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VPH in Future Healthcare. Where Will We Be in 10 Years from Now?


VPH in Future Healthcare. Where Will We Be in 10 Years from Now?. Frangi A. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)

VPH in Future Healthcare. Where Will We Be in 10 Years from Now?. Frangi A. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)

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  • 1. VPH in future healthcare where will we be in 10 years from now? World of Health IT Barcelona, March 15-18th 2010 Alejandro F. Frangi, PhD Center for Computational Imaging & Simulation Technologies in Biomedicine Universitat Pompeu Fabra, Barcelona, Spain Networking Center on Biomedical Research – Bioengineering, Biomaterials and Nanomedicine Institució Catalana de Recerca i Estudis Avançats
  • 2. Outline  Context & Current Trends  Glimpses at a Plausible Routine Future  Discussion & Conclusions 2
  • 4. Current healthcare: Why a change? The need for change defies simple solutions, as illustrated by citizens’ dissatisfaction levels! • Invest more money? • Public vs. private systems? Redefining value – From “sick care” to healthcare • from reactive to proactive • patient as an object or an actor? 4
  • 5. Medical Product Development: why a change?  R&D expenditure by pharmaceutical industries has dramatically increased  The number of successful drugs reaching the commercialization phase has however stagnated  Critical Path is mostly focused in the clinical phases increasingly involving expensive large-scale multi-centric studies 5
  • 6. Healthcare trends for the future? > A patient-centric and care-cycle perspective  The hospital/healthcare of tomorrow will have as key characteristics  Patient-centric design: for personalized services and ambient experience  Individualized risk assessment: based on all relevant information (incl. demographic, genotype, phenotype, lifestyle)  Clinical work-flows: focused on Care Cycles (and care pathways), not on organizational Departments  Treatment strategies: minimally invasive and image-guided procedures  Converging medical technologies: impacting prevention, diagnosis & treatment  Federation of information systems: fully digital and connected to the clinician, the hospital, the health insurers, the government and the home 6
  • 7. The patient’s journey through a disease > care cycles Verbeek XAAM and Lord WP (2007), The care cycle: an overview, Medica Mundi, 2007;51(2):40-47. 7
  • 8. Converging medical technologies > are transforming healthcare 8
  • 9. Information & communication systems > Patient-centric ICT  Convergence of sensors, digital communications and interfaces HeartCycle Concept descriptions and Overview on technical specifications and used technologies, Deliverable 4B. 9
  • 10. Connecting for Health: regional data integration  Digital archiving and connectivity, and seamless access to population data derived from regional clinical records 10
  • 11. Secondary use of EHRs or digital graves?  From information acquisition & structuring to Information access and enrichment  Substantial ethical and privacy issues involved on this model of data use! Normalisation Knowledge De-identification Discovery Application Suites: Patient Record Information Information access @neuLink - Genetic Data Clinical acquisition @neuFuse - Imaging Data Information and enrichment @neuRisk - Clinical Data & structuring System @neuEndo Query Clinical Reference Patient Denormalisation Record Re-identification Information Model (CRIM) 11
  • 12. Virtual Physiological Human (VPH) or the Digital Me  A European Network of Excellence operated by 12 core EU institutions “help support and progress 13 Core Partners European research in 4 UK (UCL, UOXF, UNOTT, USFD) biomedical modeling and 3 France (CNRS, INRIA, ERCIM) simulation of the human 2 Spain (UPF, IMIM) body.This will improve our 1 Germany (EMBL [EBI]) 1 Sweden (KI) ability to predict, 1 Belgium (ULB) diagnose and treat 1 New Zealand (UOA) disease, and have a dramatic impact on the future of healthcare, the pharmaceutical and medical device Associate / General Members industries.” 19 Candidate General Members 3 Candidate Associate Members (organisations) 5 Candidate Associate Members (industry) 9 Associate Projects … and growing 12
