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
1
Constituents of e-Health*
Administrative and
Financial
Systems
e-Pharmacy
Electronic
Health Record
Telemedicine
m-Health
e-Health
*ITU-Seminar
On e-Health2003
2
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
Patient Database
Contact Details
Language Preference
TB History
Progress reports
Message
DB
Monitoring
Program
Medication reminders
and confirmations
Awareness
Message
distribution
program
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
Provincial level
MoH
MoH
Access to data
PUBLIC HEALTH ACTION
District level
Smart phone with template
SMS
ACTION
SMS
ACTIO
N
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.
Do you wear glasses?
Please put them on
i
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.
When you OK
are ready,
Press ‘OK’ to start the test
OK
APuHC Program 1 Projects
• 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).
Agents for HealthCare
1
PATIENT
PATIENT
COMPLAINT
COMPLAINT
INVESTIGATION
INVESTIGATION
HISTORY
HISTORY
EXAMINATION
EXAMINATION
TESTS
TESTS
2
3
4
TREATMENT
TREATMENT
PLAN
PLAN
DIAGNOSIS
DIAGNOSIS
5
TREATMENT
TREATMENT
COMPLETION
COMPLETION
& RESOLUTION
& RESOLUTION
THE HEALTHCARE CYCLE
8
PATIENT
PATIENT
7
6
Sporadic Contact
8
DOCTOR
DOCTOR
7
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
Ontology
Mapping
Research in the context
of the Semantic Web
eHealth Privacy
Management
First order logic, model
theory
Ontology
Development
Application and
business logic
modelling
SWRL, RuleML
Cancer Biomedical
Information Grid caBIG®
Vision/Goals (adopted in
200 organisations)
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
•
•
•
•
•
•
C3PR
PSC
caAERS
caXchange
CTODS
caGrid
Life Sciences
Distribution
•
•
•
•
•
•
•
CTODS
caArray
caTissue
geWorkbench
caGWAS
NCIA
caGrid
Data Sharing
and Security
Framework
• caBIG™ Policies
• Processes and Best
Practices
• Model Documents
• Trust Fabric
caBIG™ Clinical Trials
Framework
PSC
caXchange
C3PR
CTODS
CLINICAL TRIALS
COMPATIBILITY FRAMEWORK
Data Sharing & Security
Framework
caGrid
Data for Sharing
caAERS
• caAERS: Cancer Adverse
Event Reporting System
• caXchange: Cancer Data
Exchange System
• PSC: Patient Study
Calendar
• C3PR: Cancer Central
Clinical Participant
Registry
• CTODS: Clinical Trials
Object Data System
• caGrid: caBIG™
compatible systems
architecture
caBIG® 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)
• 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




y
Create an
Information
Model in a
Modeling Tool
Perform
Semantic
Integration using
the Semantic
Integration
Workbench (SIW)
Transform the
Information
Model into
Metadata using
the UML Loader
Generate Code
and Messaging
Interfaces using
the caCORE SDK
Code Generator
Informa
tion
Vocabul
aries
CDEs
APIs
Generate a
caGrid Interface
using “Introduce”
y
Software Development for
caBIG


XMI
File
Create an
Information
Model in a
UML
Modeling
Tool
Using
SDK
CodeG
en?
YES
N
O

Perform
Semantic
Integration
using the
Semantic
Integration
Workbench
(SIW)
YES
Verified
Annotated
UML
Model
CodeGen
Success?
Generate Code and
Messaging
Interfaces using the
caCORE SDK Code
Generator
Input
for next
version
XMI
File
y
Upload application
to the Grid using
Introduce
caGrid Introduce
Toolkit
Roundtrip
UML
Model
caDSR
SANDBOX
XMI
File


UML
Loader
Load to
Sandbox
Exported
using
SDK 3.1
format
Run
caCORE
SDK Code
Generation
NO
caDSR
Terminology
Services
XMI
File
XMI
File
Transform the
Information Model
into Metadata using
the UML Loader
Approved
Annotated
XMI

NO
Load to
Load
Prod
Success?
Compatibility
Terminology
Review
Services
Yes
Review
Final
caCORE
SDK Code
Generation
Public
APIs
UML
Loader
Prod
SIW
RoundTrip
caDSR
Production
Metadata Retrieval
Index
Service
Global
Model
Exchange
caGrid Service
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
Practice
Community
Hospital
Research
Hospital
Research
Institution
Industry
Consumer
Knowledge
Cloud
Comparative
Effectiveness
Decision
Support
Quality
Data
Aggregators
PharmacoVigilance
Analytics
Biomedical
Research
BioSurveillance