The Center for Population Health Informatics (CPHI), a center within the Institute for Informatics (I²) at Washington University in St. Louis, is developing and studying innovative uses for data and technology at the point of care and beyond to improve population health outcomes. “I want to make sure that we are conducting projects and gaining insights into how to improve the well-being of our clinic populations, but also the broader populations in the St. Louis region and beyond,” says CPHI Director Randi Foraker, PhD, an associate professor of medicine in general medical sciences at Washington University School of Medicine.
Outreach: Creating Partnerships Across Disciplines
To accomplish its mission, the CPHI is actively engaged in cross-disciplinary collaborations. Foraker maintains a multidisciplinary lab of students and trainees from the McKelvey School of Engineering and the Brown School with whom she meets with regularly to facilitate new research opportunities and ongoing projects. “There are some very natural connections between the research that those faculty and students are doing and our expertise in the CPHI,” she says.
On the faculty side, she’s currently assisting Sean Joe, a Benjamin E. Youngdahl professor of social development in the Brown School, with a grant application to investigate using I² clinical data sources to gain insights into the journey of patients with mental health diagnoses through the healthcare system. The objective is to learn how that path is linked to important outcomes, such as hospital readmissions and community-service referrals.
Research: Using Data to Increase Awareness of Cardiovascular Disease Risk in Cancer Patients
The CPHI’s latest research project is the development and testing of AH-HA, or Automated Heart Health Assessment, a clinical decision support tool designed for use in cancer survivorship settings. The web application builds upon an earlier CPHI-developed tool known as SPHERE, or Stroke Prevention in Healthcare Delivery Environments. Like SPHERE, AH-HA is embedded in patients’ electronic health records and automatically populates with their personal medical data to create an interactive infographic of their risk for heart disease.
While SPHERE was primarily focused on modifiable cardiovascular disease risks — physical activity, diet, smoking status, blood pressure and body mass index, among others — AH-HA takes it one step further by also factoring in cancer survivorship risks, specifically the cardiotoxic treatments received by some cancer patients.
“The rationale for expanding on that project is that cancer survivors are at an elevated risk for cardiovascular disease compared to the general population,” Foraker says. “They tend to be in adverse cardiovascular health coming into their diagnosis. And some cancer patients receive cardiotoxic treatments that damage the heart. So, both of those mechanisms predispose them to developing cardiovascular issues.”
With AH-HA, Foraker and her fellow researchers are hoping to increase awareness and dialogue at the point of care. “Oftentimes, cancer patients are laser focused on their cancer and getting well following their diagnosis but aren’t necessarily thinking about the effects on the cardiovascular system,” Foraker says. “Using the app positions the oncologist to talk to the patient about their cardiovascular health. It’s a very personalized approach to delivering information at the point of care.”
AH-HA has received grant funding from the National Cancer Institute and will be implemented in oncology clinics this summer as part of a five-year randomized study done in conjunction with academic partners from the Wake Forest School of Medicine and the University of Texas Southwestern Medical Center.
In the same vein as AH-HA, the CPHI is also developing an algorithm that predicts cardiovascular disease risk among breast cancer survivors. “There’s not yet an algorithm that takes into account the traditional risk factors for cardiovascular disease and the cardiotoxic therapies that patients receive,” Foraker says. “This is an important gap because traditional cardiovascular risk algorithms underestimate risk among cancer patients.”
Analyses of the research data conducted by Foraker, Katie Zhang, a cardio-oncology fellow in the WUSM Department of Internal Medicine’s cardiovascular division, and Aixia Guo, CPHI’s postdoctoral research fellow, demonstrated that taking both the traditional cardiovascular risk factors and cardiotoxic-treatment data into account was better at predicting a breast cancer survivor’s risk of developing heart disease than considering the data independently. They recently presented on the algorithm to the American Heart Association.
“I want to make sure that we are conducting projects and gaining insights into how to improve the well-being of our clinic populations, but also the broader populations in the St. Louis region and beyond,” says CPHI Director Randi Foraker, PhD.