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Founded Sutter Research, Development, and Dissemination with four major areas of focus: Digital Health, Advanced Analytics, Precision Medicine, Health Services Research. DIGITAL HEALTH: Led development of point of care digital applications designed to make it easier for providers to get more work and higher quality work done with less effort. We integrated use of patient reported data for real-time use in encounters, along with EHR and other data to improve efficiency and quality of care.MACHINE LEARNING with EHR data: lead a multi-site team using RNN and other models to predict future events (e.g., heart failure diagnosis, need for palliative care), to segment patients into homogeneous subgroups based on disease burden and need for care, and to model activity using log data. MASS CUSTOMIZED CARE: Pioneered an integrated population health management and point of care services model with a specific focus on primary care management of cardio-metabolic health. The care model recognized efficiency and quality gains in health care by combining sophisticated methods of patient segmentation, segment specific care models, and scalable point of care digital solutions that made it easier to deliver guideline-based care BIOBANKING: Led the development, funding, and implementation of a system-wide biobank and a largely automated pipeline process from consenting to bio-banking, with a pragmatic focus on improving treatment decision making and diagnostics for high priority progressive diseases in oncology, neurology, and cardiology.

Founded the Geisinger Center for Health Research, the R&D unit for Geisinger Health System organized with four areas of focus: health services research, digital health, precision medicine, and advanced analytics Pioneered the R&D model for health care delivery with the launch and leadership of the Center for Health Research. The Center focused on directly influenced care and supported Geisinger’s nationally-recognized care models, including Proven Care, Medical Home, and Diabetes Bundle. Led work on the value created from these programs in reducing mortality and cost of care. Pioneered digital health R&D work years before others were thinking about how such solutions could change the delivery of healthcare. With industry and federal funding, our team invented novel encounter-based software applications that interfaced with Epic EHR. This work was far ahead of the market in understanding how to integrate patient reported outcomes and other information into the clinical encounter and to make it easier for doctors and nurses to deliver higher quality care with less effort. Designed and co-lead the implementation of Geisinger’s biobank and biobanking infrastructure, one of the earliest such efforts within health systems that combined EHR and genomics and -omics data. This early work laid the foundation for the Geisinger-Regeneron collaboration.Pioneered the application of machine learning to longitudinal EHR data to detect pre-diagnostic heart failure 12 to 24 months before actual diagnosis and completed parallel work to identify biological mediators of HF in the pre-diagnostic period, by combining predictive models and leveraging Geisinger’s biobanking infrastructure.

Pioneered methods to quantify the work impact of health problems and measure presenteeism and absenteeism from specific health problemsFounded the Center for Health Research. The Center focused on directly on improving care and supported Geisinger’s care models, including Proven Care, Medical Home, and Diabetes Bundle. Led work on the value created from these programs in reducing mortality and cost of care. Pioneered digital health R&D work years before others were thinking about how such solutions could change the delivery of healthcare. My team invented novel encounter-based software applications that interfaced with Epic EHR. This work was far ahead of the market in understanding how to integrate patient reported outcomes and other information into the clinical encounter.Designed and co-lead the implementation of Geisinger’s biobank, one of the earliest such efforts within health systems. This work laid the foundation for the Geisinger-Regeneron collaboration.Pioneered use of machine learning with EHR data to detect pre-diagnostic heart failure 12 to 24 months before actual diagnosis and completed parallel work to identify biological mediators of HF in the pre-diagnostic period, by combining predictive models and leveraging Geisinger’s biobanking infrastructure.Created the American Productivity Audit Database of the US workforce to measure presenteeism and absenteeism and attribution to health problems. The database revealed the economic and individual impact of illnesses, the substantial costs of lost productivity from common illnesses, and the recognition that so called indirect costs were severely underestimated if only absence time is considered.Expanded the paradigm for understanding migraine as a progressive disease that has parallels to traditional chronic diseases. Developed methods to simplify estimating incidence, remission, and progression of chronic episodic diseases to better understand mediators of disease progression and remission.

Founded IMR with a novel approach to substantially reduce the time required to complete Phase III RCTs. Reduced time to enrollment by as much as 66% using a combination of neighborhood clinics, random digital dialing in local neighborhoods, and phone interview diagnostics for health problems of interest. The method was particularly useful for phase III OTC trials, where a population based sample (i.e., versus a clinic sample) was preferable. Led the design and implementation of population-based phase III clinical trials work that supported a migraine indication for Excedrin and for other OTC pain medicationsPioneered work that established migraine as a progressive disease, revealing the substantial gaps in care for management and prevention of persistence and progression, and that provided patients and physicians with tools to improve management.Led the sale of IMR to AdvancePCS in 1998.

Established a neuro-epidemiology research team focused on three distinct areas of work (migraine, head injury, adult lead exposure), supported by five R01s and foundation and industry support ($18M+ in funding) and more than 50 related publications. Specific accomplishments include but were not limited to:• Completed foundational work on the epidemiology of migraine, revealing its high prevalence and functional impact and the gaps in healthcare to mitigate disease impact. • Led a six-city, ten-year longitudinal study of neurologic and cognitive impact of amateur boxing with 10-years of funding from the US Olympic Foundation and the NIH. The study influenced the International Olympic Committee’s decision to retain amateur boxing as a sport. • Co-developed and patented one of the first devices to measure head acceleration in humans that later influenced the creation of such devices for monitoring head acceleration in sports.• Completed foundational work demonstrating the longitudinal impact of organic and inorganic lead on adult brain function and structures.