  • 13. VPH- I FP7 projects Industry Parallel VPH projects Grid access CA CV/ Atheroschlerosis Liver surgery IP STREP Breast cancer/ Heart/ LVD surgery diagnosis STREP STREP Osteoporosis Oral cancer/ BM IP D&T STREP Cancer Networking STREP Heart /CV NoE disease STREP Vascular/ AVF & Liver cancer/RFA haemodialysis STREP therapy STREP Heart /CV disease STREP Alzheimer's/ BM & diagnosis STREP Other Security and Privacy in VPH CA Clinics
  • 15. Looking ahead 10 years from now? > Glimpses of a plausible routine future?  We are seeing already the future in some of the current R&D projects  Still substantial acceptance, penetration, consolidation to be achieved  The challenge: demonstrating the anticipated clinical value  Some glimpses follow based on @neurIST… 15
  • 16. Cerebral aneurysm management > The @neurIST “template project”  Unruptured intracranial aneurysms are increasingly diagnosed due to modern imaging techniques  It is more and more important to develop holistic and sound approaches to patient management.   Two clinical questions Management of unruptured aneurysms is controversial  decision making is currently based mainly on aneurysm size and location mainly  At-risk individuals/patient selection? (ISUIA). D.O. Optimal treatment planning? Wiebers Unruptured intracranial aneurysms: natural history and clinical management. Update on the international study of unruptured intracranial aneurysms. Neuroimaging Clin N Am. 2006 Aug;16(3):383-90  There is evidence that genetic predisposition may be involved in the natural  VPH as a new perspective for history of aneurysms. More principled disease understanding and phenotyping, Krischek Inoue I. The genetics of intracranial aneurysms. J Hum Genet. 2006;51(7):587-94. B,  Development of novel diagnostic and prognostic  Currently endovascular treatment is favored over surgical treatment for many biomarkers, and aneurysms (ISAT)  both treatments are risky, costly and dotreatment planning and guidance  Computational tools for not always prevent recurrence. van Rooij WJ, Sluzewski M. Procedural morbidity and mortality of elective coil treatment of unruptured intracranial aneurysms. AJNR Am J Neuroradiol. 2006 Sep;27(8):1678-80 Molyneux A. Ruptured intracranial aneurysms - clinical aspects of subarachnoid hemorrhage management and the International Subarachnoid Aneurysm Trial. Neuroimaging Clin N Am. 2006 Aug;16(3):391-6  There is a need to support a new generation of endovascular devices treating the cause rather than symptoms of the disease 16
  • 17. Cerebral aneurysm management > Natural history of complex diseases Ruptured Prevalence 0.2-1.0%/yr Initiation 1-5% F>M Mortality  Growth 33% vasospasm clotting ISAT (Oxford) Etiology Treat! Prevention, Diagnosis Coil vs clip follow-up Treat? ? Morbidity  Unruptured [99% silent] 33% Degenerative ISUIA (Mayo) Normal size/location Prevention Treatment 33% 17
  • 18. Cerebral aneurysm management > Gathering evidence across Europe PACS Descriptive Data PACS @neuQuest ERGO IPCI Representative Data PACS Bonn NHR ISAT PACS eRadiology Archives Conservation of samples PACS PACS Bio Bank PACS @neurIST BioIS PACS I.H. Rajasekaran, L. Iacono, P. Summers, S. Benkner, G. Engelbrecht, T. Arbona, A. Chiarini, C.M. Friedrich, B. Moore, P Bijlenga, J. Iavindrasana, R.D. Hose, A.F. Frangi (2008), @neurIST: Towards a System Architecture for Advanced Disease Management through Integration of Heterogeneous Data, Computing, and Complex Processing Services, IEEE International Symposium on Computer-Based Medical Systems, Finland, pp. 361-66.
