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Lecture fjms ballarat 2012

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Presentation given at Ballarat University by Prof Fernando Martin-Sanchez on 13 June 2012

Presentation given at Ballarat University by Prof Fernando Martin-Sanchez on 13 June 2012

Published in: Health & Medicine

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  • 1. Health and Biomedical informatics: information processing for preventative Medicine Colloquia Series at University of Ballarat June 13, 2012 Fernando J. Martin-Sanchez Professor and Chair of Health Informatics Melbourne Medical School Faculty of Medicine, Dentistry & Health Sciences & Adjunct Professor, School of EngineeringDirector, IBES Health and Biomedical Informatics Research Lab.
  • 2. Outline•  Current challenges in Medicine•  The Vision: HebyEq•  Opportunities from Health Informatics and Technology•  Personalised Medicine•  Participatory Health•  Self-omics•  The central role of Informatics•  HBIR @ UoM
  • 3. Currentchallenges in medicine
  • 4. Main problems•  Demographic change – Aging population.•  Increasing number of patients with chronic diseases•  Unhealthy life habits (sedentary, fast food, alcohol, tobacco)•  Rapidly increasing cost of medical technology•  Climate change – rise of infectious disease•  Workforce shortage àUnsustainability of the US National Center for Disease Control Healthcare system?
  • 5. Current challenges in Medicine•  Need of earlier diagnosis•  More personalized therapies Personalised•  Clinical trials and the development of new medicine drugs need to be faster and more effective•  Improve disease classification systems Preventative•  Risk profiling, disease prediction and medicine prevention•  Control health system costs Participatory•  Citizens should take more responsibility for medicine the maintenance of their own health.àEmphasis on prevention, not cure
  • 6. The Vision: Health by equation verse in which Prospero calls Caliban: A devil, a born devil, on whose natureNurture can never stick; on whom my pains, Humanely taken, all, all lost, quite lost; William Shakespeare, The Tempest, 1610
  • 7. G*E=P•  Disease phenotypes arise from complex interactions among individual genetic information and environment (way of life, risk factors, external agents)
  • 8. Activation factors Way of life Environmental Environmental exposure risk Mutagen agents Disease risk Disease Mutations and GeneticInheritance polymorphisms risk
  • 9. Visions of the future for the field of BMI•  Integrated environments for assessing and modeling the relative contribution of factors (genetic, environmental, phenotypic) that confer an individual a relative risk of developing a disease•  Models coupled to information systems to contextualize the patient molecular information and clinical decision making support systems at the Point of Care for personalized care
  • 10. •  Prevention is better than a cure; how to prevent is the question.•  What if it was possible to calculate accurately a person s medical strengths and weaknesses as a combination of genetic and environmental factors?•  This will illustrate how informatics and technology will play a major role in a new wave of preventative medicine, by estimating risk factors as a personalised profile and supporting personalized clinical decision making.
  • 11. Health by Equation - Rationale•  Research and Technology development in genetic analysis, informatics, clinical devices•  New data and knowledge: ü Availability of genomic personal information – Characterising individual genetic variation – Human Genome ü Characterising human phenotypes, including disease – Human Phenome ü Knowledge about action mechanisms of environmental factors (toxic agents, drugs, food, …) – Envirome or Exposome
  • 12. Background•  Well-being is not only the absence of disease. It is also related with the risk of future problems.•  Future emphasis on understanding health protecting factors (Healthome) instead of only causes of disease (Diseasome).
  • 13. The Equation Health Profile•  The different genetic and environmental factors, will be weighted in terms of their contribution to health maintenance or loss.•  The ratio between positive and negative factors yields a Health Profile that could be informative of the current health status of an individual and even predictive of future health problems.
  • 14. Life-long (longitudinal) records Health = Profile f( Healthome Diseasome )HealthProfile
  • 15. HeByEq•  Health by Equation is an informatics system for the prevention of diseases and the maintenance of health.•  It can be readily accessed and used by professionals around the world.•  By using its tables, decision matrices and protocols, doctors can evaluate genetic, clinical, and environmental data for a patient.•  They can then offer the patient recommendations for treatment and disease prevention.•  These recommendations are comprehensive, individualised and safe, and are based on the patient s health status and risk profile.
  • 16. Opportunities from Health Informatics and technology
  • 17. The Digitalization of Medicine•  Digital  revolu-on  in  other  domains  (banking,  insurance,   leisure,  government,…)  •  The  incorpora-on  of  digital  systems  in  healthcare  is  lagging   behind  other  sectors:   –  Reasons:  complexity,  privacy,  volume  of  data,  lack  of  demand   –  It  has  greatly  affected  healthcare  at  the  hospital  or  research   centre  level.     –  The  digital  revolu-on  has  not  yet  reached  medicine,  at  the   pa-ent/ci-zen  level     • BUT  THIS  IS  STARTING  TO  HAPPEN  NOW  !!!  
