
- Digital Research Service, University of Nottingham, Nottingham, United Kingdom
| | - Sam Rising
- Digital Research Service, University of Nottingham, Nottingham, United Kingdom
| | - Charlotte Dodsley
- Digital Research Service, University of Nottingham, Nottingham, United Kingdom
| | - Jill Hampton
- Health Informatics Centre, Division of Population and Health Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Andrew Hadfield
- Digital Research Service, University of Nottingham, Nottingham, United Kingdom
| | - Roberto Santos
- Digital Research Service, University of Nottingham, Nottingham, United Kingdom
| | - Simon Tarr
- Digital Research Service, University of Nottingham, Nottingham, United Kingdom
| | - Vasiliki Panagi
- Digital Research Service, University of Nottingham, Nottingham, United Kingdom
| | - Joseph Lavagna
- Digital Research Service, University of Nottingham, Nottingham, United Kingdom
| | - Tracy Jackson
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Antony Chuter
- Lay Partnership in Healthcare Research, Lindfield, United Kingdom
| | - Jillian Beggs
- Health Informatics Centre, Division of Population and Health Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | | | - Helen Ward
- School of Public Health, Imperial College London, London, United Kingdom
| | - Julie von Ziegenweidt
- Department of Haemotology, University of Cambridge, Cambridge, United Kingdom
- National Institute for Healthcare Research BioResource, Cambridge University Hospitals NHS Foundation, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Frances Burns
- Centre for Public Health, Belfast Institute of Clinical Science, Queens University Belfast, Belfast, United Kingdom
| | - Joanne Martin
- Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Neil Sebire
- Institute of Child Health, Great Ormond Street Hospital, London, United Kingdom
| | | | - Declan Bradley
- Centre for Public Health, Institute of Clinical Science, Queen's University Belfast, Belfast, United Kingdom
- Public Health Agency, Belfast, United Kingdom
| | - Rob Baxter
- EPCC, University of Edinburgh, Edinburgh, United Kingdom
| | | | | | - Amelia Shoemark
- Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Ana M Valdes
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Benjamin Ollivere
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Charlotte Manisty
- Institute of Cardiovascular Sciences, University of College London, London, United Kingdom
| | - David Eyre
- Big Data Institute, University of Oxford, Oxford, United Kingdom
| | - Stephanie Gallant
- Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - George Joy
- Barts Heart Centre, London, United Kingdom
| | - Andrew McAuley
- Clinical and Protecting Health Directorate, Public Health Scotland, Glasgow, United Kingdom
| | - David Connell
- School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Kate Northstone
- Population Health Sciences, Avon Longitudinal Study of Parents and Children, Bristol, United Kingdom
| | - Katie Jeffery
- Radcliffe Department of Medicine, Oxford University, Oxford, United Kingdom
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Emanuele Di Angelantonio
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, United Kingdom
- Health Data Research UK Cambridge, Wellcome Genome Campus, University of Cambridge, Cambridge, United Kingdom
- Health Data Science Research Centre, Human Technopole, Milan, Italy
| | - Amy McMahon
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, United Kingdom
| | - Mat Walker
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, United Kingdom
| | - Malcolm Gracie Semple
- Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infections, University of Liverpool, Liverpool, United Kingdom
- Respiratory Department, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | | | | | - Bethan Davies
- School of Public Health, Imperial College London, London, United Kingdom
| | - John Kenneth Baillie
- Outbreak Data Analysis Platform, University of Edinburgh, Edinburgh, United Kingdom
| | - Ming Tang
- NHS England, Worcestershire, United Kingdom
| | - Gary Leeming
- Civic Data Cooperative, Digital Innovation Facility, University of Liverpool, Liverpool, United Kingdom
| | - Linda Power
- Public Health England, London, United Kingdom
| | - Thomas Breeze
- Avon Longitudinal Study of Parents and Children, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Duncan Murray
- University of Birmingham, Birmingham, United Kingdom
- University Hospital Coventry & Warwickshire NHS Trust, Coventry, United Kingdom
| | - Chris Orton
- Population Data Science, Swansea University Medical School, Swansea, United Kingdom
| | - Iain Pierce
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Ian Hall
- Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Shamez Ladhani
- Immunisation and Countermeasures Division, Public Health England Colindale, London, United Kingdom
| | | | - Matthew Whitaker
- School of Public Health, Imperial College London, London, United Kingdom
| | | | | | | | | | | | | | - Aziz Sheikh
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Philip Quinlan
- Digital Research Service, University of Nottingham, Nottingham, United Kingdom
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
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18
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Kim Y, Seo SI, Lee KJ, Kim J, Yoo JJ, Seo WW, Shin WG. Risks of long-term use of proton pump inhibitor on ischemic vascular events: A distributed network analysis of 5 real-world observational Korean databases using a common data model. Int J Stroke 2022; 18:590-598. [PMID: 36190338 DOI: 10.1177/17474930221133219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Proton pump inhibitors (PPIs) are frequently prescribed drugs. However, it has been suggested that they are associated with an increased risk of ischemic vascular events (IVE) including stroke, although the data are inconsistent. AIMS We investigated the association between PPIs use and IVE in five observational Korean databases using a common data model (CDM). METHODS This study included patient-based retrospective, observational cohort data of subjects aged over 18 years between January 1, 2004, and December 31, 2020, from five medical centers as part of the Observational Medical Outcomes Partnership (OMOP) CDM. Subjects who were included in both cohorts or had a previous history of ischemic stroke were excluded. After propensity matching, 8007 propensity-matched pairs between the PPIs and H2 receptor antagonist (H2RA) users were included in this study. RESULTS In the 1:1 propensity score matching with 8007 in each group, long-term PPIs use (⩾365 days) was not associated with ischemic stroke (odds ratio (OR) = 1.05, 95% confidence interval (CI) 0.71-1.56; I2 = 57%), ischemic stroke and transient ischemic attack (OR = 1.02, 95% CI 0.71-1.48; I2 = 53%), and net adverse clinical events (OR = 1.08, 95% CI 0.83-1.40; I2 = 47%) compared with H2RAs users. CONCLUSIONS Our analysis in a large dataset found no evidence that long-term use of PPIs was associated with an increased risk of ischemic stroke.
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Affiliation(s)
- Yerim Kim
- Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Seung In Seo
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Kyung Joo Lee
- University Industry Foundation, Hallym University, Chuncheon, Korea
| | - Jinseob Kim
- Department of Epidemiology, School of Public Health, Seoul National University, Seoul, Korea
| | - Jong Jin Yoo
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Won-Woo Seo
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Woon Geon Shin
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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19
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Kumar S, Arnold M, James G, Padman R. Developing a common data model approach for DISCOVER CKD: A retrospective, global cohort of real-world patients with chronic kidney disease. PLoS One 2022; 17:e0274131. [PMID: 36173958 PMCID: PMC9521926 DOI: 10.1371/journal.pone.0274131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 08/22/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives
To describe a flexible common data model (CDM) approach that can be efficiently tailored to study-specific needs to facilitate pooled patient-level analysis and aggregated/meta-analysis of routinely collected retrospective patient data from disparate data sources; and to detail the application of this CDM approach to the DISCOVER CKD retrospective cohort, a longitudinal database of routinely collected (secondary) patient data of individuals with chronic kidney disease (CKD).
Methods
The flexible CDM approach incorporated three independent, exchangeable components that preceded data mapping and data model implementation: (1) standardized code lists (unifying medical events from different coding systems); (2) laboratory unit harmonization tables; and (3) base cohort definitions. Events between different coding vocabularies were not mapped code-to-code; for each data source, code lists of labels were curated at the entity/event level. A study team of epidemiologists, clinicians, informaticists, and data scientists were included within the validation of each component.
Results
Applying the CDM to the DISCOVER CKD retrospective cohort, secondary data from 1,857,593 patients with CKD were harmonized from five data sources, across three countries, into a discrete database for rapid real-world evidence generation.
Conclusions
This flexible CDM approach facilitates evidence generation from real-world data within the DISCOVER CKD retrospective cohort, providing novel insights into the epidemiology of CKD that may expedite improvements in diagnosis, prognosis, early intervention, and disease management. The adaptable architecture of this CDM approach ensures scalable, fast, and efficient application within other therapy areas to facilitate the combined analysis of different types of secondary data from multiple, heterogeneous sources.
