Presented by Leif Hanlen Technology Director, NICTA

1. eHealth: Big data,
sports analysis & clinical records
Leif Hanlen
Technology Director, NICTA
Assoc. Prof. ICT @ Australian National
University
Prof. Health @ University of Canberra
From imagination to impact

2. Conclusion
• “Big Data” in health is using existing/available information to
support better delivery of better care.
• It’s not special: it’s just health.
• It’s not how big it is, it’s how you use it.
The convergence of biology, informatics, and engineering is turning
healthcare into an information industry.
Mario Castañeda, CBET, BS, MBA, National Director of the Clinical
Technology Department at Kaiser Permanente
“[T]he effectiveness of telehealth is currently limited by
positioning telehealth outside the mainstream of healthcare”
Mitchell, DCITA report, 2
1999
From imagination to impact

3. Too much data, ill-used
“Current medical practice relies
heavily on the unaided mind to
recall a great amount of detailed
knowledge – a process which, to
the detriment of all
stakeholders, has repeatedly
been shown unreliable”
Robert M. Crane and Brian Raymond
The Permanente Journal
Winter 2003 Volume 7 No.1
Kaiser Permanente Institute for Health Policy
Emphasis added.
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4. Who is NICTA?
• Australia’s ICT research center of excellence
– “Use inspired research”
• Making fundamental advances in ICT that can underpin
the development of globally competitive
products, processes and services.
– 700 people (300 research staff)
– 5 laboratories, 15 partner universities
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5. We’ve launched a 15 startups in the last 10 years.
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6. Transforming innovative technologies
to advance the understanding of
human diseases and to improve the
health and well being of Australians
From imagination to impact
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7. Australia Health
AU$120b per annum
Where it goes
45,000
40,000
35,000
Series3
30,000
Series2
25,000
Series1
20,000
Expon. (Series1)
15,000
10,000
5,000
Src. AIHW
Expon. (Series2)
Expon. (Series3)
0
1
2
3
4
5
6
7
8
9
10
11
Hospital spending in $millions per year, by source
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From imagination to impact

8. Healthcare: a systemic change is needed
40% : hospitals ($48b)
18% : medical services
5% : community health ($6b)
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9. Healthcare: a systemic change is needed
Information shifts this balance
40% : hospitals ($48b)
20% : medical services
5% : community health ($6b)
Scaling status quo does not help
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10. But: it’s not only “the system” at fault
“Health informatics has been technology driven
and IT creators have misconceptions about how
clinical work is done, what characterises workers
and their environment, what problems they
face, and how they will use the artifact.”
Redcliffe Hospital study, 2011
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11. Meet the next ^ Chief Information Officer.
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12. This is her office:
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13. This isn’t her office.
It’s a conference room for clinicians
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14. Where will the ‘health’ data come from?
“Gigabit person days”
Clinical notes analysis
2Mb per person per day
45% population
Implants
1 Gb per person per hour
0.001% population
Genomics
10 Gb per person
1% population
Wearables
1 Mb per person per day
25% population
From imagination to impact
Proteomics
10 Tb per person
0.01% population
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15. Where will the ‘health’ data come from?
“Gigabit person days”
Improvements in clinician efficiency & effectiveness
Clinical notes
•
•
•
•
•
•
About 15k~20k providers (Health Info. Systems)
Limited interoperability incentive
Web-interface (PCEHR) but no analytics API
Privacy!
Access (clinicians  developers)
Adoption path: clinical champions, health systems
Huge potential for community engagement
Wearables
• About 15m~20m providers (sensors, software, apps)
• No interoperability incentive, no standards
• Privacy … but many people don’t care
• Access often local
• Adoption path: sports : wellness : community benefit
From imagination to impact
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16. But delivery will be via mobile video
Video accounts for 37% of mobile data.
Ref: CISCO Systems 2011
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17. eHealth is here.
Online image viewer
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18. It's a very sobering feeling to
be up in space and realize
that one's safety factor was
determined by the lowest
bidder on a government
contract.
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19. IT innovation: Old vs new
• IT solutions in-house or
procured
• Data never leaves
– Security by lock down
• National (central)
innovation applied
locally
• IT solutions by
community; in-house
evaluation
• Data security, open design
• Innovation local, grows
nationally
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20. Health data (old)
Design system
Predict queries
Hope
(and wait)
(and pay)
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21. Old way: Lots of data stores, no interoperability
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22. New way: Keep the data, use it better
Restful services
Eg. BioGrid in AU
Cluster analysis for enterprise
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23. Secure data, real time, useful.
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24. Interoperability, technology adoption, community care
NATIONAL E-HEALTH LIVING LABORATORY
Embedding ICT in the next generation’s workflow
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25. U. Canberra
AIS
1km
Aged care
Tertiary Hospital
ANU
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NICTA

