Found in Translation
Windber Research Institute Pioneers the Next Generation in Translational Medicine

When patients diagnosed with breast cancer or heart disease walk into the Windber Medical Center, 80 miles from Pittsburgh PA, they ask a lot of questions about choice of therapies and associated risks. Today, armed with a new take on translational medicine and powerful software built on the Oracle Database 10g, Windber clinicians can provide better answers--and more effective care.

Translational medicine has traditionally been defined as the process of taking results from a laboratory experiment and converting them into information that can be used to care for patients. Windber Research Institute (WRI), a partner of the Windber Medical Center and a pioneer in data-intensive biomedical research, is turning this system on its head.

“We focus on working with clinicians to identify the problems they see on a day-to-day basis, when the patient is sitting in the room with them, and then move the problem back to the research bench,” says Michael Liebman, Executive Director of WRI. “Now, when a researcher brings all his or her expertise and technology to bear on a research problem, the solution has an immediate use in the clinic.” The benefits of WRI’s approach are enormous: patients benefit faster from cutting edge research, and researchers get invaluable clinical data to support, clarify, and refine further research.

A Range of Data Sources

The quality and quantity of WRI’s patient data sets it apart from most other research institutes. WRI benefits from close ties with Walter Reed Army Medical Center, which collects an unusually high 600 disparate pieces of information about patients. This includes their entire life of exposure to chemicals, whether they smoke or drink alcohol, and history of obesity, to name just a few. This level of information is extremely valuable to WRI researchers. In addition, researchers have access to a huge inventory of clinical data, including tissue samples, individual patient data, genomics, proteomics, imaging data from mammographies and ultrasound, PET, CT, and MRI scans, as well as pathology images. “We’ve built a patient-centric data model that integrates all of that data and makes it available to our researchers,” says Liebman.

Researchers use the data to enhance the quality of their research in a range of fields.

“We have a lot of different disciplines looking at any given problem, such as a molecular approach, with genomics and proteomics technologies” says Liebman. “At the same time we’re looking at the clinical data. We’re looking at the socioeconomic data. We’re looking at the psychological information. We’re looking at how patients respond to a range of treatments. We’re even looking at things like how patients respond to being told that they’re high risk or low risk,” he adds.

WRI then takes this complicated data set and adds one more dimension. “We treat patients as a collection of longitudinal information,” say Liebman. “A disease is a process that takes place over time. Our patients are changing while they have the disease. It’s an important aspect to look at, but very few places are doing it,” he states. “We need to understand how patients’ aging processes will impact their responses to a therapy or their susceptibility to other diseases.”

A Single Integrated View

The challenge for WRI has been to build an IT support infrastructure that provides a "plug-and-play" informatics environment for researchers with workflow that can continually change and evolve as researchers work with a mix of clinical science, molecular science, and clinical practice.

“How do you combine that data with high throughput experimental techniques like genome mix, genetics, and proteomics,” says Jonathan Sheldon, chief scientific officer at InforSense, a pioneer in integrative analytics technology and WRI's key partner in its translational medicine initiative. “And how do you bring those technologies together with the clinical data and make the results mean something to researchers?”

Working with InforSense, WRI has adopted an approach that provides a single integrated view of its various data resources, combined with the pathology and appropriate analytical tools, so that the clinician and the molecular scientist or the epidemiologist can collaborate within a single informatics environment. “With InforSense on Oracle, the researcher can integrate these different types of data and do that in a very ad hoc, flexible way,” says Sheldon. “He or she can bring in the clinical data, merge that with the genome-expression data and carry out various analytics or modeling to look for combinations that have a clinical significance and utility,” he says. 

Once a researcher has identified a gene that, for example, suggests whether or not a patient will respond to a particular treatment, the system delivers that information back to the clinician at the medical center in the form of risk analysis algorithms.

“To make the information usable to the clinician, the InforSense solution for WRI takes complex analytical workflows, wraps them up, and deploys them as a Web portal that hides all the complexity,” says Sheldon.  In the WRI Web portal, researchers and clinicians can browse and dynamically drill down into data, choosing from hundreds of dimensions, to identify patient populations for further exploration. The identified populations can then be used as a starting point for Web-deployed workflows that enable complex analysis of experimental data. As data and analysis techniques change, new workflows can easily be published into the portal, enabling informatics staff to support a broad, disparate and evolving user community within a single technology framework. “Even though the researcher may have built the most complex workflows that uses many different kinds of data sets, the clinician can hit a few buttons and the system runs the analytics in the background,” says Sheldon. “The results are returned back into a portal that has very intuitive interface for the clinician.” 

Choosing Oracle

WRI and InforSense selected Oracle Database 10g as the engine that is powering their next-generation solution. Besides being powerful and easy to manage, the Oracle database was the clear choice for several reasons.

First, WRI has to seamlessly integrate data from diverse sources, including research institutes, hospitals, government agencies, pharmaceutical companies, healthcare providers--all with disparate IT systems. Oracle Database, certified on all major hardware and operating systems including Linux, was the logical choice. 

Just as important, WRI and InforSense needed a solution that helped ensure the security of highly sensitive medical data. By enabling in-database analytics, Oracle Database 10g minimizes movement of data in and out of the database, significantly reducing security risks. “For security and compliance reasons that was a key issue for WRI,” says Sheldon.  “They didn’t want the data going off into lots of different systems.” In addition, InforSense's in-database Oracle processing ensures that data integrity is maintained and WRI's high volume data sources (measured in terabytes) are processed efficiently.

ROI for the Research Center

As biomedical information grows exponentially more complex, from genomics to advanced body imaging, translational research is testing the limits of ordinary IT solutions. Sheldon believes enterprise software that incorporates IT best practices with best practices in the research institute will become a must. “Instead of writing custom Perl scripts to get the analysis you want, which can take hundreds of days of coding for a single study, you can install the latest software and get the same capability in as little as a couple of weeks,” says Sheldon. And unlike custom scripts, enterprise software is reusable. “Use the software to analyze a study on, say, lymphoma, then simply drop in a different disease area and the work flow would run on that data and return relevant results,” he adds.

A New Venture

With the help of InforSense informatics technologies and Oracle Database, WRI has built an IT backbone for a new kind of physician/patient decision support system based on its unique translational medicine approach.  Now WRI, a non-profit, is starting a for-profit venture to assist other medical centers in doing the same. It has already begun commercial ventures in the US and the Netherlands. In the Netherlands, WRI will work with the Dutch government, Dutch medical centers, Phillips Medical Research, and Organon Pharmaceuticals to leverage both WRI’s research methods and its vast clinical data to bring the benefits of next-generation translational medicine to the Netherlands.

Moving Forward

“Translational research is a very, very hot area,” says Sheldon. “Everybody’s talking about it, but there is very little out there that really does accomplish it. People talk about translational medicine but never speak to a clinician. WRI and InforSense have designed the system with clinicians’ needs in mind,” he emphasizes. “That’s really why the collaboration between InforSense and WRI has been such a success, and why other medical centers are taking notice.”

"InforSense workflow technology using Oracle Database enables us to build solutions that are flexible enough to support the dynamic and iterative thought processes of our scientists and our clinicians,” says Liebman. “Combined with the ability to then deploy these findings throughout our research teams, this technology enables our scientists to translate their research into real decisions that can impact patient care. We see this solution as the 'command-and-control center' for our clinicians to give patients the best possible answers and the best possible care."