1. Building the Electronic Data Infrastructure: Lessons from Indiana PROSPECT Paul Dexter, MD Chief Medical Information Officer, Wishard Health Services Regenstrief Institute Scientist Supported by AHRQ Grant R01 HS19818-01 Dr Dexter has no conflict of interest.

2. Enhancing health care IT infrastructure A learning health system Coordinated clinical, research, and quality improvement efforts Outcomes important to patients CER, PCOR Leveraging EHRs and other data sources Rapid, comprehensive, hypothesis-generating results

3. Local opportunities and challenges A large health information exchange Creation of new software Study enrollment challenges, PBRN Investigator access to preliminary data Integration of clinical and genetic research Capture of patient reported outcomes Improved support of standards

4. Specific aims Enhance existing information technology infrastructure: Support providers, caregivers, and researchers by providing new tools for communication and co-management Provide de-identified access to the INPC database for CER work Capture and store health care outcomes important to patients and their caregivers Comparative effectiveness clinical trial of medication treatment for behavioral symptoms of Alzheimer’s disease

5. INPC Data  80 hospitals signed up  46 hospitals “live”  1,400 interfaces  12 million individuals  4 billion structured results Also includes: Laboratories Radiology centers Public health 5 large payors

8. Record Count as denominator Realtime

9. Automated study recruitment

10. Informatics decision support research

11. Record Count as denominator Realtime Study design tool

12. Record Count as denominator Realtime Study design tool

13. Integration and enhancements to eMR-ABC

14. Automated biospecimen tracking Lab Technician caTrack PDA with Scanner Web Service Phlebotomist caTissue Application BioSpecimen Database caTrack Business Logic Scan patient barcode Scan blood tube barcode Scan centrifuge barcode Scan blood tube barcode Scan box barcode Scan aliquot barcode

15. De-identified I2b2 queries

16. I2B2 Database Global ID De-identification Staging Server INPC Biospecimen Tissue Tracking myTrack Molecular Data INPC Biospecimen Tissue Tracking

17. “Vending machine” concepts Diabetes mellitus Coronary artery disease Myocardial infarction Heart failure COPD Asthma Hypertension Breast cancer Prostate cancer Lung cancer Colorectal cancer Ovarian cancer Esophageal cancer Stroke Chronic kidney disease GI bleeding HIV/AIDS Schizophrenia Hyperlipidemia Osteoarthritis Rheumatoid arthritis Falls ADHD Etc….

18. UIMA/cTAKES open source NLP

19. Real-time NLP

21. Integration of LOINC survey instruments

26. Striving for sustainability

27. Thank you