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Affiliation(s)
- Supriya Kumar
- Real World Evidence Data and Analytics, BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD, United States of America
- * E-mail:
| | - Matthew Arnold
- Real World Evidence Data and Analytics, BioPharmaceuticals Medical, AstraZeneca, Cambridge, United Kingdom
| | - Glen James
- Formerly Cardiovascular, Renal, Metabolism & Epidemiology, BioPharmaceuticals Medical, AstraZeneca, Cambridge, United Kingdom
| | - Rema Padman
- Heinz College of Information Systems and Public Policy, Carnegie Mellon University, Pittsburgh, PA, United States of America
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20
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Karapetian N, Vander Stichele R, Quintana Y. Alignment of two standard terminologies for dosage form: RxNorm from the National Library of Medicine for the United States and EDQM from the European Directorate for the Quality in Medicines and Healthcare for Europe. Int J Med Inform 2022; 165:104826. [PMID: 35870302 PMCID: PMC9395577 DOI: 10.1016/j.ijmedinf.2022.104826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 05/28/2022] [Accepted: 06/24/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND There is currently no system that aligns pharmaceutically equivalent medicinal products across nations, creating obstacles to transnational medication prescribing and medical research. EDQM has been internationally recognized as the leading system in systematic pharmaceutical product descriptions. RxNorm is a critical terminology based in the US and used widely in applications internationally that would benefit from alignment with EDQM-based dosage form descriptions. GOAL Demonstrate a method for alignment of RxNorm dosage forms with EDQM terminologies and with EDQM dosage forms. Describe obstacles and advantages of such an alignment for ultimate application in calculating universal Pharmaceutical Product Identifiers. METHODS A pharmaceutical sciences student and a clinical pharmacology expert in dosage forms used definitions supplied by RxNorm and EDQM technical documentation to align the 120 RxNorm dose forms to EDQM-based dosage form description terms. The alignment of RxNorm to EDQM was then used to fit the RxNorm dose forms into an ontology based on EDQM. RESULTS AND CONCLUSIONS The alignment of RxNorm and EDQM requires further validation but provides a potential method of establishing interoperability between the two terminologies without cumbersome manual reclassification. There remain ambiguities within each dosage form nomenclature that create obstacles to integrating medication databases rooted in EDQM and RxNorm into a single worldwide database.
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Affiliation(s)
- Natalie Karapetian
- Division of Clinical Informatics, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Robert Vander Stichele
- European Institute for Innovation through Health Data (I-HD), UNICOM Innovation Action; Department of Medical Informatics, Ghent University, Ghent, Belgium
| | - Yuri Quintana
- Division of Clinical Informatics, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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21
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Wyss R, Yanover C, El-Hay T, Bennett D, Platt RW, Zullo AR, Sari G, Wen X, Ye Y, Yuan H, Gokhale M, Patorno E, Lin KJ. Machine learning for improving high-dimensional proxy confounder adjustment in healthcare database studies: an overview of the current literature. Pharmacoepidemiol Drug Saf 2022; 31:932-943. [PMID: 35729705 PMCID: PMC9541861 DOI: 10.1002/pds.5500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 06/01/2022] [Accepted: 06/05/2022] [Indexed: 11/10/2022]
Abstract
Controlling for large numbers of variables that collectively serve as 'proxies' for unmeasured factors can often improve confounding control in pharmacoepidemiologic studies utilizing administrative healthcare databases. There is a growing body of evidence showing that data-driven machine learning algorithms for high-dimensional proxy confounder adjustment can supplement investigator-specified variables to improve confounding control compared to adjustment based on investigator-specified variables alone. Consequently, there has been a recent focus on the development of data-driven methods for high-dimensional proxy confounder adjustment. In this paper, we discuss the considerations underpinning three areas for data-driven high-dimensional proxy confounder adjustment: 1) feature generation-transforming raw data into covariates (or features) to be used for proxy adjustment; 2) covariate prioritization, selection and adjustment; and 3) diagnostic assessment. We survey current approaches and recent advancements within each area, including the most widely used approach to proxy confounder adjustment in healthcare database studies (the high-dimensional propensity score or hdPS). We also discuss limitations of the hdPS and outline recent advancements that incorporate the principles of proxy adjustment with machine learning extensions to improve performance. We further discuss challenges and avenues of future development within each area. This manuscript is endorsed by the International Society for Pharmacoepidemiology (ISPE). This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Richard Wyss
- Division of Pharmacoepidemioogy and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Tal El-Hay
- KI Research Institute, Kfar Malal, Israel.,IBM Research-Haifa Labs, Haifa, Israel
| | - Dimitri Bennett
- Global Evidence and Outcomes, Takeda Pharmaceutical Company Ltd., Cambridge, MA, USA
| | | | - Andrew R Zullo
- Department of Health Services, Policy, and Practice, Brown University School of Public Health and Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA
| | - Grammati Sari
- Real World Evidence Strategy Lead, Visible Analytics Ltd, Oxford, UK
| | - Xuerong Wen
- Health Outcomes, Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, RI, USA
| | - Yizhou Ye
- Global Epidemiology, AbbVie Inc. North Chicago, IL, USA
| | - Hongbo Yuan
- Canadian Agency for Drugs and Technologies in Health, Ottawa, Canada
| | - Mugdha Gokhale
- Pharmacoepidemiology, Center for Observational and Real-world Evidence, Merck, PA, USA
| | - Elisabetta Patorno
- Division of Pharmacoepidemioogy and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kueiyu Joshua Lin
- Division of Pharmacoepidemioogy and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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22
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Gomes M, Latimer N, Soares M, Dias S, Baio G, Freemantle N, Dawoud D, Wailoo A, Grieve R. Target Trial Emulation for Transparent and Robust Estimation of Treatment Effects for Health Technology Assessment Using Real-World Data: Opportunities and Challenges. PHARMACOECONOMICS 2022; 40:577-586. [PMID: 35332434 DOI: 10.1007/s40273-022-01141-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/10/2022] [Indexed: 06/14/2023]
Abstract
Evidence about the relative effects of new treatments is typically collected in randomised controlled trials (RCTs). In many instances, evidence from RCTs falls short of the needs of health technology assessment (HTA). For example, RCTs may not be able to capture longer-term treatment effects, or include all relevant comparators and outcomes required for HTA purposes. Information routinely collected about patients and the care they receive have been increasingly used to complement RCT evidence on treatment effects. However, such routine (or real-world) data are not collected for research purposes, so investigators have little control over the way patients are selected into the study or allocated to the different treatment groups, introducing biases for example due to selection or confounding. A promising approach to minimise common biases in non-randomised studies that use real-world data (RWD) is to apply design principles from RCTs. This approach, known as 'target trial emulation' (TTE), involves (1) developing the protocol with respect to core study design and analysis components of the hypothetical RCT that would answer the question of interest, and (2) applying this protocol to the RWD so that it mimics the data that would have been gathered for the RCT. By making the 'target trial' explicit, TTE helps avoid common design flaws and methodological pitfalls in the analysis of non-randomised studies, keeping each step transparent and accessible. It provides a coherent framework that embeds existing analytical methods to minimise confounding and helps identify potential limitations of RWD and the extent to which these affect the HTA decision. This paper provides a broad overview of TTE and discusses the opportunities and challenges of using this approach in HTA. We describe the basic principles of trial emulation, outline some areas where TTE using RWD can help complement RCT evidence in HTA, identify potential barriers to its adoption in the HTA setting and highlight some priorities for future work.
