EPIC SYSTEMS COSMOS

Few overdose patients are tested for fentanyl. Two doses of monkey pox vaccine are better than one. Ventilators aren't needed for some patients with severe COVID-19.

Those are among the growing number of findings from research using Cosmos, a massive database created by Verona-based Epic Systems Corp. that pools anonymous data from 210 million patients at more than 200 hospitals and other Epic clients. By using the program's vast range of information about symptoms, diagnoses and lab results, doctors and health officials are discovering new ways to address challenges such as high blood pressure, rare diseases and even human trafficking, speakers said Tuesday at Epic's annual Users Group Meeting.

When Dr. Jackie Gerhart and others at Epic analyzed data from COVID-19 patients early in the pandemic, they learned that some of those with considerably low oxygen levels didn't need ventilation.

"It was this 'aha' moment for me, that this is how real-world evidence can be used," said Gerhart, Epic's vice president for clinical informatics.

A new finding mined from Cosmos this month, that only 14% of patients who go to emergency rooms for drug overdoses are tested for fentanyl, is also instructive, Gerhart said. The figure is higher than the 5% found in a similar study a year ago, but it still shows room for improvement as communities try to track how often other opioids and drugs are laced with fentanyl — a synthetic opioid involved in many overdose deaths.

"Discovering things like that can help move how the government is going to respond," she said.

Many findings from Cosmos are published in Epic Research, an online journal Epic started in March 2020. Others are in traditional medical journals such as the New England Journal of Medicine, where a study about the vaccine for monkey pox, now known as mpox, appeared in June.

Amid an outbreak of mpox in the U.S. last year in which a relatively small number of people got one or two shots of the vaccine, Cosmos helped researchers determine the shot was effective — and even more so with two doses.

Doctors and other researchers can use Cosmos data to ask many clinical questions, Harry Freedman, who works in research informatics at Epic, told an audience of Epic users. He searched the database for Black women ages 55 to 64 who smoke and have high blood pressure, and analyzed how well top medications reduced blood pressure, strokes and heart attacks in nearly 200,000 patients.

"This is probably the largest retrospective trial that's ever been done for this cohort," Freedman said.

Look-Alikes, a program within Cosmos that started this month, allows doctors who have patients with rare or mysterious symptoms or conditions to find similar patients seen by other providers. That could help improve diagnoses and treatments for patients who often spend years trying to get help for rare diseases, said Phil Lindemann, who works on Cosmos informatics at Epic.

"We're hoping this can connect more physicians and shorten some of those rare disease odysseys that patients have to go on," Lindemann said.

Dr. Zhe Chen, who works at Lehigh Valley Hospital in Allentown, Pennsylvania, said he used Cosmos to study human trafficking, a growing concern in his community.

At his health system, only three patients had trafficking noted as a problem in their medical records. But through Cosmos, he found 100. That allowed him to learn that most were young, urban females, with the highest rates among Blacks. The analysis could help doctors screen patients for trafficking, Chen said.

"These are things you can't necessarily study in your home institution," he said.