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------=_NextPart_01C66AC8.76E9B8F0 Content-Location: file:///C:/2E65A1EC/Joyce_Mitchell_files/master05.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01C66AC8.76E9B8F0 Content-Location: file:///C:/2E65A1EC/Joyce_Mitchell_files/pres.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01C66AC8.76E9B8F0 Content-Location: file:///C:/2E65A1EC/Joyce_Mitchell_files/slide0001.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" PowerPoint Presentation
Dept of Biomedical Informatics
- Research Directions
Joyce = A. Mitchell, PhD
Professor and Chai= r
University of Utah=
April = 25, 2006
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Department History
&Oslas= h;Established 1964
lSchool of Engineering,
lDept Biophysics and Computing
&Oslas= h;Split 1972
lDept of Bioengineering
lDept of Medical Biophysics and Computing
&Oslas= h;Name change 1985 – Medical Informatics <= /span>
&Oslas= h;Name change 2006 – Biomedical Informatics
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Department Brag Facts
&Oslas= h;First Informatics department in the US =
&Oslas= h;Graduated most PhDs in US (> 100)
&Oslas= h;3 Spin-off companies
&Oslas= h;Internationally recognized for research in
lElectronic medical records
lClinical decision support systems
lMethods to find genes in large pedigrees
lInformatics methods for genetics
lDevelopment of terminologies & standards <= /span>
lInformatics for homeland security
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J. Mitchell’s Research
ØUsing information from the Human Genome Project for health care (Clin= ical Bioinformatics)
lGenetics Home Reference
&= #8226;= http://www.ghr.nlm.nih.gov 
lGenetics/genomics in the electronic medical record
&= #8226;Hemochromatosis (single gene example)
&= #8226;CYP450 genes (drug metabolizing example)
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What is the
Genetics Home Reference?
ØAn information system focusing on the health implications of research arising from the Human Genome Project
lTargets the public<= /span>
lBridges consumer health information and bioinformatics data <= /span>
lLinks to existing resources (NLM and other)
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Building Bridges
Data Harvesting
Data Harvesting
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Kudos from the Public
ØNews links from CNN, Nature, Forbes
ØPositive feedback:
l“The best overall reference on human heredity for students…” - from educator&#= 13;
l“The first time I have read information that was parent friendly...” = - from parent
l“Just what I have been searching for several = years…” - from phy= sician
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  Ensembl <= /div>
  Conditions related to genes on        Chromosome
  GeneCards
  Genes on Chromosome
DATA SOURC= E
CHROMOSOME FIELD
  UMLS
  Synonyms
  MeSH Medical Subject Headings=
  Name
DATA SOURC= E
CONDITION FIELD
  Gene Ontology via HGNC & Entr= ez Gene
  Gene Ontology Annotations
  UMLS Unified Medical Language Sys= tem
  Synonyms
  Entrez Gene
  Ensembl
  Cytogenetic Location
  Molecular Location
  HGNC or Entrez Gene
  Name <= /span>
  HGNC or Entrez Gene
  Symbol
DATA SOURC= E
GENE FIELD=
Data Sources Map
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Genetics Home Reference
ØKey elements;
lKnowledge management
lBridging between trusted knowledge sources and data harvesting to keep current
lUser and content evaluations for guidance
Ø
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Genetics in the EMR
Building on the knowl= edge in the Genetics Home Reference
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Human Disease Gene
ØGenes linked to human diseases
<= span class=3DBB style=3D'position:absolute;left:-4.43%;top:.22em'>Ø+ 425 in 2 yrs from 2002 - 2004
<= span class=3DBB style=3D'position:absolute;left:-4.43%;top:.22em'>Ø1700/20,000 =3D 9% of loci
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Genetics in the EMR
ØCan order more than 1200 genetic tests from over 600 laboratories.
l= http://www.genereviews.org
l
ØMore gene tests will be ordered. [reports = of 300% increase in gene tests in 2003.]
lArch Pathol Lab Med – 2004, 128(12):1330-1333
Ø
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= Genetic data in electronic medical records?
ØImplications for component systems:
lLaboratory
lPharmacy
lComputerized order entry
lDocumentation and notes
ØKnowledge management
lAlerts and reminders
lFinding patients matching profiles
lPractice guidelines and clinical trials
Ø
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Example:  Hemochromatosis
&Oslas= h;2 copies of mutated HFE gene - too much iron absorbed from diet, which accumulates.  Causes arthritis, liver disease, diabetes, = hormonal regulation problems.
l(1 million people in US)
&Oslas= h;HFE gene regulates the storage, transport and absorption of iron
&Oslas= h;Labs doing gene tests use different = techniques:  full sequence vs limited analysis
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What S= hould You Store in the EMR?
Ø= ;Do you put the DNA sequence for the gene into = the EMR?  Where do you put it?
&Oslas= h;Do you just store meta-data about the DNA <= /span>= sequence? = HFE test abn or (cys282tyr) What about the normal variants?
Ø= ;If you don’t store the sequence, what do you= do = when the reference sequence changes?
&Oslas= h;How do you trigger alerts and reminders?  And = for what? People with hemochromatosis need = = special screening and check-ups.
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Some Possible Alerts
- hemochromatosis
&Oslas= h;If C282Y homozygous, follow serum ferritin = levels (these levels are age and sex dependent).&#= 13;
Ø= ;If serum ferritin is elevated, consider regular = phlebotomy.
&Oslas= h;If serum ferritin is over 1000 ng/mh, evaluate the= patient for abnormal iron storage, including a = liver biopsy.
&Oslas= h;If the biopsy shows liver fibrosis, keep a close <= /span>= watch for hepatocellular cancers.
&Oslas= h;Test the full siblings for the C282Y mutation.
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Drug metabolizing genes
ØComplicated data to generate the alerts coming from multiple EMR components:
lLaboratory system
lPharmacy system
lDietary records
lEnvironmental exposures
lPast medical history and allergy records
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Drug Metabolizing Enzymes
ØCYP2C9 and VKORC1
= l“Estimated warfarin daily dose requirement for a 170-cm tall 90-year-old patient with the CYP2C9*1/*3 and VKORC1-AA genotype is over 6 times lower than that for a 30= -year-old patient of the same height and with CYP2C9 wild-type and VKORC1-GG genotype.”
ØSconce et al. Blood 2005; 106(7):2329-2333.=
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