1. Leveraging the Electronic Health Record for Clinical Research John P. Glaser, PhD Vice President and CIO Partners HealthCare July 21, 2008

2. A Vision for Personalized Medicine EMR with clinical decision support Genomic research with high capacity IT Integrated genomic and phenotypic data repository Facilitated translational research leading to Diagnostic discovery Drug development Improved individualized medicine & pre / post symptomatic disease management

3. Consent Tracking System (CTS) Research Patient Data Registry (RPDR) Enterprise LIMS Superstructure (GIGPAD / PowerPath) Genomic Knowledge Base (GeneInsight) Genomic Variant Interpretation Engine (GVIE) Enterprise Tissue Banking Infrastructure Electronic Health Record (EHR) Clinical Decision Support Rules Engine Shared Pathology Information Network (SPIN) Clinical Research I2B2 (HIVE / RelNet / Pharmacologic Surveillance) Computational Cluster and Storage Resources Partners Personalized Medicine Infrastructure

4. i2b2 Hive

5. Can SSRI Response be Predicted?

6. Costs of “High Throughput” Clinical Research

7. Post Market Medication Surveillance Brownstein, PLoS ONE, 2007

8. Patient Genetic Profile GMR Genetic Markers State Mgmt. Genetic Assessments Clinician SystemsEnterprise Service Bus Genetics Reference & Authoring Svcs. Genetics Runtime Services Patient Genome Browser CPOE Decision Support CDR Genetic Test Reports LMR Fully Genetics Enabled EHR Architecture PEAR Genetic-based Drug Allergies Data Access Assessment Engine Knowledge Access Bus. Rules Mgmt. Sys. Event/Workflow Engine Gene Insight Ensemble VariantWire Result Receiver PEPR Family History, Genetic-based Problems GVIE Master Order Catalog Genetic Test Coverage Patient Data Warehouse To Pt Data Warehouse

9. Organization u Harvard Partners Center for Genetics and Genomics –Scientific leadership –Laboratory operations –Initiated with $50M Harvard Medical School/Partners commitment u Informatics for Integrating Biology and the Bedside –Medical informatics and bioinformatics core –$20M/5 Year NIH funding u Partners Information Systems –Software development –Research Patient Data Registry –$5M annual operating budget u Industry sponsorship –HP –Affymetrix

10. Governance u HPCGG –Scientific Director reports to the Dean, HMS and CEO, Partners –External Advisory Board u Information Technology –Quarterly meeting with Partners CEO, VP – Academic Affairs, and CEO, Physician Network –Bi-monthly IT operations meeting