Mark Hoffman, Ph.D.Director – Translational Medicine

Aug 24, 2007

Shawnee Mission South

Bio-sketch

• Raytown South High School 1987

• BA - William Jewell College 1991– Oxford University 1990

• Ph.D. - University of Wisconsin 1996– 1994 internship at DNAStar

• Postdoctoral training – National Animal Disease Center (USDA) 1996-1997

High school

• Science Honor Society– Knowledge Bowl

• Equal interest in science and social studies

William Jewell College

• Oxbridge Honors Program– Molecular Biology Major– Semester in England studying bioethics

• Electives in political science– Cold War politics– International relations

Undergraduate summers

• UMKC– Learned how to do basic Microbiology tasks

• KU– Learned biochemical techniques– Protein purification– Small research problems

• Refolding of purified proteins

• JC Penney commission sales

University of Wisconsin

• Department of Bacteriology

• Funded by biotechnology training program– NIH program provides tuition and stipend for

first 3 years– Requires internship in industry– Coursework outside major

Graduate school

• Years 1-2 – Classes– Identify research project

• Preliminary exams• Years 3 – x

– Research– Publications– Write thesis– Defend thesis

Staphylococcal enterotoxin A

• Causes food poisoning

• Activates immune system through unusual mechanism

• Are the two related?

Rhesus monkey umbilical cordblood stimulation assay

Molecular modeling

Sites associated with vomiting Sites associated with immune activity

Internship

• DNAStar

• Developed programs that perform DNA and protein sequence analysis– Immunology related algorithms to predict

immunogenic epitopes in proteins• Rational vaccine design

NADC• National Animal Disease Center – USDA

• Ames, Iowa

• Research on diseases of importance to agriculture and human food safety

• Biosecurity level 2 and 3 barns

EC 0157:H7• E. coli O157:H7

– Causes enterohemorrhagic colitis– 7% of cases progress to hemolytic uremic

syndrome

• Live oral vaccination

Clin. Diag. Immun. 1998 5:242-246

Cerner

• Software developer for Microbiology team– Respond to issues– Write programs

• Team leader– Responsibilities above + lead team

• Architect

• Solution Manager

Our VisionOur Vision• Begin where youwant to end:– Automate

enterprise workflow

– Connect the community

– Structure and analyze

– Create executable knowledge

• The objective: close the loop

Critical DecisionsCritical Decisions

.

Cerner Millennium Solutions PortfolioCerner Millennium Solutions Portfolio

Innovation You Can Trust™

©2003 Cerner Corporation. All rights reserved. This document contains confidential information which may not be reproduced or transmitted without the expressed written consent of Cerner.Version 3.0

Community &Consumer Systems

PhysicianPortal

PowerLink

ConsumerRelationshipManagement

ConditionCenters

Call Center Bio-SurveillanceHealthSentry

SpecialtyCare Systems

CardiologyCVNet

OncologyPowerChartOncology

Women’sHealth Children’s Orthopedics Pulmonology Home Health

ProCall

ClinicalCenter Systems Clinical TrialsLaboratory

PathNetRadiology

RadNetImage

ManagementCerner ProVision

PharmacyPharmNet

Financial & OperationalSystems

PatientAccounting

ProFit

CostAccounting

Supply ChainProCure

HealthInfo. Mgmt.

ProFile

WorkforceManagement

OutcomesMeasurement

PowerInsight

ComparativeData

HealthFacts

Knowledge-DrivenCare Solutions

DecisionSupport Engine

Discern Expert

ReportingDiscern Explorer

PowerVision

Outcomes & BenchmarkingCerner APACHE

DrugDatabase

Cerner Multum

ReferentialKnowledge

Zynx

ExecutableKnowledge

DirectCare Systems

EMRPowerChart

CDR

AmbulatoryCare

PowerChart OfficeEmergency

FirstNetCritical Care

INet

Surgery &Anesthesia

SurgiNet

Acute CareCareNet

PowerOrders

Plans & Protocol Mgmt.

PowerPlan

Multi-ContributorDocumentation

PowerNote &PowerForms

ConnectivityTechnologies

InterfaceEngine

Open Engine

InterfaceLibraryOpenPort

Medical DeviceInterfaces

ApplicationDev. Kit

MobileSolutions

Health Economy DistributedDatabase EMPI

DistributedDatabase EMR

Access SystemsEnterprise

Master PersonIndex

RegistrationEnterprise

Registration Mgmt.