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Affiliation(s)
- Manuel Gomes
- Department of Applied Health Research, University College London, London, UK.
| | - Nick Latimer
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Marta Soares
- Centre for Health Economics, University of York, York, UK
| | - Sofia Dias
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Gianluca Baio
- Department of Statistical Science, University College London, London, UK
| | - Nick Freemantle
- Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Dalia Dawoud
- Science, Policy and Research group, National Institute for Health and Care Excellence, London, UK
- Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Allan Wailoo
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Richard Grieve
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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23
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Chung YG, Jeon Y, Yoo S, Kim H, Hwang H. Big data analysis and artificial intelligence in epilepsy - common data model analysis and machine learning-based seizure detection and forecasting. Clin Exp Pediatr 2022; 65:272-282. [PMID: 34844397 PMCID: PMC9171464 DOI: 10.3345/cep.2021.00766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 10/27/2021] [Indexed: 11/27/2022] Open
Abstract
There has been significant interest in big data analysis and artificial intelligence (AI) in medicine. Ever-increasing medical data and advanced computing power have enabled the number of big data analyses and AI studies to increase rapidly. Here we briefly introduce epilepsy, big data, and AI and review big data analysis using a common data model. Studies in which AI has been actively applied, such as those of electroencephalography epileptiform discharge detection, seizure detection, and forecasting, will be reviewed. We will also provide practical suggestions for pediatricians to understand and interpret big data analysis and AI research and work together with technical expertise.
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Affiliation(s)
- Yoon Gi Chung
- Division of Pediatric Neurology, Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | | | - Sooyoung Yoo
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hunmin Kim
- Division of Pediatric Neurology, Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Hee Hwang
- Division of Pediatric Neurology, Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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24
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Kostka K, Duarte-Salles T, Prats-Uribe A, Sena AG, Pistillo A, Khalid S, Lai LYH, Golozar A, Alshammari TM, Dawoud DM, Nyberg F, Wilcox AB, Andryc A, Williams A, Ostropolets A, Areia C, Jung CY, Harle CA, Reich CG, Blacketer C, Morales DR, Dorr DA, Burn E, Roel E, Tan EH, Minty E, DeFalco F, de Maeztu G, Lipori G, Alghoul H, Zhu H, Thomas JA, Bian J, Park J, Martínez Roldán J, Posada JD, Banda JM, Horcajada JP, Kohler J, Shah K, Natarajan K, Lynch KE, Liu L, Schilling LM, Recalde M, Spotnitz M, Gong M, Matheny ME, Valveny N, Weiskopf NG, Shah N, Alser O, Casajust P, Park RW, Schuff R, Seager S, DuVall SL, You SC, Song S, Fernández-Bertolín S, Fortin S, Magoc T, Falconer T, Subbian V, Huser V, Ahmed WUR, Carter W, Guan Y, Galvan Y, He X, Rijnbeek PR, Hripcsak G, Ryan PB, Suchard MA, Prieto-Alhambra D. Unraveling COVID-19: A Large-Scale Characterization of 4.5 Million COVID-19 Cases Using CHARYBDIS. Clin Epidemiol 2022; 14:369-384. [PMID: 35345821 PMCID: PMC8957305 DOI: 10.2147/clep.s323292] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 01/27/2022] [Indexed: 01/20/2023] Open
Abstract
Purpose Routinely collected real world data (RWD) have great utility in aiding the novel coronavirus disease (COVID-19) pandemic response. Here we present the international Observational Health Data Sciences and Informatics (OHDSI) Characterizing Health Associated Risks and Your Baseline Disease In SARS-COV-2 (CHARYBDIS) framework for standardisation and analysis of COVID-19 RWD. Patients and Methods We conducted a descriptive retrospective database study using a federated network of data partners in the United States, Europe (the Netherlands, Spain, the UK, Germany, France and Italy) and Asia (South Korea and China). The study protocol and analytical package were released on 11th June 2020 and are iteratively updated via GitHub. We identified three non-mutually exclusive cohorts of 4,537,153 individuals with a clinical COVID-19 diagnosis or positive test, 886,193 hospitalized with COVID-19, and 113,627 hospitalized with COVID-19 requiring intensive services. Results We aggregated over 22,000 unique characteristics describing patients with COVID-19. All comorbidities, symptoms, medications, and outcomes are described by cohort in aggregate counts and are readily available online. Globally, we observed similarities in the USA and Europe: more women diagnosed than men but more men hospitalized than women, most diagnosed cases between 25 and 60 years of age versus most hospitalized cases between 60 and 80 years of age. South Korea differed with more women than men hospitalized. Common comorbidities included type 2 diabetes, hypertension, chronic kidney disease and heart disease. Common presenting symptoms were dyspnea, cough and fever. Symptom data availability was more common in hospitalized cohorts than diagnosed. Conclusion We constructed a global, multi-centre view to describe trends in COVID-19 progression, management and evolution over time. By characterising baseline variability in patients and geography, our work provides critical context that may otherwise be misconstrued as data quality issues. This is important as we perform studies on adverse events of special interest in COVID-19 vaccine surveillance.
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Affiliation(s)
- Kristin Kostka
- IQVIA, Cambridge, MA, USA
- OHDSI Center at The Roux Institute, Northeastern University, Portland, ME, USA
| | - Talita Duarte-Salles
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Albert Prats-Uribe
- Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
| | - Anthony G Sena
- Janssen Research & Development, Titusville, NJ, USA
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Andrea Pistillo
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Sara Khalid
- Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
| | - Lana Y H Lai
- School of Medical Sciences, University of Manchester, Manchester, UK
| | - Asieh Golozar
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Dalia M Dawoud
- National Institute for Health and Care Excellence, London, UK
| | - Fredrik Nyberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Adam B Wilcox
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, USA
- Unviersity of Washington Medicine, Seattle, WA, USA
| | - Alan Andryc
- Janssen Research & Development, Titusville, NJ, USA
| | - Andrew Williams
- Tufts Institute for Clinical Research and Health Policy Studies, Boston, MA, USA
| | - Anna Ostropolets
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
| | - Carlos Areia
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Chi Young Jung
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, South Korea
| | | | - Christian G Reich
- IQVIA, Cambridge, MA, USA
- OHDSI Center at The Roux Institute, Northeastern University, Portland, ME, USA
| | - Clair Blacketer
- Janssen Research & Development, Titusville, NJ, USA
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Daniel R Morales
- Division of Population Health and Genomics, University of Dundee, Dundee, UK
| | - David A Dorr
- Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
| | - Edward Burn
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
| | - Elena Roel
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Eng Hooi Tan
- Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
| | - Evan Minty
- O’Brien Institute for Public Health, Faculty of Medicine, University of Calgary, Calgary, Canada
| | | | | | - Gigi Lipori
- University of Florida Health, Gainesville, FL, USA
| | - Hiba Alghoul
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Hong Zhu
- Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
| | - Jason A Thomas
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, USA
| | - Jiang Bian
- University of Florida Health, Gainesville, FL, USA
| | - Jimyung Park
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, South Korea
| | - Jordi Martínez Roldán
- Director of Innovation and Digital Transformation, Hospital del Mar, Barcelona, Spain
| | - Jose D Posada
- Department of Medicine, School of Medicine, Stanford University, Redwood City, CA, USA
| | - Juan M Banda
- Georgia State University, Department of Computer Science, Atlanta, GA, USA
| | - Juan P Horcajada
- Department of Infectious Diseases, Hospital del Mar, Institut Hospital del Mar d’Investigació Mèdica (IMIM), Universitat Autònoma de Barcelona, Universitat Pompeu Fabra, Barcelona, Spain
| | - Julianna Kohler
- United States Agency for International Development, Washington, DC, USA
| | - Karishma Shah
- Botnar Research Centre, NDORMS, University of Oxford, Oxford, UK
| | - Karthik Natarajan
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
- New York-Presbyterian Hospital, New York, NY, USA
| | - Kristine E Lynch
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Li Liu
- Biomedical Big Data Center, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
| | - Lisa M Schilling
- Data Science to Patient Value Program, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Martina Recalde
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Mengchun Gong
- Institute of Health Management, Southern Medical University, Guangzhou, People’s Republic of China
| | - Michael E Matheny
- Tennessee Valley Healthcare System, Veterans Affairs Medical Center, Nashville, TN, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Nicole G Weiskopf
- Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
| | - Nigam Shah
- Department of Medicine, School of Medicine, Stanford University, Redwood City, CA, USA
| | - Osaid Alser
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Rae Woong Park
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, South Korea
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea
| | - Robert Schuff
- Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
| | | | - Scott L DuVall
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Seng Chan You
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Seokyoung Song
- Department of Anesthesiology and Pain Medicine, Catholic University of Daegu, School of Medicine, Daegu, South Korea
| | - Sergio Fernández-Bertolín
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | | | - Tanja Magoc
- University of Florida Health, Gainesville, FL, USA
| | - Thomas Falconer
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
| | - Vignesh Subbian
- College of Engineering, The University of Arizona, Tucson, AZ, USA
| | - Vojtech Huser
- National Library of Medicine, National Institutes of Health, Bethesda, MD, USA
| | - Waheed-Ul-Rahman Ahmed
- Botnar Research Centre, NDORMS, University of Oxford, Oxford, UK
- College of Medicine and Health, University of Exeter, St Luke’s Campus, Exeter, UK
| | - William Carter
- Data Science to Patient Value Program, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Yin Guan
- DHC Technologies Co. Ltd., Beijing, People’s Republic of China
| | | | - Xing He
- University of Florida Health, Gainesville, FL, USA
| | - Peter R Rijnbeek
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
- New York-Presbyterian Hospital, New York, NY, USA
| | - Patrick B Ryan
- Janssen Research & Development, Titusville, NJ, USA
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
| | - Marc A Suchard
- Departments of Biostatistics, Computational Medicine, and Human Genetics, University of California, Los Angeles, CA, USA
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Simpson A, Ramagopalan SV. R WE ready for reimbursement? A round up of developments in real-world evidence relating to HTA: part 5. J Comp Eff Res 2022; 11:213-215. [PMID: 34989244 DOI: 10.2217/cer-2021-0302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In the latest update we focus on recent publications which have provided insights into the importance of focusing on the development and consideration of a body of real-world evidence, and an approach to evaluating the complex area of treatment sequencing.
