Photo caption: Researcher Dr. Aroldo Dargél.
When it comes to improving patient care and solving medical mysteries, clinicians and researchers at The Ottawa Hospital (TOH) are reaching for the stars — or rather, the Cosmos.
Cosmos is a massive database of patient information captured by health-care organizations that have adopted Epic, a digital health information system that securely stores, organizes and provides access to patient records.
Here's just a snapshot of what Cosmos can do: With anonymized data from more than 300 million patients at their fingertips, researchers can make meaningful discoveries that advance medicine. And for clinicians, Cosmos offers a suite of point-of-care tools to support individualized patient care, including the ability to connect with other providers to collaborate on care for patients with rare diagnoses, as well as access to condition-specific growth charts to show how chronic conditions may affect a child's development.
Cosmos launched at TOH in May, followed by a fall rollout across the Atlas Alliance — a network of Eastern Ontario health-care organizations using Epic — making us the first group in Canada to go live with the platform.
“By integrating this platform into our clinical and research environments, we can both enrich the quality of care for our patients of today and accelerate the discovery of new treatments and tools that will benefit our patients of tomorrow," says Deanna Rothwell, Director of Analytics at TOH.
“This platform has the power to enable our researchers to not only better understand diseases but also to predict health outcomes, uncover health disparities and improve care," says Dr. Venkatesh Thiruganasambandamoorthy, Chief Research Information Officer at the Ottawa Hospital Research Institute (OHRI).
Cosmos Pilot Projects Focus on Lung, Kidney and Mental Health
Earlier this year, three pilot projects at TOH were selected to showcase Cosmos' capabilities and help inform the broader rollout in the fall:
Predicting Cardiac Outcomes in Patients With COPD
With the help of Cosmos, Dr. Tetyana Kendzerska and her research team are developing an algorithm to accurately predict the risk of cardiovascular disease (CVD) in patients who have been hospitalized due to a flare-up — a sudden worsening of symptoms — of chronic obstructive pulmonary disease (COPD).
Research shows that COPD flare-ups sharply elevate the risk of developing CVD and that this risk remains high for up to a year afterward. However, there are currently no validated prediction models designed to forecast short- and medium-term CVD outcomes — such as heart attack and stroke — following a COPD flare-up, reports Dr. Kendzerska.
Dr. Kendzerska and her team see an opportunity to close this gap by leveraging rich, real-world data from electronic health records to build dynamic, personalized prediction tools.
Predicting Kidney Failure and Mortality in Patients with Advanced Chronic Kidney Disease
Chronic kidney disease (CKD) affects millions of people worldwide and represents a significant burden on health-care systems. Accurate risk prediction for kidney failure and mortality in CKD patients is crucial for clinical decision-making and health-care resource allocation. While several risk prediction models exist, their application across different populations and health-care systems remains limited, explain Drs. Ran Klein and Chris McCudden.
Previously, Drs. Klein and McCudden led a research group that successfully developed and validated CKD risk prediction models using local Ottawa data. This was followed by an ongoing study that's showing promise in validating these models with data from across Ontario and Alberta. The team now aims to build on this work further by testing and validating the models with Cosmos data predominantly from the United States.
The PROBLEM Study: Advancing Cardiometabolic and Mental Health for All
In Canada, nearly 30 per cent of adults live with obesity and one in three has metabolic syndrome, costing the health-care system more than $27.6 billion each year. These risks are even greater for people living with mental health disorders, yet both conditions are often underdiagnosed and undertreated, reports Dr. Aroldo Dargél.
Led by Dr. Dargél, the PROBLEM study — Predicting Obesity & Metabolic Syndrome in Patient Care — seeks to change this by improving cardiometabolic monitoring and supporting earlier detection and treatment of risk factors, for patients with and without serious mental illness.
Safeguarding Patient Data
Patient privacy is a top priority for both TOH and Epic. Before implementing the platform, TOH conducted extensive privacy, security and legal reviews to ensure compliance with Ontario's PHIPA guidelines and Canadian health care and privacy legislation. Epic's Cosmos protects patient data by securely transmitting and storing it, omitting direct patient identifiers and not allowing data to be exported — among other safeguards.
Stargazing into the Future
Epic will be expanding Cosmos' capabilities to include genomics and artificial intelligence (AI), including generative AI, in Canada. These enhancements will unlock even deeper insights, further empowering researchers and clinicians at TOH and across the Atlas Alliance to drive evidence-based research and support individualized patient care.