  • 18. Enabling science and technology•  Broadband  technologies  and  networks  •  High  performance  compu-ng  (and  A.I.  systems)  •  Ubiquity  of  smartphones,  tablets,  and  apps  •  Sensors,  imaging  and  wearables  •  Personal  genome  sequencing,  gene-c  tes-ng  and   epigene-cs  •  Metagenomics  and  the  Human  Microbiome  Project•  Social  networks,  games  and  the  Quan-fied  Self  •  Knowledge  on  gene-c  diseases  and    gene-c   varia-on  •  Systems  biology  modelling  
  • 19. Measuring the genome•  Human Genome Project Maps of genetic variation (Human Variome) DNA Sequencer – designed to sequence the entire human genome in a day for $1,000 Benchtop  Ion  Proton™  
  • 20. Measuring the phenome (physiology, …)
  • 21. Measuring the Exposome•  Only 3% spent on prevention (USA), 2/3 of cancers are preventable deaths (CDC) (NCI) (American Cancer Society), 72% of all chronic diseases are preventable•  Compilation of exposures experienced over an individual lifetime (Christopher Wild, 2005)•  OUTSIDE / INSIDE – Absorbed -- Industrial chemicals, combustion emissions, radiation, response to stress, physical activity levels – heat/cold, noise, food, microbiome•  Evaluating Personal Exposures •  Phones: Light meters, GPS, Accelerometer •  Senspod Monitor (Ozone, carbon monoxide, CO2, NO, Noise and UV) •  Arizona State University – Petroleum derived hydrocarbons (Benzene, Toluene)
  • 22. Sensors for data collection Environmental sensors Genomic sensors Phenomic sensorsEnvironmental risk factors Biomarkers (DNA sequence,(pollution, radiation, toxic agents, …) proteins, gene expression, epigenetics Physiological, biochemical parameters (cholesterol, temperature, glucose, heart rate…) Integrated personal health record
  • 23. National Broadband Network
  • 24. High-­‐capacity  Broadband  technologies  and  networks  •  The  availability  of  ultra-­‐high-­‐speed,   high-­‐capacity,  ubiquitous,  ‘always-­‐on’   broadband  connec-vity  will  contribute   to  the  development  of  an  integrated   digital  infrastructure  for  medicine,   reaching  the  ci-zen,  that  will  make   feasible  the  concepts  of  personalized   medicine  and  par-cipatory  health.  
  • 25. Personalized medicine
  • 26. Definition•  Personalized medicine uses an individuals genetic (and molecular) profile and individual information about environmental exposures to guide decisions made in regard to (risk profiling) and the prevention, diagnosis, and treatment of disease. (Adapted from F. Collins, Director NIH)
  • 27. Clinical applications of genomic information• Pharmacogenetics – Personalized Medicine Coalition - 72 drugs in 2011• Cystic fibrosis – successful clinical trial for a specific mutation• Identification of metabolic diseases
  • 28. Personal Genomics
  • 29. Participatory Health
  • 30. Participatory Health• •  From Web 1.0 – Use of internet to find health information to Web 2.0 – web- based communities and services. NHS Social Care Model (NHS)•  A survey of 1,060 U.S. adults by the PwC Health Research Institute found that a third of respondents are gravitating toward social media as a place for discussions of health care.•  Pew Internet study – 27% of US internet users had tracked health data online•  Care management, disease management, supported self-care, promoting better health à Patients empowered, informed and involved in decision making, prevention and learning
  • 31. DIY EHR- The Cathedral and the Bazaar
  • 32. Social media & PCEHR•  Quality = patients reviewing their own records - Shared Medical Records•  MyHealth@Vanderbilt – information on prescriptions is shared. Knowledge management team – consumers will have convenient e-access to their medical records and genetic profiles to social media & games•  Facebook • Lifeline – support line for suicide • Organ donor status • Blood type – app will contact the user
  • 33. Social  media  as  a  research  tool  •  We  are  witnessing  a  transi-on  from  research  informa-on  systems  centralized   at  hospitals  and  clinical  research  centres  to  distributed  systems  that  reach  out   to  the  residence  of  any  ci-zen  /  pa-ent  who  opts  in.    •  Clinical  Research  with  the  pa-ents,  not  on  the  pa-ents  •  Examples   –  23andMe  –  Parkinson’s  Disease  –  PLoS  Gene-cs,  2  new  gene-c   associa-ons   –  Pa-entsLikeMe  –  Nature  Biotech.  Self-­‐reported  data  from  600  pa-ents   on  the  use  of  lithium  for  Amyotrophic  Lateral  Sclerosis  (ALS)  
  • 34. Crowdsourced clinical trials•  DIY science, Crowdsourced Health Research Studies, Citizen science, Amateur Scientist, Self-Experimentation•  Patients Like Me – 125.000 members. 1000 condition-based communities –25 Papers published in PNAS, Nat Biotech, JMIR, …•  23andme – 23 and we –•  Acor, RevolutionHealth, Curetogether, Genomera, Althea Health self tracking devices Social web games Participatory Health mobile Internet of things sensors PCEHR