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Affiliation(s)
- Alex Simpson
- Global Access, F Hoffmann-La Roche, Basel, Switzerland
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26
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Applying Machine Learning in Distributed Data Networks for Pharmacoepidemiologic and Pharmacovigilance Studies: Opportunities, Challenges, and Considerations. Drug Saf 2022; 45:493-510. [PMID: 35579813 PMCID: PMC9112258 DOI: 10.1007/s40264-022-01158-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2022] [Indexed: 01/28/2023]
Abstract
Increasing availability of electronic health databases capturing real-world experiences with medical products has garnered much interest in their use for pharmacoepidemiologic and pharmacovigilance studies. The traditional practice of having numerous groups use single databases to accomplish similar tasks and address common questions about medical products can be made more efficient through well-coordinated multi-database studies, greatly facilitated through distributed data network (DDN) architectures. Access to larger amounts of electronic health data within DDNs has created a growing interest in using data-adaptive machine learning (ML) techniques that can automatically model complex associations in high-dimensional data with minimal human guidance. However, the siloed storage and diverse nature of the databases in DDNs create unique challenges for using ML. In this paper, we discuss opportunities, challenges, and considerations for applying ML in DDNs for pharmacoepidemiologic and pharmacovigilance studies. We first discuss major types of activities performed by DDNs and how ML may be used. Next, we discuss practical data-related factors influencing how DDNs work in practice. We then combine these discussions and jointly consider how opportunities for ML are affected by practical data-related factors for DDNs, leading to several challenges. We present different approaches for addressing these challenges and highlight efforts that real-world DDNs have taken or are currently taking to help mitigate them. Despite these challenges, the time is ripe for the emerging interest to use ML in DDNs, and the utility of these data-adaptive modeling techniques in pharmacoepidemiologic and pharmacovigilance studies will likely continue to increase in the coming years.
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Bohm N, Bermingham S, Grimsey Jones F, Gonçalves-Bradley DC, Diamantopoulos A, Burton JR, Laing H. The Challenges of Outcomes-Based Contract Implementation for Medicines in Europe. PHARMACOECONOMICS 2022; 40:13-29. [PMID: 34480324 PMCID: PMC8738500 DOI: 10.1007/s40273-021-01070-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/18/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES The aim was to outline the challenges of implementing outcomes-based contracts (OBCs) in Europe. METHODS A scoping review was conducted, building on the searches of a previous systematic review and updating them for December 2017 until May 2021. The combined results were screened, based on inclusion and exclusion criteria. All identified studies published in the English language that described specific OBC schemes for medicines in European countries were included. Insights into the challenges of OBCs were extracted and analysed to develop a conceptual framework. RESULTS Ten articles from the previous systematic review matched our inclusion criteria, along with 14 articles from electronic searches. Analysis of these 24 articles and classification of the challenges revealed that there are multiple barriers that must be overcome if OBCs that benefit all stakeholders are going to be adopted widely across Europe. These challenges were grouped according to five key themes: negotiation framework; outcomes; data; administration and implementation; and laws and regulation. CONCLUSIONS If the promise of OBCs is to be fully realised in Europe, there remain major challenges that need to be overcome by all stakeholders working in partnership. The overlapping and interconnected nature of these challenges highlights the complexity of OBC arrangements.
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Affiliation(s)
- Natalie Bohm
- Pfizer Limited, Walton Oaks, Dorking Road, Tadworth, KT20 7NS, UK.
| | | | | | | | | | - Jessica R Burton
- Pfizer Limited, Walton Oaks, Dorking Road, Tadworth, KT20 7NS, UK
| | - Hamish Laing
- Value-Based Health and Care Academy, School of Management, Swansea University, Swansea, UK
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Can we use existing guidance to support the development of robust real-world evidence for health technology assessment/payer decision-making? Int J Technol Assess Health Care 2022; 38:e79. [DOI: 10.1017/s0266462322000605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Advances in the digitization of health systems and expedited regulatory approvals of innovative treatments have led to increased potential for the use of real-world data (RWD) to generate real-world evidence (RWE) to complement evidence from clinical trials. However, health technology assessment (HTA) bodies and payers have concerns about the ability to generate RWE of sufficient quality to be pivotal evidence of relative treatment effectiveness. Consequently, there is a growing need for HTA bodies and payers to develop guidance for the industry and other stakeholders about the use of RWD/RWE to support access, reimbursement, and pricing. We therefore sought to (i) understand barriers to the use of RWD/RWE by HTA bodies and payers; (ii) review potential solutions in the form of published guidance; and (iii) review findings with selected HTA/payer bodies. Four themes considered key to shaping the generation of robust RWE for HTA bodies and payers were identified as: (i) data (availability, governance, and quality); (ii) methodology (design and analytics); (iii) trust (transparency and reproducibility); and (iv) policy and partnerships. A range of guidance documents were found from trusted sources that could address these themes. These were discussed with HTA experts. This commentary summarizes the potential guidance solutions available to help resolve issues faced by HTA decision-makers in the adoption of RWD/RWE. It shows that there is alignment among stakeholders about the areas that need improvement in the development of RWE and that the key priority to move forward is better collaboration to make data usable for multiple purposes.
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29
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Williams RD, Reps JM, Kors JA, Ryan PB, Steyerberg E, Verhamme KM, Rijnbeek PR. Using Iterative Pairwise External Validation to Contextualize Prediction Model Performance: A Use Case Predicting 1-Year Heart Failure Risk in Patients with Diabetes Across Five Data Sources. Drug Saf 2022; 45:563-570. [PMID: 35579818 PMCID: PMC9114056 DOI: 10.1007/s40264-022-01161-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 01/28/2023]
Abstract
INTRODUCTION External validation of prediction models is increasingly being seen as a minimum requirement for acceptance in clinical practice. However, the lack of interoperability of healthcare databases has been the biggest barrier to this occurring on a large scale. Recent improvements in database interoperability enable a standardized analytical framework for model development and external validation. External validation of a model in a new database lacks context, whereby the external validation can be compared with a benchmark in this database. Iterative pairwise external validation (IPEV) is a framework that uses a rotating model development and validation approach to contextualize the assessment of performance across a network of databases. As a use case, we predicted 1-year risk of heart failure in patients with type 2 diabetes mellitus. METHODS The method follows a two-step process involving (1) development of baseline and data-driven models in each database according to best practices and (2) validation of these models across the remaining databases. We introduce a heatmap visualization that supports the assessment of the internal and external model performance in all available databases. As a use case, we developed and validated models to predict 1-year risk of heart failure in patients initializing a second pharmacological intervention for type 2 diabetes mellitus. We leveraged the power of the Observational Medical Outcomes Partnership common data model to create an open-source software package to increase the consistency, speed, and transparency of this process. RESULTS A total of 403,187 patients from five databases were included in the study. We developed five models that, when assessed internally, had a discriminative performance ranging from 0.73 to 0.81 area under the receiver operating characteristic curve with acceptable calibration. When we externally validated these models in a new database, three models achieved consistent performance and in context often performed similarly to models developed in the database itself. The visualization of IPEV provided valuable insights. From this, we identified the model developed in the Commercial Claims and Encounters (CCAE) database as the best performing model overall. CONCLUSION Using IPEV lends weight to the model development process. The rotation of development through multiple databases provides context to model assessment, leading to improved understanding of transportability and generalizability. The inclusion of a baseline model in all modelling steps provides further context to the performance gains of increasing model complexity. The CCAE model was identified as a candidate for clinical use. The use case demonstrates that IPEV provides a huge opportunity in a new era of standardised data and analytics to improve insight into and trust in prediction models at an unprecedented scale.
