Evidence map›Paper›PMID 27018265›Full record

ArticleJournal of the American Medical Informatics Association : JAMIA2016

SMART precision cancer medicine: a FHIR-based app to provide genomic information at the point of care.

Jeremy L Warner, Matthew J Rioth, Kenneth D Mandl, Joshua C Mandel, David A Kreda, Isaac S Kohane, Daniel Carbone, Ross Oreto, Lucy Wang, Shilin Zhu and 2 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of the American Medical Informatics Association : JAMIA, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 35 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
35citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

35 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Review
  3. Article
  4. Review
  5. Article
  6. Article
  7. Introducing HL7 FHIR Genomics Operations: a developer-friendly approach to genomics-EHR integration.Journal of the American Medical Informatics Association : JAMIA · 2023
    Article
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  16. Article
  17. Review
  18. Article
  19. User stories as lightweight requirements for agile clinical decision support development.Journal of the American Medical Informatics Association : JAMIA · 2019
    Article
  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Jeremy L WarnerDepartment of Medicine, Division of Hematology and Oncology, Vanderbilt University, Nashville, TN, USA Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, USA jeremy.warner@vanderbilt.edu.
Matthew J RiothDepartment of Medicine, Division of Hematology and Oncology, Vanderbilt University, Nashville, TN, USA Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, USA.
Kenneth D MandlBoston Children's Hospital Computational Health Informatics Program, Boston, MA, USA Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA.
Joshua C MandelBoston Children's Hospital Computational Health Informatics Program, Boston, MA, USA Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA.
David A KredaIndependent Consultant, New York, NY, USA.
Isaac S KohaneBoston Children's Hospital Computational Health Informatics Program, Boston, MA, USA Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA, USA Department of Pediatric Endocrinology, Boston Children's Hospital, Boston, MA, USA.
Daniel CarboneVanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA.
Ross OretoVanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA.
Lucy WangVanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA.
Shilin ZhuDepartment of Electrical Engineering and Information Science, University of Science and Technology of China, Hefei, China.
Heming YaoDepartment of Medicine, Division of Hematology and Oncology, Vanderbilt University, Nashville, TN, USA.
Gil AlterovitzBoston Children's Hospital Computational Health Informatics Program, Boston, MA, USA Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA, USA.

Funding

Tumor Immunology and Microenvironment Research ProgramP30CA068485 · NCI · VANDERBILT UNIVERSITY MEDICAL CENTER · PI STACIE B DUSETZINA · 1995 to 2026
$172.8M
Vanderbilt Biomedical Informatics Training ProgramT15LM007450 · NLM · VANDERBILT UNIVERSITY · PI Jessica S. Ancker, Bradley A. Malin · 2002 to 2026
$19.7M
Heartland Institute for Clinical and Translational ResearchUL1TR000001 · NCATS · UNIVERSITY OF KANSAS MEDICAL CENTER · PI BAROHN, RICHARD J. · 2012 to 2015
$13.0M
NCATS NIH HHS UL1 TR000001NCI NIH HHS P30 CA068485NLM NIH HHS T15 LM007450
6 · The paper itself

Abstract

backgroundPrecision cancer medicine (PCM) will require ready access to genomic data within the clinical workflow and tools to assist clinical interpretation and enable decisions. Since most electronic health record (EHR) systems do not yet provide such functionality, we developed an EHR-agnostic, clinico-genomic mobile app to demonstrate several features that will be needed for point-of-care conversations.

methodsOur prototype, called Substitutable Medical Applications and Reusable Technology (SMART)® PCM, visualizes genomic information in real time, comparing a patient's diagnosis-specific somatic gene mutations detected by PCR-based hotspot testing to a population-level set of comparable data. The initial prototype works for patient specimens with 0 or 1 detected mutation. Genomics extensions were created for the Health Level Seven® Fast Healthcare Interoperability Resources (FHIR)® standard; otherwise, the prototype is a normal SMART on FHIR app.

resultsThe PCM prototype can rapidly present a visualization that compares a patient's somatic genomic alterations against a distribution built from more than 3000 patients, along with context-specific links to external knowledge bases. Initial evaluation by oncologists provided important feedback about the prototype's strengths and weaknesses. We added several requested enhancements and successfully demonstrated the app at the inaugural American Society of Clinical Oncology Interoperability Demonstration; we have also begun to expand visualization capabilities to include cancer specimens with multiple mutations. DISCUSSION: PCM is open-source software for clinicians to present the individual patient within the population-level spectrum of cancer somatic mutations. The app can be implemented on any SMART on FHIR-enabled EHRs, and future versions of PCM should be able to evolve in parallel with external knowledge bases.

Indexed as

Mobile ApplicationsPoint-of-Care SystemsPrecision MedicineDNA, NeoplasmElectronic Health RecordsGenomeHealth Information InteroperabilityHealth Level SevenHumansMutationNeoplasmsUser-Computer InterfaceDNA, Neoplasmelectronic health recordsgenomicshealth information managementinformation sciencemobile healthneoplasms

Identifiers

PMID27018265
PMCPMC6080684

What OpenQuestion holds

Textmetadata
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.