  • 35. NBN and patient empowermentCurrent NBN-enabled Driving forces: patient empowerment,networks personalized medicine, social networksEHR Personally Citizens are able to maintain and control Controlled EHR their own health informationGene-disease Personal Citizens ask for genetic analysis of theirassociation genomics DNA through the Internet and receivestudies reports on various aspects of their healthClinical trials Crowdsourced The patient voluntarily shares information clinical trials on treatments and evolution of his/her illness with other patients
  • 36. Social media strategy•  “The democratization of information through social media is shaping clinical encounters and the patient-provider relationship (Wen-ying Sylvia Chou, NCI)•  Many health care organizations are reshaping their social media strategy from marketing to engage patients, interact with them and even provide services at lower cost.•  “Participatory Health Research is helping to expand the conceptual scope of medicine from the traditional focus on disease cure to the personalised preventative medicine of the future” (Melanie Swan)•  Be careful! – terms for use of social media.
  • 37. Self-omics
  • 38. •  Self tracking / self quantifying / self monitoring•  The belief that gathering and analysing data can help them improve their lives!•  QS’ers doubling every year.– 5524 members, 42 meetup groups•  Larry Smarr– 10years quantifying his body –  Weight – physical activity: calories burnt (body media) – Food intake – Sleep (Zeo) – blood chemicals (60 Markers) – cholesterol/triglycerides / Apo B / Ω – 6, Ω – 3/ C-reactive protein - Ultrasound – (plaque in arteries) – stool test – colonoscopy – DNA – Microbiome•  Fitbit – Sleep – Movement•  +9000 health apps, each person connected to 140 devices, 9 billion of connected devices now, 24 billion by 2020•  NODE Sensor Environment
  • 39. Self-genomics - Clinical annotation of individual genomes •  Prof. Quake - Stanford - - Nature genetics paper - $50.000, 1 week, Helicos. Stanford team - •  Clinical annotation of genome from “patient Zero” –  Drug metabolism –  Rare genetic variants - rare diseases –  Common genetic variants - Risk of complex diseasesAshley et al. The Lancet, Volume 375, Issue 9725, Pages 1525 - 1535, 1 May 2010
  • 40. First personal longitudinal OMICS profiling exercise•  Combined analysis of genomic, transcriptomic, proteomic, metabolomic and immunological profiles from a single individual (one of the authors- Prof. Michael Snyder), over a 14 month period. More than 3 billion measurements.•  He contracted two mild viral infections in the data-gathering period, which left their molecular signature in the analyses.•  During one of these infections, his blood glucose levels began to approach those of a diabetes sufferer. After changing his diet and exercise habits, glucose level returned to normal.•  This study shows that diseases are a product of an individual’s genetic profile as well as interaction with the environment and that disease can be treated based on molecular information. (Chen et al, Cell 148, 1293-1307 March 16 2012 )
  • 41. Personal Quantified Smartphones Sensors omics Self & apps Selfomics (Personal molecular profiles, life habits, physiological measures, environmental exposure) Social media & networks Big data (Cloud) Personalized Preventative Participatory Medicine Medicine Health
  • 42. The central role of informatics
  • 43. Health and Biomedical Informatics•  Informatics is the science of information•  Information is data plus meaning•  Biomedical informatics is the science of information in the context of biomedicine.•  Informaticians study information (data + meaning).•  Thus, HBI practitioners must understand the context or domain (biomedicine).•  Health Informatics – use of information, often aided by technology, to improve individual health, healthcare, public health and biomedical research 4
  • 44. Adapted from: Stead et al. 2011, Acad. Med.
  • 45. “A man in his late 80s with congestive heart failure, failing kidneys, weight and appetite loss, declining cognitive ability and the need for extensive assistance has a 69 percent chance ofHierarchical Association dying within sixRule Model months”.
  • 46. Role of informatics - New taxonomy of diseasesStratification of disease – ICD 11 – US Nat Academy – Towards Precision MedicineNew taxonomy based on human molecular biologyskin, colon, parathyroid – BRAF MutationMD Anderson CC – Breast, Ovarian, Uterine, Cervical – PIK3CA Mutation trial
  • 47. Role of informatics - Network and systemsmedicine
  • 48. Role of informatics - Measuring the exposome Environment-Wide Association Study on Type 2 Diabetes Mellitus 266 environmental Factors Future: combined GWAS-EWAS? (Patel et al. 2010 PloS One)
  • 49. HBIR @ UoM
  • 50. Conclusions•  The routine application of personalised medicine is still a long way ahead, however we have now all the ingredients to make it happen.•  The convergence of medicine and the digital revolution will produce an information ecosystem that will facilitate the advent of safer and more efficient preventive, diagnostic and therapeutic solutions.•  The citizen will have access to her genetic profile and clinical record, and will monitor and adjust her health using next generation sensors and social networks to share this information with peers, clinicians and researchers.•  But  all  of  this  will  only  be  possible  if  we  realise  that  it  is  9me  for  us   to  take  responsibility  for  our  own  health.    
  • 51. Thank you for your attention!© Copyright The University of Melbourne 2011

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