Building a vertically integrated genomic learning health system: The biobank at the Colorado Center for Personalized Medicine.

Precision medicine initiatives across the globe have led to a revolution of repositories linking large-scale genomic data with electronic health records, enabling genomic analyses across the entire phenome. Many of these initiatives focus solely on research insights, leading to limited direct benefit to patients. We describe the biobank at the Colorado Center for Personalized Medicine (CCPM Biobank) that was jointly developed by the University of Colorado Anschutz Medical Campus and UCHealth to serve as a unique, dual-purpose research and clinical resource accelerating personalized medicine. This living resource currently has more than 200,000 participants with ongoing recruitment. We highlight the clinical, laboratory, regulatory, and HIPAA-compliant informatics infrastructure along with our stakeholder engagement, consent, recontact, and participant engagement strategies. We characterize aspects of genetic and geographic diversity unique to the Rocky Mountain region, the primary catchment area for CCPM Biobank participants. We leverage linked health and demographic information of the CCPM Biobank participant population to demonstrate the utility of the CCPM Biobank to replicate complex trait associations in the first 33,674 genotyped individuals across multiple disease domains. Finally, we describe our current efforts toward return of clinical genetic test results, including high-impact pathogenic variants and pharmacogenetic information, and our broader goals as the CCPM Biobank continues to grow. Bringing clinical and research interests together fosters unique clinical and translational questions that can be addressed from the large EHR-linked CCPM Biobank resource within a HIPAA- and CLIA-certified environment.

The Case for Virtual Sepsis Surveillance and Intervention.

Study Objective:To determine whether deployment of an integrated virtual sepsis surveillance program could improve time to antibiotics and mortality in a longitudinal cohort of non-present on admission (NPOA) sepsis cases.Methods:We used an uncontrolled pre- and poststudy design to compare time to antibiotics and mortality between a time-based cohort of NPOA sepsis cases separated by the deployment of a virtual sepsis surveillance program.Results:A total of 566 NPOA sepsis cases were included in this study. Three hundred and thirty-five cases compromised the preintervention arm, whereas the postintervention cohort included 231 cases. After deployment of the virtual sepsis surveillance program, median time to antibiotics improved from 92 to 59 min (p < 0.001). Mortality was reduced from 30% to 21% (p = 0.015).Conclusion:Deployment of a virtual sepsis surveillance program resulted in a decreased time to antibiotics and an overall reduction in NPOA sepsis mortality.

Showing "what right looks like"--how to improve performance through a paradigm shift around implementation thinking.

During a three-year period, Christiana Care has observed significant and sustained improvements in technology-enabled project outcomes. Just in the patient throughput area, Christiana Care has seen an 11 percent reduction in length of stay in the emergency department (ED), a 23 percent reduction in patients leaving ED without treatment and a 28 percent reduction in bed-clean turnaround time, all while accommodating patient volume increases of 7 percent. This performance is directly related to a broader view of implementation embraced by the organization. By looking at more than just traditional project management, Christiana Care has shifted their implementation paradigm, focusing on benefits planning, user adoption, value realization and goal delivery within the portfolio. This has been a result of a journey that has included a subtle but deliberate introduction of the new implementation thinking, primarily marked by an experience-driven approach of demonstrating the benefits of good implementation practices. Christiana Care has created the environment and process to get the greatest value for its IT-related investments and to show "what right looks like."