Evidence-Based Medicine Integrator (EBMI)
Information last updated: Based on information supplied for 2010 Mt Hood Challenge meeting
Participated in following Mt Hood Diabetes Challenge Meetings: 2010.
Publicly accessible?: Yes. Documentation has been posted to the EBMI open-source code website,
Is the model continuing to be developed?: Not known to be under active development.
EBMI is a free, open-source medical computation framework that integrates three kinds of knowledge using stochastic discrete-event microsimulation: (1) risk estimates derived from patient data, (2) comparative-effectiveness estimates obtained from randomized clinical trials, and (3) genetic knowledge from basic research. EBMI is designed to be used with electronic medical to identify all potential treatments for every patient and to recommend next treatment steps. It also can generate or accept population data to do management, trial-planning, policy and research studies. EBMI’s direct use of local data and RCT results maximizes clinical safety. Assumptions are quickly changeable as new trials appear. The EBMI code and documentation are at
Currently, EBMI simulates all major macro- and microvascular complications of type 2 diabetes, plus associated expenditures and utility effects. Highly detailed protocols use natural dosage increments for all classes of diabetes and CVD treatments, plus user-defined classes. Event-driven protocols are also programmable.
EBMI is designed to safely integrate reliable knowledge with local circumstances, not to predict the results of treatments that have not been trialled (although the user can hypothesize effects). Therefore, the traditional concept that simulators should be validated against trials does not apply to EBMI in the usual way. It is important to demonstrate that EBMI can reproduce the relative effects of treatment trials, and also reproduce local data where it is to be used. The EBMI version used in Mt Hood 5 is derived from, and has been validated against, the Kaiser Permanente Northwest diabetes registry.
Key Publications describing the model:
Shany Blum; Moshe Vardi; Jonathan B Brown; Allen Russell; Uzi Milman; Chen Shapira; Nina S Levy; Rachel Miller-Lotan; Rabea Asleh; Andrew P Levy. Vitamin E Reduces Cardiovascular Disease in Individuals with Diabetes Mellitus and the Haptoglobin 2-2 Genotype. Pharmacogenomics. 2010;11(5):675-684.