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Affiliation(s)
- Ross D. Williams
- Department of Medical Informatics, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Jenna M. Reps
- Janssen Research and Development, Titusville, NJ USA
| | - Jan A. Kors
- Department of Medical Informatics, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | | | - Ewout Steyerberg
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Katia M. Verhamme
- Department of Medical Informatics, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Peter R. Rijnbeek
- Department of Medical Informatics, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
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Characterization of Medication Trends for Chronic Kidney Disease: Mineral and Bone Disorder Treatment Using Electronic Health Record-Based Common Data Model. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5504873. [PMID: 34853790 PMCID: PMC8629641 DOI: 10.1155/2021/5504873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/26/2021] [Accepted: 10/29/2021] [Indexed: 11/25/2022]
Abstract
Chronic kidney disease–mineral bone disorder (CKD-MBD) is the most common complication in CKD patients. Although there is a consensus on treatment guidelines for CKD-MBD, it remains uncertain whether these treatment recommendations reflect actual practice. Therefore, the aim of this study was to investigate the CKD-MBD medication trend in real-world practice. This was a retrospective and observational study using a 12-year period database transformed into a common data model from three tertiary university hospitals. Study populations were subjects initially diagnosed as CKD. The date of diagnosis was designated as the index date. New patients were categorized year to year from 2008 to 2019 with a fixed observation period of 365 days to check the prescription of CKD-MBD medications including calcium-containing phosphate binder, noncalcium-containing phosphate binder, aluminium hydroxide, vitamin D receptor activator (VDRA), and cinacalcet. The numbers of CKD patients in the three hospitals were 7555, 2424, and 5351, respectively. The proportion for patients with CKD-MBD medication prescription decreased yearly regardless of hospital and CKD stage (p for trend < 0.05). The use of aluminium hydroxide disappeared steadily while the use of VDRA increased annually in all settings. Despite these changes in prescription patterns, the mean value for CKD-MBD-related serologic markers was almost within target range. The proportion of the population within the target value was not significantly changed. Irrespective of hospital and CKD stage, similar trends of prescription for CKD-MBD medications were observed in real-world practice. Further research with a distributed network study may be helpful to understand medication trends in CKD-MBD treatment.
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Thurin NH, Pajouheshnia R, Roberto G, Dodd C, Hyeraci G, Bartolini C, Paoletti O, Nordeng H, Wallach-Kildemoes H, Ehrenstein V, Dudukina E, MacDonald T, De Paoli G, Loane M, Damase-Michel C, Beau AB, Droz-Perroteau C, Lassalle R, Bergman J, Swart K, Schink T, Cavero-Carbonell C, Barrachina-Bonet L, Gomez-Lumbreras A, Giner-Soriano M, Aragón M, Neville AJ, Puccini A, Pierini A, Ientile V, Trifirò G, Rissmann A, Leinonen MK, Martikainen V, Jordan S, Thayer D, Scanlon I, Georgiou ME, Cunnington M, Swertz M, Sturkenboom M, Gini R. From Inception to ConcePTION: Genesis of a Network to Support Better Monitoring and Communication of Medication Safety During Pregnancy and Breastfeeding. Clin Pharmacol Ther 2021; 111:321-331. [PMID: 34826340 PMCID: PMC9299060 DOI: 10.1002/cpt.2476] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 10/24/2021] [Indexed: 02/01/2023]
Abstract
In 2019, the Innovative Medicines Initiative (IMI) funded the ConcePTION project-Building an ecosystem for better monitoring and communicating safety of medicines use in pregnancy and breastfeeding: validated and regulatory endorsed workflows for fast, optimised evidence generation-with the vision that there is a societal obligation to rapidly reduce uncertainty about the safety of medication use in pregnancy and breastfeeding. The present paper introduces the set of concepts used to describe the European data sources involved in the ConcePTION project and illustrates the ConcePTION Common Data Model (CDM), which serves as the keystone of the federated ConcePTION network. Based on data availability and content analysis of 21 European data sources, the ConcePTION CDM has been structured with six tables designed to capture data from routine healthcare, three tables for data from public health surveillance activities, three curated tables for derived data on population (e.g., observation time and mother-child linkage), plus four metadata tables. By its first anniversary, the ConcePTION CDM has enabled 13 data sources to run common scripts to contribute to major European projects, demonstrating its capacity to facilitate effective and transparent deployment of distributed analytics, and its potential to address questions about utilization, effectiveness, and safety of medicines in special populations, including during pregnancy and breastfeeding, and, more broadly, in the general population.
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Affiliation(s)
- Nicolas H Thurin
- Bordeaux PharmacoEpi, INSERM CIC-P1401, Univ. Bordeaux, Bordeaux, France
| | - Romin Pajouheshnia
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | | | - Caitlin Dodd
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, and PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Giulia Hyeraci
- Agenzia regionale di sanità della Toscana, Florence, Italy
| | | | - Olga Paoletti
- Agenzia regionale di sanità della Toscana, Florence, Italy
| | - Hedvig Nordeng
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, and PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Helle Wallach-Kildemoes
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, and PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Elena Dudukina
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Thomas MacDonald
- MEMO Research, School of Medicine, University of Dundee, Dundee, UK
| | - Giorgia De Paoli
- MEMO Research, School of Medicine, University of Dundee, Dundee, UK
| | - Maria Loane
- Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
| | | | - Anna-Belle Beau
- INSERM, CERPOP: SPHERE, CIC 1436, Université de Toulouse, Toulouse, France
| | | | - Régis Lassalle
- Bordeaux PharmacoEpi, INSERM CIC-P1401, Univ. Bordeaux, Bordeaux, France
| | - Jorieke Bergman
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Karin Swart
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - Tania Schink
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Clara Cavero-Carbonell
- Fundació per al Foment de la Investigació Sanitaria i Biomédica de la Comunitat Valenciana (FISABIO), Valencia, Spain
| | - Laia Barrachina-Bonet
- Fundació per al Foment de la Investigació Sanitaria i Biomédica de la Comunitat Valenciana (FISABIO), Valencia, Spain
| | - Ainhoa Gomez-Lumbreras
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Maria Giner-Soriano
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - María Aragón
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Amanda J Neville
- IMER Registry (Emila Romagna Registry of Birth Defects), Center of Epidemiology for Clinical Research, University of Ferrara, Ferrara, Italy
| | - Aurora Puccini
- Drug Policy Service, Emilia Romagna Region Health Authority, Bologna, Italy
| | - Anna Pierini
- Epidemiology of Rare Diseases and Congenital Anomalies Unit, National Research Council-Institute of Clinical Physiology (CNR-IFC), Pisa, Italy
| | - Valentina Ientile
- Department of Biomedical and Dental Sciences and Morpho-functional Imaging, University of Messina, Messina, Italy
| | - Gianluca Trifirò
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Anke Rissmann
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty, Otto-von-Guericke-University, Magdeburg, Germany
| | | | | | - Sue Jordan
- Faculty of Health and Life Science, Swansea University, Swansea, UK
| | - Daniel Thayer
- Faculty of Health and Life Science, Swansea University, Swansea, UK
| | - Ieuan Scanlon
- Faculty of Health and Life Science, Swansea University, Swansea, UK
| | | | | | - Morris Swertz
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Miriam Sturkenboom
- Department Datascience and Biostatistics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rosa Gini
- Agenzia regionale di sanità della Toscana, Florence, Italy
