GeneRAlizable Sepsis Phenotyping (GRASP) using Electronic Health Records and Continuous Monitoring Sensors

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Abstract Sepsis, a heterogeneous syndrome characterized by whole-body inflammation caused by the body's response to an infection, is the most expensive and deadly condition treated in hospitals, with over 270,000 cases of sepsis-related deaths in the U.S. alone. Untreated sepsis may result in dilated and leaky blood vessels and severe hypotension requiring vasoactive medications (aka septic shock), and eventual injury to kidneys, lungs, and liver (aka organ injury) with mortality rates in excess of 40%. Successful prevention and management of sepsis, septic shock, and organ injury rely on the ability of clinicians to anticipate and estimate the risk, and administer the right life-saving treatments (e.g., antibiotics, fluids and vasopressors) at the right time. In recent years, data-driven modeling has been shown to enable early prediction of sepsis and to reveal clusters (or phenotypes) of sepsis, which may help with personalizing therapeutic interventions. However, crossing the translational chasm between clinical research and improving patient care also requires addressing 1) `data deserts' at different levels of care through better data integration, smarter lab ordering, and utilization of continuous monitoring wearable sensors; 2) interoperability and portability of clinical data and analytics; 3) principled dissemination and implementation studies; and 4) education of the next generation of caregivers to effectively utilize advanced analytical tools. The proposed research program builds upon PI's K01 early career development award focused on multicenter development and validation of sepsis predictive analytic algorithms (including hourly EHR data spanning ED and inpatient encounters from over 500,000 hospitalized patients across five district healthcare systems). Drawing insights from recent advances in domain adaptation and multi-task learning (sub-fields of machine learning), this project aims to discover generalizable dynamic phenotypes that are directly relevant to the prediction and management of sepsis, septic shock, and downstream organ injury. We propose to augment EHR-based analytics with high-resolution data from bedside devices (e.g., monitors, ventilators, dialysis, and IV pumps) and wearables (e.g., continuous blood pressure and lactate sensors) to address existing gaps in monitoring. Additionally, this program aims at advancing FHIR (Fast Healthcare Interoperability Resources) and OMOP (Observational Medical Outcomes Partnership) interoperability standards through the implementation of specific resources for high-resolution data sources. Finally, this research program will be conducted in close collaboration with our dissemination and implementation and hospital quality improvement teams to ensure early assessment of usability, barriers to implementation, and effective education to maximize the potential for clinical impact.