Towards an Intelligent and ubiquitous Healthcare Infrastructure

Prof Pradeep Ray, Director, Asia Pacific ubiquitous Healthcare Research Centre (APuHC), University of New South Wales www.apuhc.unsw.edu.au

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Constituents of e-Health

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Administrative and Financial e-Pharmacy Systems

Electronic Health Record

Telemedicine

e-Health

*ITU-Seminar On e-Health2003

m-Health

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APuHC Research Programs

1. Projects on e-Research infrastructure – UNSW e-Research Infrastructure for health incl Cancer Biomedical Informatics Grid (CaBIG) and electronic Practice Based Research Network (ePBRN) 2. eHealth Projects on primary care and aged care – New $1million collaborative initiative supported by the Aged Care IT Council incl contributions from industry and universities 3. International projects on the assessment of mHealth – Global mHealth Assessment Initiative ($1.6 million) with contributions from WHO &UGeneva (Swisse), AII (Aust), INSA-Lyon(France), NST (Norway), PNG Health (PNG), CMC (Ind), TRCL & ICDDRB(B’Desh), NUS (Singapore), UBC (Canada), IEEE &NIH (USA), CDC(China), POLIMI (Italy) 3

Benefits of Mobile Communication Technology in Healthcare

• Improved quality of care (e.g. better and/or faster diagnosis, improved treatment compliance, access to healthcare professionals, support for carers, etc.) • Reduced healthcare costs (e.g. fewer number of physician appointments, shorter hospital stays, avoidance of unnecessary admissions, etc.) • Reduced chances of medical or administrative errors (e.g. by avoiding duplication of data entry, better coordination in multi-disciplinary settings, etc.) • Increase efficiency (e.g. in administrative processes, billing, etc.) • Improve knowledge base (e.g. epidemiology statistics, research databases, etc)

APuHC in Global mHealth

• APuHC jointly led (with Tokai Univ-Japan)

ITU-D/IEEE Mobile eHealth Initiative for Developing Countries,

started in 2004 (consortium of twenty countries) for mHealth in – Emergency Telemedicine – Epidemic Control – Combating Bioterrorism • Mekong Basin Disease Surveillance (MBDS)-funded by the Rockefeller Foundation (2007-2008) in Laos, Cambodia, Vietnam, Thailand and part of China • APuHC led (2006-2009) the WHO Research on the Assessment of eHealth in four countries in Asia Pacific (India, China, Vietnam and Philippines) leading a comprehensive e-Health Readiness Assessment Methodology- now being used for Pandemic Preparedness • APuHC now leading (since 2010) the global study on the assessment of mHealth in collaboration with twelve countries all over the world 5

Completed WHO Study

• WHO Research on the Assessment of eHealth for Health Care Delivery (eHCD) from 2006-2009 • Participant countries: India, China, Vietnam and Philippines • eHealth Scenarios Studied: – Demonstration of cost-effectiveness of Electronic Patient Records (EPRs) in Primary Healthcare Centres (PHCs) in a country (Vietnam and Philippines) – Demonstration of training effects and improved quality through teleconsultation in cardiology (China and India) – Evaluation of the usage of e-learning modalities in PHCs (India and Philippines) • Led to APuHC eHealth Readiness Assessment 6 Methodology and Framework (EHRAM)

Program 3 Projects

• SMS-based Smoking Cessation (Aust/NZ) sponsored by HSAGlobal (NZ), Macquarie Telecom, NST (Norway) and ePBRN (Aust) • Tele-consultations using Mobile Phones with TRCL (Bangladesh) • SMS based TB Treatment with CMC Vellore (India) funded by Australia India Institute Grant2011 • Screening of cognitive disorders of HIV patients in PNG using smart phones- collaborative project involving researchers in Australia, USA and PNG • Smart phone based Depression Treatment sponsored by the St. Vincent’s Hospital and DOHA (Aust) • SMS based Disease Surveillance in PNG (M2M application) • eHealth Preparedness for Pandemics: case Studies in China and Australia sponsored by the ARC Linkage Project with Aust Hospitals and CDC Beijing

SMS based mHealth Service

Message DB

Patient Database

Contact Details Language Preference TB History Progress reports Monitoring Program Awareness Message distribution program Medication reminders and confirmations Awareness and motivational messages

ITU-T M2M Focus Group work plan(March2012)

General points open for consideration for work plan – To develop the work plan in alignment with FG ToRs – To develop vision and high level objectives based on FG ToRs – To consider if a) Use cases for healthcare only b) use cases also for other M2M sectors (from a synergy perspective) c) also some use cases from other (few key) M2M sectors (sourced from external) to be used for the Service Layer work – It is assumed independence from specific network technologies – It would be useful to describe interaction among the WGs (in terms of work process) –

Life time of the FG

Public M2M Applications

National level

Access to database Automatically generated reports PUBLIC HEALTH ACTION MoH

Provincial level

Access to data PUBLIC HEALTH ACTION MoH

District level

Smart phone with template SMS

ACTIO N

SMS

ACTION

Can smart phones enable timely and representative outbreak data?

• Implementation of pilot study » Randomise sites, train staff etc • Evaluation of pilot – Qualitative (Focus groups, key informant interviews – Sustainability (functionality, acceptability, ownership) – Quantitative

(

Pre & post (Districts prior to smart phones vs. post) & Comparative (Districts with smart phones vs. without) • Indicators – Number of outbreaks identified – Number of districts reporting timely data – Number of provincial hospitals reporting timely data – Number of investigations conducted (e.g. measles cases)

Screening Neuro-Cognitive Disorders using Smartphones

In the next 10 minutes or so, we will ask you to sit in quiet space at a table and place your phone horizontally on the table, right in front of you, exactly as shown in the picture.

Welcome!

