Transcript Challenge 5: Towards Sustainable and Personalised Healthcare

Challenge 5: Towards Sustainable and
Personalised Healthcare: Current Stateof-the Art and Opportunities Within the
FP7 ICT Call 1
Panagiotis BAMIDIS
Lab of Medical Informatics,
Medical School,
Aristotle University of Thessaloniki,
Thessaloniki, Greece
Talk Roadmap
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Healthcare in EU
eHealth
Before FP7
To FP7
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Challenges of Health Sector
• better, faster and more responsive health care
services for the citizens
• more sophisticated and user friendly medical
equipment, systems and tools for practitioners
• more efficient and cost effective management of
services for managers
• faster and efficient supply of medical products for
suppliers
• better co-ordination and management of health
care services at European level for policy makers
[Source: R. Zobel, eHealth 2003 Conference]
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What is eHealth?
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ICT for Health (also known as eHealth) describes
the application of information and
communications technologies across the whole
range of functions that affect the health sector,
from the doctor to the hospital manager, via
nurses, data processing specialists, social
security administrators and - of course - the
patients.
http://ec.europa.eu/information_society/activities/health/whatis_ehealth/index_en.htm
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eHealth support in EU
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eHealth is developing in at least three areas: research and technology
development; policy; and applications and deployment.
European Community research programmes have been supporting
eHealth for the last two decades, co-financing research projects to the
tune of €500 million.
The European Union’s Member States are committed to sharing their
best practices and experiences to create a European eHealth
eHealth – which once had purely a research and development profile –
is now moving ever closer to deployment and use of actual
applications. (see the eTEN programme)
http://ec.europa.eu/information_society/
activities/health/index_en.htm
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R&D activities at EC
• Medical Informatics - standalone PC era
– Systems for the storage, retrieval, sharing and optimal use of
biomedical data, information and knowledge
• Health Telematics - early telecommunication days
– Regional health care networks, remote diagnosis and telemedicine
applications
• eHealth - Internet era
– Internet-based applications and services, medical content for
prevision, intranets for the management of health services
• Personalised eHealth - Ambient Intelligence era
– health knowledge infrastructure, wearable and implantable systems,
Biomedical informatics for personalised health, Health GRIDs
[Source: R. Zobel, eHealth 2003 Conference]
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R&D activities at EC
FP2
ESPRIT
FP3
RACE/AIM
Medical
Informatics
FP4
TELEMATICS
Health
Telematics
1991
(con’t)
FP5
IST/Health
Applications
FP6
eHealth
Personalised
eHealth
eHealth
2002
•20M €
•100M €
•140M €
•200M €
•30 Projects
•63 Projects
•158 Projects
•125Projects
•Feasibility Study •AIM Community •1st wave of
products
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•EU Telematics
Industry
Total
600M€
(15Years)
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[Source: R. Zobel, eHealth 2003 Conference]
Personalized eHealth
Medical Informatics
Bio Informatics
Electronic Health Records
Functional Genomics
Medical Imaging
Proteomics
Clinical Decision Support
Computational Biology
Telemedicine
Personalised eHealth
Knowledge
Neuro-Informatics
Machine Learning
Knowledge Discovery
Human Computer Interfaces
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[Source: R. Zobel, eHealth 2003 Conference]
Personal Health Systems
- PHS
• A relatively recent concept
 Introduced in the 1990s
 Place the individual citizen in the centre of the healthcare delivery process
• Key facilitators for:
 Continuity of care
 Preventive & personalised care
 Citizen-centred care
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citizen empowerment
preventive lifestyle & early diagnosis
disease management
independent living for ageing society
[Source: Loukianos Gatzoulis, IST event 2006, Helsinki]
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Personal Health Systems
In the form of:
 Wearable, implantable, portable systems
 Point-of-care systems
Non-/minimally-invasive monitoring
 Remote and continuous health status monitoring
 Personalised medical advice, recommendations and treatment as necessary
Emphasis so far:
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Physiological monitoring (vital signs)
Physical activity monitoring (body-kinematics)
Functional stimulation (post-event rehabilitation)
Molecular diagnostics for screening applications (e.g. cancer)
[Source: Loukianos Gatzoulis, IST event 2006, Helsinki]
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ICT for health – FP6 focus
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Research funded under the eHealth Strategic Objective of the
IST research programme aimed at
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The focus was on:
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creating an 'intelligent environment' allowing ubiquitous
management of each person's health status
assisting health professionals in coping with major health
challenges.