26. Sod turning, Feb 2013, opening Feb 2014
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27. Why?
• Change the culture of care delivery: ICT part of the oxygen
• Encourage bottom-up innovation
– Matched to strategic (top-down) goals
• Co-design, co-develop, co-deploy.
– And then scale
• No “death by pilot-itis”
• No faith-based system changes
“Scientists reproduce results; engineers build impressive and
enduring artifacts; and theologians muse about what they
believe but can’t see or prove.”
Ted Pederson, Empiricism is not a matter of faith
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28. The Lab Philosophy
• Everyone’s skin in the game
– No cash for “research pilots”.
– Unsustainable business models need not apply.
• Open. Web based. HTML 5.
– No lock-in. Open source, open access, achieve standards
– Restful API’s, open data standards, privacy built in (not locked)
• Mobile by defaults
• Keep it real
– Lab has consumers, practitioners, developers, researchers, students
all co-located. No room for “not-invented-here”
From imagination to impact
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29. Health challenge: 10 bed hospital
• What would a health-system look like if
– 10-beds were the “norm” for hospitals?
– In-home was the “norm” for care?
– Tertiary hospitals were the “weapon of last resort?”
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30. Health challenge: 10 bed hospital
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31. Social media: monitoring health socially
Australia/NZ has 29% of google pharmaceutical searches
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32. Clinical Information Processing
Use the data that is already
captured; to trigger early
warnings.
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33. From imagination to impact
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34. Technology demonstrator
• Testing with partners
– Use clinical notes to
improve detection
– Web-app visualization
– Mobile data
• Keep it useful for
clinicians and then
– Get the data we need.
From imagination to impact
http://nicta-ifi.s3-website-ap-southeast-2.amazonaws.com/
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35. Clinical Information Processing
Nurses,
Are you tired of wasting time
writing handover notes?
Just talk.
Let the computer sort it out.
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36. Nursing handover
• Social: nurses talk, in a group, at bedside
• Information passed at shift-change
– And recorded on paper records 8+ hours later
• Information is lost
– Errors: adverse events, medication errors, omissions etc.
• Workflow is inefficient
– Time wasted, frustrating
Nurses want to have speech recorded, but not like this.
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37. Technology demonstrator
•
Proof-of-concept
•
In 3 major teaching
hospitals & 6 ward/units
within
•
•
•
South West Sydney
Local Health District
Sydney Local Health
District
Web-based HTML5 app
From imagination to impact
http://nicta-stct.s3-website-ap-southeast-2.amazonaws.com/
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38. Sports analysis: gateway drug for population health
“The stats of exercise are really important to me to check out my
performance”
Cross-country skier Colby Rook uses the device for training
From imagination to impact

39. From engagement to solution
• Problem “how can we track performance?”
– Approached by Australian Institute of Sport to quantify training
– Paper notes are impossible to search, time-consuming to fill and often
missing records.
AIS logbooks circa 1958
AIS logbooks circa 1998
From imagination to impact
AIS logbooks circa 2010

40. Technology demonstrator
• In use at Aust. Institute
Sport for last 18 months
• Commercialisation
under way
– Consumer technology
with web-app
integration
From imagination to impact

41. Next steps?
• Expertise in data mining and machine learning
– Including text processing
• Range of projects, interested in developing new collaboration
• Also developing community for ICT development/adoption.
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42. From imagination to impact
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