Wecoome !

In the next 4 tasks we will test how well you can concentrate, how fast you can move shapes, how fast you can tap on a shape on the screen, and how well you can remember some shapes. We will then ask you a few questions about how good you think your concentration and memory are.

Do you wear glasses? Please put them on

i OK

, Press ‘OK’ to start the test

OK

APuHC Program 1 Projects

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Projects on eResearch infrastructure (Cooperative Management and Interoperability) in Australia and overseas (eg, India)

APuHC researchers and collaborators in this program work on the development and management of ontology-based e-Research infrastructure needed for the electronic sharing of research data by researchers in different academic disciplines (e.g., healthcare research).

8 8 1

Agents for HealthCare

PATIENT COMPLAINT

INVESTIGATION

HISTORY EXAMINATION TESTS

2 3

TREATMENT PLAN

4 THE HEALTHCARE CYCLE 7 Sporadic Contact 7

TREATMENT COMPLETION & RESOLUTION

5 6 6

 Most Healthcare Technology is dedicated to the resolution of a patient’s complaint  There is a lack of software that fulfills the patient and doctor’s needs when NOT actively managing a complaint (activities 6-8).  The Agent paradigm offers a solution to this issue.

Ontology-based and Intelligent Systems

Research in the context of the Semantic Web

Ontology Mapping

First order logic, model theory

eHealth Privacy Management Ontology Development Application and business logic modelling SWRL, RuleML

Cancer Biomedical Information Grid caBIG 200 organisations)

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Vision/Goals (adopted in

caBIG ® Vision A virtual network of interconnected data, individuals, and organizations whose goal is to redefine how research is conducted, care is provided, and patients/participants interact with the biomedical research enterprise.

caBIG ® – Goals

Adapt or Build

tools for collecting, analyzing, integrating, and disseminating information associated with cancer research and care –

Connect

the cancer research community through a shareable, interoperable electronic infrastructure –

Deploy and Extend

standard rules and a common language to more easily share information

caBIG Application Bundles

Compatibility Achieved through caBIG™ Bundles Clinical Trials Compatibility Framework

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C3PR

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PSC

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caAERS

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caXchange

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CTODS

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caGrid Life Sciences Distribution

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CTODS

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caArray

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caTissue

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geWorkbench

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caGWAS

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NCIA

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caGrid Data Sharing and Security Framework

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caBIG™ Policies

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Processes and Best Practices

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Model Documents

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Trust Fabric

caBIG™ Clinical Trials Framework

PSC caXchange C3PR CTODS CLINICAL TRIALS COMPATIBILITY FRAMEWORK caAERS Data Sharing & Security Framework caGrid

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caAERS: Cancer Adverse Event Reporting System

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caXchange: Cancer Data Exchange System

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PSC: Patient Study Calendar

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C3PR: Cancer Central Clinical Participant Registry

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CTODS: Clinical Trials Object Data System

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caGrid: caBIG™ compatible systems architecture Data for Sharing

caBIG

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Data Sharing and Security Framework (DSSF)

The Data Sharing and Security Framework includes: • Resources to address the legal and cultural barriers to data sharing: – Tools to evaluate the sensitivity of data – Tools to expedite the execution of data sharing agreements between organizations (guidelines for data sharing plans) – Tools to capture patient consent to share data (model informed consent forms) – Other model documents and white papers to inform institutions on data sharing issues • Technology infrastructure to ensure secure data exchanges: – Tools to implement federated authentication and authorization – Policies to assure that organizations adhere to security standards (Grid Host Agreement)

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Five steps in developing a caBIG™ compatible application

1. Creating an Information Model 2. Performing Semantic Integration (Vocabularies) 3. Transforming the Information Model into Metadata (Common Data Elements) 4. Generating Code and Messaging Interfaces (API’s) 5. Generating a caGrid Interface 

Create an Information Model

in a Modeling Tool

Informa tion Models



Perform Semantic Integration

using the Semantic Integration Workbench (SIW)

Vocabul aries



Transform the Information Model into Metadata

using the UML Loader 

Generate Code and Messaging Interfaces

using the caCORE SDK Code Generator y

Generate a caGrid Interface

using “Introduce” y

CDEs APIs

Software Development for caBIG



Create an Information Model

in a UML Modeling Tool NO XMI File XMI File XMI File Run caCORE SDK Code Generation CodeGen Success?

Exported using SDK 3.1 format  Using SDK CodeG en?

YES N O

Perform Semantic Integration

using the Semantic Integration Workbench (SIW) YES caDSR 

Transform the Information Model into Metadata

using the UML Loader UML Loader Verified Annotated UML Model Terminology Services Load to Sandbox caDSR SANDBOX Approved Annotated XMI  XMI File NO Terminology Load Success?

Load to Prod Compatibility Review Services Yes Review UML Loader 

Generate Code and Messaging Interfaces

using the caCORE SDK Code Generator  Input for next XMI File version Roundtrip UML Model SIW RoundTrip Final caCORE SDK Code Generation Public APIs y

Upload application to the Grid

using Introduce caGrid Introduce Toolkit Index Service Global Model Exchange

caGrid Service

Prod caDSR Production Metadata Retrieval

Multi-jurisdiction Perspective

• More and more international cooperation on eHealth needed across countries and regions for: – Disaster Management – Pandemic response – Climate Control – Management of healthcare (cost, quality, access) • Barriers include different regulatory, cultural, linguistic and regulatory environments in different countries 22

The Ultimate Vision: Intelligent ubiquitous Infrastructure for Personalised Medicine Consumer Practice Community Hospital Research Hospital Research Institution Industry Decision Support Data Aggregators Analytics Knowledge Cloud Biomedical Research Bio Surveillance Pharmaco Vigilance Quality Comparative Effectiveness