key technologies (biosensors and secure communications, 'smart
clothes' and implants, which help patients - and their doctors monitor and manage health status)
software tools to help health professionals take the best possible
decisions assuring patient safety
networking multidisciplinary researchers in the fields of bioinformatics, genomics, and neuro-informatics to help create a new
generation of eHealth systems to assist the 'individualisation' of
disease prevention, diagnoses and treatment
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ICT for health – FP6 calls
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Under the Sixth Research Framework Programme
(FP6), the Commission has sought proposals for
eHealth research projects twice:
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the 1st Call for Proposals, which closed on 24 April 2003;
the 4th call for proposals, which closed on 22/03/05
(http://ec.europa.eu/information_society/activities/health/doc
s/projects/fp6call4projects-studies.pdf)
There was also a joint call on bio-sensors for Diagnosis and
Healthcare in June 2004
Call 6: The Strategic Objective 'Ambient Assisted Living
(AAL) for the Ageing Society' (closed 25/04/2006)
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Personal Health Systems
Examples of FP6 projects
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MYHEART (http://www.hitechprojects.com/euprojects/myheart/)
Wearable systems (intelligent textiles) for prevention, early diagnosis
and management of cardiovascular diseases
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OFSETH (www.ofseth.org)
Textiles with optical sensors for physiological monitoring
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HEARTFAID (www.heartfaid.org)
Knowledge-based platform for heart failure management
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SMARTHEALTH (www.smarthealthip.com) and
MICROACTIVE (www.sintef.no/microactive)
Point of care devices for cancer screening (breast, cervical and
colorectal cancer)
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Challenges for
European Health Systems
• Pressure on healthcare systems
 Citizens’ expectations for high-quality care
 Demographic changes
 more people will require prolonged care
 Increased prevalence of chronic diseases
 substantial part of the overall healthcare costs
 Medical accidents
 Staff shortages
 Reactive model of healthcare delivery
 after appearance of symptoms
 Rising healthcare costs
 faster than the economic growth itself
• How to offer high-quality & affordable care?
[Source: Gérard Comyn, IST event 2006, Helsinki]
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Strategic Directions
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Mix of policy and research actions:
 Shift from hospital-centred to person-centred systems
 Shift from reactive to proactive (preventive) healthcare
 Policy instrument:
 Action Plan for a European eHealth Area
COM(2004) 356
 Research instrument:
 Seventh Framework Programme for Research (FP7)
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[Source: Gérard Comyn, IST event 2006, Helsinki]
FP 7 - Challenge 5
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ICT WP 2007-08 - Strategic Objective:
“Personal Health Systems for Monitoring and
Point of Care diagnostics”
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Strategic Research Orientations:
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Personal Health Systems
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Patient Safety
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Virtual Physiological Human
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FP7 Objective 3.5.1.1
Focus on:
(a) Personalised (health status) monitoring
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For people at risk or chronically ill
Wearable or portable/mobile ICT systems
Enable remote monitoring & care
Multi-parametric information (physiological; biochemical; activity,
location, social and environmental context)
Intelligent systems to correlate multi-parametric data with expert
biomedical knowledge
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aid diagnosis
 user support
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Interoperable with electronic medical records
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FP7 Objective 3.5.1.1 - (2)
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Focus on:
a1) Chronic disease management
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intelligent closed-loop approaches
detect and assess trends and episodes
facilitate adaptive care
remote management, avoiding hospitalisation
promote doctor-patient interaction
potential for integration in the healthcare process
a2) Preventive monitoring for people at risk
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identify evolving patterns/trends in health & lifestyle parameters
indicate elevated risks of disease development
reveal episodes at early stages
facilitate personalised guidance
encourage citizen compliance
prompt for early medical intervention
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FP7 Objective 3.5.1.1 (3)
 Focus on:
(b) Point-of-Care diagnostics
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Multi-analyte screening at primary care (GP offices)
Portable or handheld devices (based on LoC, microarrays, etc.)
Multiple tests (e.g. genome, proteome, metabolome levels)
Identify disease predisposition
Early diagnosis of diseases & their recurrence
Assistance to treatment
• dosage advice
• suitability of drug use
Significant advances in:
• sensitivity and specificity
• data processing, analysis and quality control
Interface with hospital and laboratory information systems & electronic
medical records
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FP7 Objective 3.5.1.1 (4)
(c) Additional Support Actions on:
1)
R&D roadmap on Personal Health Systems
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Wireless transmission of health-related information
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reliability aspects
need for exclusive radio frequency bands?
Interoperability of Personal Health Systems with other eHealth
systems
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emerging technologies and potential applications
user demand and business aspects
ethical and legal considerations
promotion and recommendations for continuous care
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FP7 Objective 3.5.1.1 (5)
• Expected Impact
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Higher quality care at the patient location
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Better support and reassurance to people at risk
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Stabilise the cost of health delivery systems
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Reinforce leadership of the EU Personal Health Systems industry
• Call 1 funding:
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More on ICT WP 2007-08
Challenge 5
“Advanced ICT for Risk Assessment and
Patient Safety”
Objective IST-2007.5.2
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Research proposed in Objective IST-2007.5.2
a) Advanced computerised adverse event systems:
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New tools for identification, prediction, detection and
monitoring of adverse events and other relevant information.
Based on innovative data mining and integration techniques
of existing databases and specific applications.