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Rehm HL, Page AJ, Smith L, Adams JB, Alterovitz G, Babb LJ, Barkley MP, Baudis M, Beauvais MJ, Beck T, Beckmann JS, Beltran S, Bernick D, Bernier A, Bonfield JK, Boughtwood TF, Bourque G, Bowers SR, Brookes AJ, Brudno M, Brush MH, Bujold D, Burdett T, Buske OJ, Cabili MN, Cameron DL, Carroll RJ, Casas-Silva E, Chakravarty D, Chaudhari BP, Chen SH, Cherry JM, Chung J, Cline M, Clissold HL, Cook-Deegan RM, Courtot M, Cunningham F, Cupak M, Davies RM, Denisko D, Doerr MJ, Dolman LI, Dove ES, Dursi LJ, Dyke SO, Eddy JA, Eilbeck K, Ellrott KP, Fairley S, Fakhro KA, Firth HV, Fitzsimons MS, Fiume M, Flicek P, Fore IM, Freeberg MA, Freimuth RR, Fromont LA, Fuerth J, Gaff CL, Gan W, Ghanaim EM, Glazer D, Green RC, Griffith M, Griffith OL, Grossman RL, Groza T, Guidry Auvil JM, Guigó R, Gupta D, Haendel MA, Hamosh A, Hansen DP, Hart RK, Hartley DM, Haussler D, Hendricks-Sturrup RM, Ho CW, Hobb AE, Hoffman MM, Hofmann OM, Holub P, Hsu JS, Hubaux JP, Hunt SE, Husami A, Jacobsen JO, Jamuar SS, Janes EL, Jeanson F, Jené A, Johns AL, Joly Y, Jones SJ, Kanitz A, Kato K, Keane TM, Kekesi-Lafrance K, Kelleher J, Kerry G, Khor SS, Knoppers BM, Konopko MA, Kosaki K, Kuba M, Lawson J, Leinonen R, Li S, Lin MF, Linden M, Liu X, Liyanage IU, Lopez J, Lucassen AM, Lukowski M, Mann AL, Marshall J, Mattioni M, Metke-Jimenez A, Middleton A, Milne RJ, Molnár-Gábor F, Mulder N, Munoz-Torres MC, Nag R, Nakagawa H, Nasir J, Navarro A, Nelson TH, Niewielska A, Nisselle A, Niu J, Nyrönen TH, O’Connor BD, Oesterle S, Ogishima S, Ota Wang V, Paglione LA, Palumbo E, Parkinson HE, Philippakis AA, Pizarro AD, Prlic A, Rambla J, Rendon A, Rider RA, Robinson PN, Rodarmer KW, Rodriguez LL, Rubin AF, Rueda M, Rushton GA, Ryan RS, Saunders GI, Schuilenburg H, Schwede T, Scollen S, Senf A, Sheffield NC, Skantharajah N, Smith AV, Sofia HJ, Spalding D, Spurdle AB, Stark Z, Stein LD, Suematsu M, Tan P, Tedds JA, Thomson AA, Thorogood A, Tickle TL, Tokunaga K, Törnroos J, Torrents D, Upchurch S, Valencia A, Guimera RV, Vamathevan J, Varma S, Vears DF, Viner C, Voisin C, Wagner AH, Wallace SE, Walsh BP, Williams MS, Winkler EC, Wold BJ, Wood GM, Woolley JP, Yamasaki C, Yates AD, Yung CK, Zass LJ, Zaytseva K, Zhang J, Goodhand P, North K, Birney E. GA4GH: International policies and standards for data sharing across genomic research and healthcare. CELL GENOMICS 2021; 1:100029. [PMID: 35072136 PMCID: PMC8774288 DOI: 10.1016/j.xgen.2021.100029] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The Global Alliance for Genomics and Health (GA4GH) aims to accelerate biomedical advances by enabling the responsible sharing of clinical and genomic data through both harmonized data aggregation and federated approaches. The decreasing cost of genomic sequencing (along with other genome-wide molecular assays) and increasing evidence of its clinical utility will soon drive the generation of sequence data from tens of millions of humans, with increasing levels of diversity. In this perspective, we present the GA4GH strategies for addressing the major challenges of this data revolution. We describe the GA4GH organization, which is fueled by the development efforts of eight Work Streams and informed by the needs of 24 Driver Projects and other key stakeholders. We present the GA4GH suite of secure, interoperable technical standards and policy frameworks and review the current status of standards, their relevance to key domains of research and clinical care, and future plans of GA4GH. Broad international participation in building, adopting, and deploying GA4GH standards and frameworks will catalyze an unprecedented effort in data sharing that will be critical to advancing genomic medicine and ensuring that all populations can access its benefits.
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Affiliation(s)
- Heidi L. Rehm
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Angela J.H. Page
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Global Alliance for Genomics and Health, Toronto, ON, Canada
| | - Lindsay Smith
- Global Alliance for Genomics and Health, Toronto, ON, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Jeremy B. Adams
- Global Alliance for Genomics and Health, Toronto, ON, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Gil Alterovitz
- Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | | | - Michael Baudis
- University of Zurich, Zurich, Switzerland
- SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Michael J.S. Beauvais
- Global Alliance for Genomics and Health, Toronto, ON, Canada
- McGill University, Montreal, QC, Canada
| | - Tim Beck
- University of Leicester, Leicester, UK
| | | | - Sergi Beltran
- CNAG-CRG, Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - David Bernick
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | | | | | - Tiffany F. Boughtwood
- Australian Genomics, Parkville, VIC, Australia
- Murdoch Children’s Research Institute, Parkville, VIC, Australia
| | - Guillaume Bourque
- McGill University, Montreal, QC, Canada
- Canadian Center for Computational Genomics, Montreal, QC, Canada
| | | | | | - Michael Brudno
- Canadian Center for Computational Genomics, Montreal, QC, Canada
- University of Toronto, Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
- Vector Institute, Toronto, ON, Canada
- Canadian Distributed Infrastructure for Genomics (CanDIG), Toronto, ON, Canada
| | | | - David Bujold
- McGill University, Montreal, QC, Canada
- Canadian Center for Computational Genomics, Montreal, QC, Canada
- Canadian Distributed Infrastructure for Genomics (CanDIG), Toronto, ON, Canada
| | - Tony Burdett
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Hinxton, UK
| | | | | | - Daniel L. Cameron
- Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
- University of Melbourne, Melbourne, VIC, Australia
| | | | | | | | - Bimal P. Chaudhari
- Nationwide Children’s Hospital, Columbus, OH, USA
- The Ohio State University, Columbus, OH, USA
| | - Shu Hui Chen
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Justina Chung
- Global Alliance for Genomics and Health, Toronto, ON, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Melissa Cline
- UC Santa Cruz Genomics Institute, Santa Cruz, CA, USA
| | | | | | - Mélanie Courtot
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Hinxton, UK
| | - Fiona Cunningham
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Hinxton, UK
| | | | | | | | | | | | | | - L. Jonathan Dursi
- University Health Network, Toronto, ON, Canada
- Canadian Distributed Infrastructure for Genomics (CanDIG), Toronto, ON, Canada
| | | | | | | | | | - Susan Fairley
- Global Alliance for Genomics and Health, Toronto, ON, Canada
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Hinxton, UK
| | - Khalid A. Fakhro
- Sidra Medicine, Doha, Qatar
- Weill Cornell Medicine - Qatar, Doha, Qatar
| | - Helen V. Firth
- Wellcome Sanger Institute, Hinxton, UK
- Addenbrooke’s Hospital, Cambridge, UK
| | | | | | - Paul Flicek
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Hinxton, UK
| | - Ian M. Fore
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mallory A. Freeberg
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Hinxton, UK
| | | | - Lauren A. Fromont
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain
| | | | - Clara L. Gaff
- Australian Genomics, Parkville, VIC, Australia
- Murdoch Children’s Research Institute, Parkville, VIC, Australia
- Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
- University of Melbourne, Melbourne, VIC, Australia
| | - Weiniu Gan
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Elena M. Ghanaim
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - David Glazer
- Verily Life Sciences, South San Francisco, CA, USA
| | - Robert C. Green
- Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Malachi Griffith
- Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Obi L. Griffith
- Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | | | | | | | - Roderic Guigó
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Dipayan Gupta
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Hinxton, UK
| | | | - Ada Hamosh
- Johns Hopkins University, Baltimore, MD, USA
| | - David P. Hansen
- Australian Genomics, Parkville, VIC, Australia
- The Australian e-Health Research Centre, CSIRO, Herston, QLD, Australia
| | - Reece K. Hart
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Invitae, San Francisco, CA, USA
- MyOme, Inc, San Bruno, CA, USA
| | | | - David Haussler
- UC Santa Cruz Genomics Institute, Santa Cruz, CA, USA
- Howard Hughes Medical Institute, University of California, Santa Cruz, CA, USA
| | | | | | | | - Michael M. Hoffman
- University of Toronto, Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
- Vector Institute, Toronto, ON, Canada
| | - Oliver M. Hofmann
- University of Toronto, Toronto, ON, Canada
- University of Melbourne, Melbourne, VIC, Australia
| | - Petr Holub
- BBMRI-ERIC, Graz, Austria
- Masaryk University, Brno, Czech Republic
| | | | | | - Sarah E. Hunt
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Hinxton, UK
| | - Ammar Husami
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | | | - Saumya S. Jamuar
