Health informa.cs Fernando Mar*n-‐Sanchez Ins$tute for a Broadband-‐Enabled Society & Melbourne Medical School
Introduc$on • Broadband can provide many opportuni$es for the health sector: – Improving youth mental health and aged care services – Monitoring health condi$ons – Enabling shared electronic health records • Broadband technologies are revolu$onising the delivery of health care. Convergence with other technologies towards Digitally Enabled Personalized Medicine
Aging Well – Mobile and broadband technologies for ameliora.ng social isola.on in older people – Smart Homes for the Elderly – recent developments in Korea Youth Mental Health − HORYZONS: Online Recovery for Youth Onset Psychosis
Telehealth – Individual Electronic Health Records – The Telestroke Study – Hap*c Tele-‐Rehabilita/on – Teleden/stry – Virtual visits: Inves*ga*ng the acceptability of webcam consulta*ons for young adults’ sexual health – Wireless broadband monitoring of knee osteoarthri/s – Overcoming geographical barriers for community health – Interpreter mediated cogni*ve assessments using video conferencing soFware – SeeCare IPTV: Personalised Health Literacy Demonstrator – Mobile Augmented Reality – Interpreter mediated cogni/ve assessments using video conferencing soFware – High resolu*on monitoring of atmospheric pollutants to iden*fy their impact on popula*on health – Overcoming geographical barriers for community health – Using video-‐conferencing to pilot an educa*on and clinical support package for rural GPs in Mildura
Health Informatics: Towards Digitally EnabledPersonalised Medicine
Current challenges in Medicine• Need of earlier diagnosis • More personalized therapies • Risk proﬁling, disease predic$on and preven$on • Improve disease classiﬁca$on systems • Control health system costs • Clinical trials and the development of new drugs need to be more agile and eﬀec$ve. • Ci$zens could take more responsibility for the maintenance of their own health. • Shortage of health professionals
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 !!!
Enabling scientific and technological advancements• New converging areas make feasible for the ﬁrst $me the idea of an integrated digital infrastructure for medicine, reaching the ci$zen, that will make feasible the concept of personalized medicine – Nanotechnology – Biotechnology – Informa$on Technologies – Cogni$ve science
Enabling scientific and technological advancements• Broadband technologies and networks • High performance compu$ng (and A.I. systems) • Ubiquity of smartphones, tablets, … • Sensors, imaging and wearables • Personal genome sequencing, gene$c tes$ng and epigene$cs • Metagenomics and the Human Microbiome Project• Social networks and the Quan$ﬁed Self • Knowledge management on gene$c diseases and systems biology modelling
Smartphone apps• Smartphone ECG system to provide physicians and pa$ents with hospital-‐quality heart rhythm monitoring outside of the hospital se`ng
Advances in genomic technology• Benchtop Ion Proton™ Sequencer – designed to sequence the en$re human genome in a day for $1,000
Graphs of my total cholesterol (blue), my “bad” LDL cholesterol (red), and my “good” cholesterol (green) over a decade. (Larry Smarr, CalTech)
Remote pa$ent data monitoring and data collec$on Environmental sensors Genomic sensors Phenomic sensorsEnvironmental risk factors Biomarkers (DNA sequence,(pollution, radiation, toxic agents, …) proteins, gene expression, epigenetics Physiological, biochemical parameters (cholesterol, temperature, glucose, heart rate…) Integrated personal health record
Digitally enabled personalised medicine • Personalized medicine refers to the tailoring of medical treatment to groups of pa$ents with similar gene$c or molecular proﬁles. • Ultra high speed broadband networks will be required to transmit enormous volumes of data from pa$ents’ homes to health prac$$oners and vice versa in a $mely manner, and to enable the processing of this deluge of data. • Personalised medicine oﬀers enormous opportuni$es for improving preven$ve, diagnos$c and therapeu$c solu$ons à improving healthcare outcomes, reducing costs and increasing pa$ent safety.
Patient Data (sensors and imaging) Sensors Genomic Phenomic Environmental Integrated Personal EHR Health Record Module 1 Health Profile GWAS Assessment Tables (weighted factors) Modelling Risks Diagnosis Personal Health Profile CDSS Health Profile Module 2 Improvement TrialbanksNBN Risk reduction Decision matrix, protocols Follow-up Personalised Therapy Health Recommendations
Social media and biomedical and clinical research • We are witnessing a transi$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$ent who opts in. • Social media as a research tool • Clinical Research with the pa$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)
Pa$ent empowerment Current NBN-enabled Driving forces: patient empowerment,networks personalized medicine, social networksEHR – Personally Citizens are able to maintain and controlElectronic Controlled EHR their own health informationHealth RecordGene-disease Personal Citizens ask for genetic analysis of theirassociation genomics DNA through the Internet and receivestudies reports on various aspects of their healthClinical trials Crowdsourced The patient voluntarily shares information clinical trials on treatments and evolution of his/her illness with other patients
Barriers• New regulatory framework (new models of clinical trials) • New informa$cs methods to compile and interpret all the informa$on • Educa$on of pa$ents and health professionals • Ethics, data security and conﬁden$ality issues • Wide availability of clinical decision support systems at the point-‐of-‐care • New cost-‐eﬀec$veness assessment and ﬁnancial models of care • Need to prove clinical eﬀec$veness before DTC services are oﬀered.
Conclusions• The rou$ne applica$on of personalised medicine is s$ll a long way ahead, however we have now all the ingredients to make it happen.• The convergence of medicine and the digital revolu$on will produce an informa.on ecosystem that will facilitate the advent of safer and more eﬃcient preven$ve, diagnos$c and therapeu$c solu$ons. • The ci$zen will have access to her gene.c proﬁle and clinical record, and will monitor and adjust her health using next genera$on sensors and social networks to share this informa$on with peers, clinicians and researchers. Virtual pa$ent – Pa$ent avatar
Conclusions• But all of this will only be possible if we realise that it is .me for us to take responsibility for our own health. – “The Crea$ve Destruc$on of Medicine” (Topol), – “Networked individualism” (Rainie), or – “P4 Medicine” (Hood). • We prefer the term “Digitally enabled personalized medicine” and have already started research work in several areas: clinical genomics, modelling and the use of social media for biomedical research. • We believe that the synergy between Health Informa$cs and the broadband network in the context of mul$disciplinary collabora$on and innova$on oﬀered by Carlton Connect will contribute to accelerate the advent of personalised medicine.
Thank you firstname.lastname@example.org www.healthinforma$cs.unimelb.edu.au Twiqer: @ibeshbir