We have to learn to truly be a learning health system—a system that continuously learns from how it performs so that it can improve its performance.

The Journey

Lara Jehi MHCDS’20 came of age in Lebanon during the country’s long civil war. She remembers studying in her basement because it was too dangerous to go to school, and also recalls her mother’s insistence that nothing—not war, not gender, not education—should limit her ambition.

Jehi studied medicine at the American University in Beirut and spent part of her residency in an emergency clinic where patients often could not afford treatment. They might have money for a single test, and Jehi’s more seasoned colleagues had become adept at ordering the one test that would classify a patient as non-transferable, allowing the government to pick up the tab. When she later came to the Cleveland Clinic, Jehi was amazed at the resources American doctors seemed to throw even at seemingly minor medical problems, but she also was troubled by the system’s inefficiency.

The Calling

In her clinical practice as an epilepsy specialist, Jehi was struck by the paucity of good data on outcomes of brain surgeries commonly used to treat the seizure disorder. Such surgeries are expensive, highly invasive and, for Jehi’s patients, fraught with both anxiety and hope. Yet when they asked for her reassurance, she couldn’t tell them what to expect. The data simply wasn’t available until Jehi led an effort to collect it. Her team developed techniques to predict and graph how individual patients would respond to epilepsy surgery.

Her data-driven algorithms have since been used to guide clinical decision-making worldwide, but what really sticks with Jehi is the look in a patient’s eyes when she’s able to ease their fears. “I remember a patient who was very resistant to surgery, and she was resistant because she was scared,” Jehi says. “Having this toolkit was extremely helpful because I could show her and say, ‘See? These are people who are exactly like you—the same age, gender and type of epilepsy—and this is how they are doing after surgery.’”

Looking Ahead

Jehi credits MHCDS with preparing her for an expanded leadership role as the Cleveland Clinic’s Chief Research Information Officer, which she began in January 2020, just two months before the COVID-19 pandemic’s initial surge in the United States. As the Cleveland Clinic scrambled to respond, Jehi worked to make sure the data collected would be useful in the coming fight against the deadly virus.

“It was a Tuesday in mid-March, and I got the call that we were going to start drive-through testing on Friday,” she recalls. Jehi put together a team across 13 different disciplines to design and implement a data registry. It was up and running when the first patient arrived for testing three days later. The registry now contains 80,000 patients and about 400 data points per patient, supporting 143 research projects and 32 publications thus far.

The dataset helped researchers determine that certain hypertension drugs do not increase mortality in COVID patients, and that people using the natural sleep aid Melatonin were 30 percent less likely to catch the disease. When Jehi parsed the data, she noted a higher incidence of COVID in Cleveland’s minority populations. “I went to the executive team and said, ‘Look, we have more minorities catching COVID, and this is why,’” Jehi says. “We worked with the chair of primary care to programs for testing within those communities. We prioritized them with our monitoring, and we reversed that trend.”

“We fixed it,” Jehi says. “That's an example of using data to help people.”