Unlocking Practice Patterns at Scale: A Framework for Developing Clinical Insights Using Epic's Cosmos

Real-world data from vendor-aggregated health information exchanges represent a powerful resource for retrospective clinical research. Epic's Cosmos platform, a large-scale centralized data warehouse, enables querying deidentified electronic health record data.We describe the iterative development of a generalizable clinical informatics workflow for retrospective studies using Cosmos.We applied the Plan-Do-Study-Act cycle to iteratively refine a collaborative research process using Cosmo's SlicerDicer interface, focusing on setting, team, technical preparation, and workflow.We identified multiple areas of improvement to facilitate streamlined collaborative studies. Our institutional review board confirmed Cosmos studies as nonhumans subject research. We expanded collaborations across institutions. We identified key insights for team definition across clinical, research, and skill domains. We expanded our team based on technical skills, domain expertise, and educational aims. We optimized query building and cohort construction, data analysis and validation, and communication processes. We clarified and optimized a collaborative workflow across clinical and informatics expertise.Our collaborative approach to secondary data analysis in Cosmos supports the development of meaningful clinical evidence to support high-quality, well-evidenced patient care. This study demonstrates the application of the Plan-Do-Study-Act cycle to a collaborative workflow for clinically focused secondary data analysis. Our approach allows rapid, reproducible cohort construction and analysis, is adaptable across clinical domains, and scales to multiorganizational collaboration. This approach offers a model for others seeking to develop key clinical insights via retrospective studies within the Cosmos data aggregation tool.