SchedulingEnterprise

Scheduling Mgmt.

Benefits Mgmt.Eligibility &

Med. Necessity

Inherent SolutionsClosed LoopMed. Process Meds Integration

HIPAACompliance

ClinicalDecisionSupport

ClinicallyDriven Revenue

Cycle

Clinically DrivenResourcePlanning

IndustrialStrength Early Maturity 2003 2004 2005 FutureKey

10 Solution Groups – 54 Solutions

Millennium Helix™

Public Health

Lab Result

Fill Out Forms by Hand

Fax to DOH

Fill out Log for HIM – HIPAA Compliance

Follow Up from DOH

Preparation of Internal IC

Reports by hand using multiple

systems

Automatic Reporting - HealthSentry

Daily Reports for Lab and IC

“Pushed” to HealthSentry

users

Public Health

HealthSentry Architecture

Daily Result Trending

2006

DATA COMPLETENESS Reportable cases (non-STD): March-Sept 2002

*Average over 6 key data fields

UNDER-REPORTING

0%

100%

200%

300%

400%

% I

nc

reas

e

0%

20%

40%

60%

80%

100%

Conventional HealthSentry

0.0

0.5

1.0

1.5

2.0

2.5

3.0

Conventional HealthSentry

TIMELINESS

% F

ield

s C

om

ple

te

*Average over all reportables

*Increased overall reporting by 96%

Da

ys

to r

ece

ive

rep

ort

HealthSentry – Proven Results

Present role• Director of Translational Medicine at Cerner

Corporation– Genomics– Biobanking– Clinical Trials– Registries– HIV Insights

• Lead group that is developing:– New software module(s)– Controlled vocabulary

Interoperability

• “You say tomato, I say tomato”

• Same meaning, different pronunciation

• Clinical example:– NA, Sodium, Sod = same meaning– EC, E. coli, Escherichia coli

Variant of like concept

• E. coli O157:H7

• E. coli O111:H11

• Bacillus

• Bacillus anthracis

• Scope:• Molecular pathology• Clinical Genetics• Infectious disease• Cytogenetics• Cell surface markers

• Current state (Jun 2008):• 12,063 Concepts• 29,355 Relationships• 761 Genes• 1,239 Nucleotide variants • 6,923 Terms 

• 5,516 Facets  

• Available from: www.clinbioinformatics.org

• Included in the NCI Metathesaurus

The Clinical Bioinformatics Ontology (CBO)

Registered Users

Registered Users - Global

Unified Report

Default- uneditable

MultiMedia Foundation (MMF)

Document Results

Protocol

Policy Issues - Genetic Testing•SACGHS

•Ordering

•Reporting

•Interpretation

•Reimbursement

•American Health Information Community (AHIC)•Standardization

•Data exchange

•Family history

Clinical Utility of Genetic Testing

• Evaluating Genomics in Practice and Prevention• Working group – generates reports• Stakeholder group – guides priorities/communication of WG• Example: CYP2D6 genotyping in non-psychotic depression treated with

SSRI

• Encourage to extend literature review model to incorporate data and other analytical methods

Pharmacogenomics• Use of genetic information in the

selection of therapy.• Sometimes used to describe the

use of Genomics to identify drug targets.

• Mutations that affect ability to metabolize drugs– Adverse Reactions

• Halothane -> Malignant Hyperthermia - RYR1

– Dosage effects• Coumadin - CYP2C9

– No benefit• Codeine - CYP2D6

Opportunities

• Internships (High School or College)

• Clinical roles– Nurse– Medtech– Physician

• Technical roles– Software engineer– Systems engineer

Options during High School

Tier 2: Velocity Academic Interns (High School)

Summer following Sophomore year in high school

3.0 cumulative GPA or above Technical career interest or previous experience Cap of 10 associates for 2008

Tier 3: Student Associate 3.0 cumulative GPA or above in High School or College

Cap of 35 associates/summer

Decisions• Seemingly small decisions can have lasting

impact

• Try to open doors and avoid closing them

• A career in science doesn’t rule out:– Business– Policy– Management

• Never say “just” – about yourself or others

• Learn what you do well and what you don’t and then accept both