Cohort Profile: Swiss BioRef: The building blocks of a nationwide IT infrastructure in Switzerland for generating precise reference intervals

Abstract

Purpose: Swiss BioRef is a nation-wide multicenter infrastructure project, the aim of which is to become a sustainable framework for the estimation and assessment of patient-group-specific reference intervals in laboratory medicine and beyond. In this unprecedented effort, nation-wide multidimensional data from multiple clinical laboratory databases has been combined under the common interoperable semantic framework of the Swiss Personalized Health Network (SPHN) initiative. The consolidated effort enables creating extremely detailed patient group-specific queries via intuitive web applications, allowing the generation of individualised, covariate adjusted reference intervals on-the-fly. Participants: The project is a collaborative effort of four major hospitals in Switzerland, the University Hospital Bern (Inselspital, Insel), University Hospital Lausanne (CHUV), Swiss Spinal Cord Injury Cohort (SwiSCI) and the University Children's Hospital Zurich (KiSpi), and two academic groups in Bern and in Lausanne. Findings to date: Within the infrastructure we deployed, the laboratory data from four major hospitals (approximately 9 million measurements from 250'000 patients) is made available to two conceptually different web applications (one centralised and statistically detailed, one decentralised using distributed computing). They enable the inference of reference intervals for more than 40 blood test variables from clinical chemistry, hematology, point-of-care-testing and coagulation testing, with various patient factors (such as age, sex and a combination of ICD-10 defined diagnoses) and analytical factors (such as type or unique identifiers) that can be used to generate precise reference intervals for the respective groups. Future plans: Now that all required basic infrastructure elements for Swiss BioRef are deployed, we are evaluating inter-cohort transferability of semantic standards, change tracking in merged databases and biological variation of the blood test variables, in order to generate precise reference intervals. While adjusting the developed web-interfaces to suit the needs of the various end-users, we additionally plan to onboard new national and international partners.