  • 19. Cerebral aneurysm management > integrative applications suites & platforms Improve decision making processes in the management of unruptured aneurysms by providing a score that @neuRisk integrates all the available information IT Support Suites for identifying at-risk patients and reducing current over treatment Support computational design processes towards a next generation @neuEndo of smart flow-correcting implants to treat ruptured aneurysms and reduce current treatment costs, side effects and recurrence. @neurIST @neuLink Support the knowledge discovery for Systems linking genetics to disease, vasospasm and blood clotting after cerebral hemorrhage WSS Model & WSS Support the integration of modeling, @neuFuse Enabling IT CFD vs US simulation and visualization of 3DRA Peak velocity PC-MR vs US Flow rates multimodal data magnitude phase CFD Support integration of data and @neuCompute/Info computing resources. 19
  • 20. Cerebral aneurysm management > “Virtual imaging” through simulations CFD Simulation: • ICA Terminal aneurysm • Inflow 230ml/min (yellow) • 3 Outflows: •2 Pressure •1 Flow of 10ml/min • High wss at neck • Inflow jet has no clear impaction zone. • Vortex in aneurysm (with main axis along feeding vessel) and in bleb. Courtesy: Philips Healthcare 20
  • 21. Cerebral aneurysm management > Building disease knowledge in silico Radiological Imaging Vascular Model Morphology Streamlines WSS OSI Blood Genetics Clinical History Cebral JR, Castro MA, Appanaboyina S, Putman CM, Millan D, Frangi AF. Efficient pipeline for image-based patient-specific analysis of cerebral aneurysm hemodynamics: technique and sensitivity. IEEE Trans Med Imaging. 2005 Apr;24(4):457-67. 21
  • 22. Cerebral aneurysm management > Treatment planning: virtual stenting Larrabide I, Radaelli AG, Frangi AF. Fast virtual stenting with deformable meshes: application to inrtracranial aneurysm. Int Conf Med Image Comput Assist Interv, 5242 (MICCAI’08), 790-7, 2008 Cebral JR, Lohner R. Efficient simulation of blood flow past complex endovascular devices using an adaptive embedding technique. IEEE Trans Med Imaging. 2005 Apr;24(4):468-76. 22
  • 23. Clot formation: A subtle interplay of genetics, haemodynamics and arterial wall mechanics  Coil-induced clot formation is the basis of endovascular treatment for cerebral aneurysms; on the other hand spontaneous formation in untreated aneurysms is potentially loose and embolic.  Computational modelling allows for the evaluation of haemodynamic, rheological and genetic factors in thrombus formation. Models accounting for activation, biochemistry and thrombus-blood coupling will help us track the various stages of the thrombogenic process, and evaluate their significance in disease and treatment. Evolution of the distribution of thrombin concentration A. S. Bedekar, K. Pant, Y. Ventikos, S. Sundaram, A computational model combining vascular biology and haemodynamics for thrombosis prediction in anatomically accurate cerebral aneurysms, Food Bioprod Proc 83 (C2), 118-126, 2005 23
  • 24. Cerebral aneurysm management > Individualized risk management Courtesy InferMed & COSSAC University of Oxford (Prof. J Fox, Y. Chronakis) 24
  • 26. EHRs, VPH and the Virtual Patient Metaphor  In practice is very unlikely to have all needed measurements before simulations can take place  VPM: A virtual patient is a logical entity that can be queried for any and all information about a human being  E.g. on-the-fly access to population average parameters where personalized data is not available Input requirements E Y Z + Age, sex, clinical history, A B C D genotype, etc… X @neurIST Database Average & deviations input conditions (Flow waveforms, pressure, Virtual Patient Mr Jones haematocrit, etc… ) 26 Derived data Literature
  • 27. VPH applications & ubiquitous sensing  Personalization needs to consider in which homeostatic conditions the individuals is while being sensed  Consider environment and allostasis  “Is this patient at risk of IA rupture?” considering his/her  Exercise-rest conditions,  Stress levels,  Daily biorhythms,  Seasonal changes, etc.  Even more: “which will be his/her typical conditions under which this patient will be at risk”  Ubiquitous physiological monitoring technologies will ultimate have to connect to VPH technologies for true personalization and be integrated therein 27
  • 28. Conclusions  EHR, PHS, VPH: tackle complementary issues to realize patient-centric/personalized care cycles  VPH will stimulate further developments of EHR and PHS and provided added value services for healthcare and medical product development  Low-hanging fruits of VPH-PHS-EHR are available which act as levers for most sophisticated adoption 28
  • 29. Thanks for your attention Announcement @neurIST Open Session Level 1, Room 114 Thursday 18/3, 14-16hs Futher contact:
  • 30. Final reflection Validation is key for VPH technology but still… Will we/clinicians ever trust computational models and VPH technology? 30