- SingHealth Duke-NUS Genomic Medicine Centre, Singapore, Republic of Singapore
- SingHealth Duke-NUS Institute of Precision Medicine, Singapore, Republic of Singapore
| | - Elizabeth L. Janes
- Global Alliance for Genomics and Health, Toronto, ON, Canada
- University of Waterloo, Waterloo, ON, Canada
| | | | - Aina Jené
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Amber L. Johns
- Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| | - Yann Joly
- McGill University, Montreal, QC, Canada
| | - Steven J.M. Jones
- Canada’s Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
| | - Alexander Kanitz
- SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Thomas M. Keane
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Hinxton, UK
- University of Nottingham, Nottingham, UK
| | - Kristina Kekesi-Lafrance
- Global Alliance for Genomics and Health, Toronto, ON, Canada
- McGill University, Montreal, QC, Canada
| | | | - Giselle Kerry
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Hinxton, UK
| | - Seik-Soon Khor
- National Center for Global Health and Medicine Hospital, Tokyo, Japan
- University of Tokyo, Tokyo, Japan
| | | | | | | | | | | | - Rasko Leinonen
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Hinxton, UK
| | - Stephanie Li
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Global Alliance for Genomics and Health, Toronto, ON, Canada
| | | | - Mikael Linden
- CSC–IT Center for Science, Espoo, Finland
- ELIXIR Finland, Espoo, Finland
| | | | - Isuru Udara Liyanage
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Hinxton, UK
| | | | | | | | - Alice L. Mann
- Global Alliance for Genomics and Health, Toronto, ON, Canada
- Wellcome Sanger Institute, Hinxton, UK
| | | | | | | | - Anna Middleton
- Wellcome Connecting Science, Hinxton, UK
- University of Cambridge, Cambridge, UK
| | - Richard J. Milne
- Wellcome Connecting Science, Hinxton, UK
- University of Cambridge, Cambridge, UK
| | | | - Nicola Mulder
- H3ABioNet, Computational Biology Division, IDM, Faculty of Health Sciences, Cape Town, South Africa
| | | | - Rishi Nag
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Hinxton, UK
| | - Hidewaki Nakagawa
- Japan Agency for Medical Research & Development (AMED), Tokyo, Japan
- RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | | | - Arcadi Navarro
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain
- Institute of Evolutionary Biology (UPF-CSIC), Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
| | | | - Ania Niewielska
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Hinxton, UK
| | - Amy Nisselle
- Murdoch Children’s Research Institute, Parkville, VIC, Australia
- University of Melbourne, Melbourne, VIC, Australia
- Human Genetics Society of Australasia Education, Ethics & Social Issues Committee, Alexandria, NSW, Australia
| | - Jeffrey Niu
- University Health Network, Toronto, ON, Canada
| | - Tommi H. Nyrönen
- CSC–IT Center for Science, Espoo, Finland
- ELIXIR Finland, Espoo, Finland
| | | | - Sabine Oesterle
- SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | | | - Vivian Ota Wang
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Emilio Palumbo
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Helen E. Parkinson
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Hinxton, UK
| | | | | | | | - Jordi Rambla
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain
| | | | - Renee A. Rider
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Peter N. Robinson
- The Jackson Laboratory, Farmington, CT, USA
- University of Connecticut, Farmington, CT, USA
| | - Kurt W. Rodarmer
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD, USA
| | | | - Alan F. Rubin
- Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
- University of Melbourne, Melbourne, VIC, Australia
| | - Manuel Rueda
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain
| | | | | | | | - Helen Schuilenburg
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Hinxton, UK
| | - Torsten Schwede
- SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland
- University of Basel, Basel, Switzerland
| | | | | | | | - Neerjah Skantharajah
- Global Alliance for Genomics and Health, Toronto, ON, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | | | - Heidi J. Sofia
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Dylan Spalding
- CSC–IT Center for Science, Espoo, Finland
- ELIXIR Finland, Espoo, Finland
| | | | - Zornitza Stark
- Australian Genomics, Parkville, VIC, Australia
- Murdoch Children’s Research Institute, Parkville, VIC, Australia
- University of Melbourne, Melbourne, VIC, Australia
| | - Lincoln D. Stein
- Ontario Institute for Cancer Research, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | | | - Patrick Tan
- SingHealth Duke-NUS Genomic Medicine Centre, Singapore, Republic of Singapore
- Precision Health Research Singapore, Singapore, Republic of Singapore
- Genome Institute of Singapore, Singapore, Republic of Singapore
| | | | - Alastair A. Thomson
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Adrian Thorogood
- McGill University, Montreal, QC, Canada
- University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | | | - Katsushi Tokunaga
- University of Tokyo, Tokyo, Japan
- National Center for Global Health and Medicine, Tokyo, Japan
| | - Juha Törnroos
- CSC–IT Center for Science, Espoo, Finland
- ELIXIR Finland, Espoo, Finland
| | - David Torrents
- Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
- Barcelona Supercomputing Center, Barcelona, Spain
| | - Sean Upchurch
- California Institute of Technology, Pasadena, CA, USA
| | - Alfonso Valencia
- Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
- Barcelona Supercomputing Center, Barcelona, Spain
| | | | - Jessica Vamathevan
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Hinxton, UK
| | - Susheel Varma
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Hinxton, UK
- Health Data Research UK, London, UK
| | - Danya F. Vears
- Murdoch Children’s Research Institute, Parkville, VIC, Australia
- University of Melbourne, Melbourne, VIC, Australia
- Human Genetics Society of Australasia Education, Ethics & Social Issues Committee, Alexandria, NSW, Australia
- Melbourne Law School, University of Melbourne, Parkville, VIC, Australia
| | - Coby Viner
- University of Toronto, Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
| | | | - Alex H. Wagner
- Nationwide Children’s Hospital, Columbus, OH, USA
- The Ohio State University, Columbus, OH, USA
| | | | | | | | - Eva C. Winkler
- Section of Translational Medical Ethics, University Hospital Heidelberg, Heidelberg, Germany
| | | | | | | | | | - Andrew D. Yates
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Hinxton, UK
| | - Christina K. Yung
- Ontario Institute for Cancer Research, Toronto, ON, Canada
- Indoc Research, Toronto, ON, Canada
| | - Lyndon J. Zass
- H3ABioNet, Computational Biology Division, IDM, Faculty of Health Sciences, Cape Town, South Africa
| | - Ksenia Zaytseva
- McGill University, Montreal, QC, Canada
- Canadian Centre for Computational Genomics, Montreal, QC, Canada
| | - Junjun Zhang
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Peter Goodhand
- Global Alliance for Genomics and Health, Toronto, ON, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Kathryn North
- Murdoch Children’s Research Institute, Parkville, VIC, Australia
- University of Toronto, Toronto, ON, Canada
- University of Melbourne, Melbourne, VIC, Australia
| | - Ewan Birney
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Hinxton, UK
- European Molecular Biology Laboratory, Heidelberg, Germany
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Covid-19 Vaccine Surveillance in Saudi Arabia: Opportunities for Real-time Assessment. Saudi Pharm J 2021; 29:914-916. [PMID: 34305424 PMCID: PMC8282449 DOI: 10.1016/j.jsps.2021.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 07/04/2021] [Indexed: 12/04/2022] Open
Abstract
After months of confronting COVID-19 pandemic, several countries, including Saudi Arabia, have recently approved newly developed vaccines to prevent COVID-19 infection. With the new technology utilized to develop some vaccines, questions arise about their long-term safety. To provide rapid response to emerging safety issues, robust surveillance programs that provide near real-time analysis of vaccines effects are required. Saudi Arabia has a well-established passive pharmacovigilance system that monitors drugs and vaccines safety. However, recent development in health digitalization in Saudi Arabia may provide a unique opportunity to harvest existing resources to generate high-quality evidence. This commentary provides an overview of the available systems that can be utilized to monitor the COVID-19 vaccines’ safety and discusses opportunities for data integration to improve data quality and generate real-world evidence on COVID-19 vaccine safety.
