One of the biggest efforts coming out of Epic recently and one of the things Judy Faulkner, Founder of Epic, is most excited about is their Epic Health Research Network. One of the major items that has come from the COVID-19 crisis, Epic and Judy decided that it would take too long to get the information they had available published in a journal. Instead of waiting, they decided to start publishing their data and findings to the Epic Health Research Network. As Judy said, “COVID couldn’t wait months for the respected journals to publish the data.”
In a recent interview, Judy shared that they have 100-200 million patients right now, but no doubt this will continue to grow and has likely already grown. One of the early findings they shared was that kids with asthma got COVID worse than those without. Although, that doesn’t seem to apply to older patients with asthma. While it’s understandable that a finding like this might not be journal ready, in a pandemic where things are moving so quickly and no one has information on it, this information is better than flying blind.
We’ve heard many calls for a new model of publishing for a long time. Everyone has known that the current medical journal model took forever and often discouraged people from publishing. However, there’s also a reason that medical journal publishing takes so long. They want to verify the findings and have third party experts examine the research to make sure the data matches the results that are being presented. This is likely why no one has tried it earlier. Although, almost everyone has recognized that the process is causing us to miss opportunities to get data out sooner.
Given this history, Judy and Epic should be applauded for what they’re doing with the Epic Health Research Network. The certainly don’t claim to be a peer reviewed journal. In fact they state the following:
EHRN is a journal designed for rapid sharing of knowledge to help solve medical problems. We make this information available with internal peer review, but without third-party peer review, to expedite sharing. It’s important that good data be available sooner, rather than perfect data be available too late. Submissions are welcome.
You can see the list of people on the EHRN Team. Plus, they’re often partnering with the leading medical organizations when they publish various findings. However, it’s important to note that they do an internal peer review, but no third party peer review. It will be interesting to see how well their findings will be accepted and incorporated by the healthcare community. Not to mention if and how they’ll continue to evolve their processes.
A great example of something they published recently was observational data on which therapeutics were being used for COVID-19 inpatient treatment. Here’s the chart they shared on which therapeutics have been used to treat COVID-19.
If you look at the commentary provided on the link above, they note the drop in Hydroxychloroquine early on by clinicians who questioned it’s efficacy after the initial pre-publication in France. Plus, Azithromycin was used a lot at the beginning, but dropped to a lower level as well. Although, it never dropped much below 30% possibly due to its indication for community acquired pneumonia or its known immunomodulatory effects.
It also shows Remdesivir and Dexamethasone leading the way after their pre-publication announcements from their respective trials and the issuance of EUAs. Although, they also note dexamethasone’s wide availability as a generic drug for likely fueling its increased use. They also note the increase in convalescent plasma, but noted that they’re not sure of whether its increased use is because of availability or some other factor. I love that they link to the journal articles where applicable.
It’s not hard to see how this observational evidence based medicine is useful and interesting. Ironically, I first saw something like this 5-10 years ago when Modernizing Medicine showed me a demo of their product. Because of the way they do EHR documentation, they empowered their users to look across the whole Modernizing Medicine network of doctors to compare how patients were being treated based on a specific diagnosis. It’s nice that Epic is starting to do the same. Although, it’s worth pointing out that Modernizing Medicine’s implementation provided this real time to any doctor. They didn’t just publish a few examples.
In other less clinical areas, Epic has also published a look at overall admissions data from pre-pandemic and post-pandemic together with their partners as the Kaiser Family Foundation. This data looks at how hospitals are likely going to be impacted financially from the drop in admissions. Plus, it looks across those admissions by gender, region, and age. Here’s a look at just one chart showing overall admissions.
We’ve all known there was so much potential waiting us in the data stored in EHRs. It’s great to see Epic finally doing more to help provide insights from this data. Hopefully, this is just the start of doing so much more.