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Prieto-Alhambra D, Kostka K, Duarte-Salles T, Prats-Uribe A, Sena A, Pistillo A, Khalid S, Lai L, Golozar A, Alshammari TM, Dawoud D, Nyberg F, Wilcox A, Andryc A, Williams A, Ostropolets A, Areia C, Jung CY, Harle C, Reich C, Blacketer C, Morales D, Dorr DA, Burn E, Roel E, Tan EH, Minty E, DeFalco F, de Maeztu G, Lipori G, Alghoul H, Zhu H, Thomas J, Bian J, Park J, Roldán JM, Posada J, Banda JM, Horcajada JP, Kohler J, Shah K, Natarajan K, Lynch K, Liu L, Schilling L, Recalde M, Spotnitz M, Gong M, Matheny M, Valveny N, Weiskopf N, Shah N, Alser O, Casajust P, Park RW, Schuff R, Seager S, DuVall S, You SC, Song S, Fernández-Bertolín S, Fortin S, Magoc T, Falconer T, Subbian V, Huser V, Ahmed WUR, Carter W, Guan Y, Galvan Y, He X, Rijnbeek P, Hripcsak G, Ryan P, Suchard M. Unraveling COVID-19: a large-scale characterization of 4.5 million COVID-19 cases using CHARYBDIS. RESEARCH SQUARE 2021:rs.3.rs-279400. [PMID: 33688639 PMCID: PMC7941629 DOI: 10.21203/rs.3.rs-279400/v1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background: Routinely collected real world data (RWD) have great utility in aiding the novel coronavirus disease (COVID-19) pandemic response [1,2]. Here we present the international Observational Health Data Sciences and Informatics (OHDSI) [3] Characterizing Health Associated Risks, and Your Baseline Disease In SARS-COV-2 (CHARYBDIS) framework for standardisation and analysis of COVID-19 RWD. Methods: We conducted a descriptive cohort study using a federated network of data partners in the United States, Europe (the Netherlands, Spain, the UK, Germany, France and Italy) and Asia (South Korea and China). The study protocol and analytical package were released on 11 th June 2020 and are iteratively updated via GitHub [4]. Findings: We identified three non-mutually exclusive cohorts of 4,537,153 individuals with a clinical COVID-19 diagnosis or positive test, 886,193 hospitalized with COVID-19 , and 113,627 hospitalized with COVID-19 requiring intensive services . All comorbidities, symptoms, medications, and outcomes are described by cohort in aggregate counts, and are available in an interactive website: https://data.ohdsi.org/Covid19CharacterizationCharybdis/. Interpretation: CHARYBDIS findings provide benchmarks that contribute to our understanding of COVID-19 progression, management and evolution over time. This can enable timely assessment of real-world outcomes of preventative and therapeutic options as they are introduced in clinical practice.
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Affiliation(s)
- Daniel Prieto-Alhambra
- Centre for Statistics in Medicine (CSM), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDROMS), University of Oxford, UK
| | | | - Talita Duarte-Salles
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | | | - Anthony Sena
- Janssen R&D, Titusville NJ, USA, 2) Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Andrea Pistillo
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Sara Khalid
- Centre for Statistics in Medicine, NDORMS, University of Oxford, UK
| | - Lana Lai
- Division of Cancer Sciences, School of Medical Sciences, University of Manchester, UK
| | - Asieh Golozar
- Regeneron Pharmaceuticals, NY USA, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, MD USA
| | - Thamir M Alshammari
- Medication Safety Research Chair, King Saud University, Riyadh, Saudi Arabia
| | - Dalia Dawoud
- National Institute for Health and Care Excellence, London, UK
| | - Fredrik Nyberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Adam Wilcox
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, USA, 2) UW Medicine, Seattle, WA, USA
| | | | - Andrew Williams
- Tufts Institute for Clinical Research and Health Policy Studies, US
| | - Anna Ostropolets
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Carlos Areia
- Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Chi Young Jung
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea
| | | | | | - Clair Blacketer
- Janssen R&D, Titusville NJ, USA, 2) Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Daniel Morales
- Division of Population Health and Genomics, University of Dundee, UK
| | - David A Dorr
- Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
| | - Edward Burn
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | | | - Eng Hooi Tan
- Centre for Statistics in Medicine, NDORMS, University of Oxford, UK
| | - Evan Minty
- O'Brien Institute for Public Health, Faculty of Medicine, University of Calgary, Canada
| | | | | | | | - Heba Alghoul
- Faculty of Medicine, Islamic University of Gaza, Palestine
| | - Hong Zhu
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jason Thomas
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, USA
| | | | - Jimyung Park
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Korea
| | - Jordi Martínez Roldán
- Director of Innovation and Digital Transformation, Hospital del Mar, Barcelona, Spain
| | - Jose Posada
- Stanford University School of Medicine, Stanford, California, USA
| | - Juan M Banda
- Georgia State University, Department of Computer Science, Atlanta, GA, USA
| | - Juan P Horcajada
- Department of Infectious Diseases, Hospital del Mar, Institut Hospital del Mar d'Investigació Mèdica (IMIM), Universitat Autònoma de Barcelona. Universitat Pompeu Fabra, Barcelo
| | - Julianna Kohler
- United States Agency for International Development, Washington, DC, USA
| | - Karishma Shah
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Karthik Natarajan
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY 10032, USA, 2) New York-Presbyterian Hospital, 622 W 168 St, PH20 New York, NY 10032 USA
| | - Kristine Lynch
- VINCI, VA Salt Lake City Health Care System, Salt Lake City, VA, & Division of Epidemiology, University of Utah, Salt Lake City, UT
| | - Li Liu
- Biomedical Big Data Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Lisa Schilling
- Data Science to Patient Value Program, University of Colorado Anschutz Medical Campus
| | - Martina Recalde
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Matthew Spotnitz
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY 10032, USA
| | | | - Michael Matheny
- VINCI, Tennessee Valley Healthcare System VA, Nashville, TN & Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
| | | | - Nicole Weiskopf
- Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
| | | | - Osaid Alser
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Rae Woong Park
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Korea
| | - Robert Schuff
- Knight Cancer Institute, Oregon Health & Science University
| | | | - Scott DuVall
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Seng Chan You
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea
| | - Seokyoung Song
- Department of Anesthesiology and Pain Medicine, Catholic University of Daegu, School of Medicine, Daegu, Korea
| | - Sergio Fernández-Bertolín
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Stephen Fortin
- Observational Health Data Analytics, Janssen Research and Development, Raritan, NJ, USA
| | | | - Thomas Falconer
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Vignesh Subbian
- College of Engineering, The University of Arizona, Tucson, Arizona, USA
| | - Vojtech Huser
- National Library of Medicine, National Institutes of Health, Bethesda, MD, USA
| | - Waheed-Ul-Rahman Ahmed
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK, 2) College of Medicine and Health, University of Exeter, St Luke's Campus, E
| | - William Carter
- Data Science to Patient Value Program, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Yin Guan
- DHC Technologies Co. Ltd, Beijing, China
| | | | - Xing He
- University of Florida Health
| | - Peter Rijnbeek
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY 10032, USA, 2) New York-Presbyterian Hospital, 622 W 168 St, PH20 New York, NY 10032 USA
| | | | - Marc Suchard
- Department of Biostatistics, UCLA Fielding School of Public Health, University of California, Los Angeles
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