Emerging technologies like semantic mining should be
explored through multimedia databases.
Include validation leading to quantitative benefits.
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Research proposed in Objective IST-2007.5.2
b) New risk prediction for large scale events -local,
regional or even global adverse health events
(infectious outbursts, bioterrorism):
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new risk prediction, assessment and management
tools for preparation, surveillance, support and
intervention in case of large adverse health events.
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complement DG SANCO Health Emergency
Operations Facility
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Research proposed in Objective IST-2007.5.2
c)
Specific International Cooperation Actions
(SICAs) with Latin America countries
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foster cooperation, transfer of technology and undertake
demonstration activities in the area of alert and decision
support systems based on Electronic Health Records.
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Funding in Objective IST-2007.5.2
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ICT in support of patient safety and risk
management in healthcare
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[Source: Symbion & Communications- and Technology Research, IST event 2006, Helsinki]
ICT in support of patient safety and
risk management in healthcare
ICT in Clinical Settings
EHR (Electronic Healthcare Record)
CPOE (Computerized Prescription Order Entry System)
DSS (Decision Support tools)
EBM (Evidence Based Medicine, guidelines)
[Source: Symbion & Communications- and Technology Research, IST event 2006, Helsinki]
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More eHealth in FP7…
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The Virtual Physiological Human
(VPH)...
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Biomedical informatics background
Biomedical information is collected, stored and processed
on/at:
1) Different Levels – molecule, cell, tissue, organ, patient,
population
2) Different Context - care, research, education,
policy/management
3) Different Representation – format, structures, ontologies,..
4) Different places:
- Clinical info resources: health records, clinical research databases,
pharma databases …
- Biomolecular info resources : DNA & protein sequences,
microrarray data, protein interactions, human genome annotations ..
- Public health info resources : epidemiological data and studies,
national and WHO databases on diseases, …
[Source: Joël Bacquet , IST event 2006, Helsinki]
Synthesis of all “Health information levels”
BMI enables integration of biomedical data for better health
(Molecular medicine)
INFORMATICS
Public Health
Informatics
Population
Patient
Medical
Informatics
Tissue, organ
Cell
Bioinformatics
Health Information levels
Molecule
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Based on
Fernando Martin Sanchez
The Virtual Physiological Human - concept
Basis is the International physiome
project www.physiome.org
Computer models of the human
physiology, which includes the
interaction across temporal and spatial
scales from molecules to cells, tissues,
organs, up to the whole human body
New basis for:
Personalised (Patient-specific)
healthcare solution
Early diagnostics & Predictive medicine
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[Source: Joël Bacquet , IST event 2006, Helsinki]
Neurotransmitter studies
Transmitter-Receptoc Fingerprints
Molecules
Animal Experiments
Anatomy
Cytoarchitectonic info
Multi-parameter Analysis
Single neuron
recordings
Imaging Modalities
EPSPs
3d
visualisation
Brain maps Atlases
Multi neuron
recordings
EEG
Behavioural/Cognitive/Social
Studies
Search for biological
basis of social cognition
IPSPs
Genetic Studies
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morphology & physiology inconsistencies
Functional Neuroimaging
of genetic variation
MEG
Other functional
Neuroimaging
(Blood flow)
PET
fMRI
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Imaging Genomics
Complex
functional
interactions
&
Behavioural
phenotypes
genes
cells
systems
behaviour
•Increasingly divergent path from genes to behaviour.
•Need estimation of genetic effects at the level of brain information processing, which
represents a more proximate biological link to genes and behaviour.
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Objective 3.5.2.1 –
Virtual Physiological Human
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Technical focus on:
a)
Patient-specific modelling and simulation
 Target: molecular, cell, tissue, organs or systems
 Modelling & simulation of organs/systems targeting specific clinical
needs.
 Go beyond the state of art of available models
 Models should be multilevel when appropriate
 Better understanding of the functioning of the organs
 New insight into the response to physiological changes
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Objective 3.5.2.1 –
Virtual Physiological Human
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Technical focus on:
b) Data integration and knowledge extraction
 Target: creation and formalisation of patient specific knowledge
from multi-level integration of biomedical data
 Requirement: open distributed health infrastructures and tools
 Focus:
 Coupling scientific research data with clinical/empirical
databases
 Linking genotype data (genetic markers, pathways) with
phenotype data (clinical data)
 Image processing assessing disease evolution/presence
 Data mining and image processing across many biological
levels
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Objective 3.5.2.1 –
Virtual Physiological Human
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Application focus on:
a)
Patient-specific modelling and simulation & b) Data
integration and knowledge extraction to be demonstrated on
c) following clinical applications:
 Medical simulation environments for surgery
 Environment used for simulation, training and planning of
surgeries
 Prediction of disease or early diagnosis (patient specific)
 knowledge and predisposition obtained from lab tests,
biomedical imaging (imaging bio-markers and other data)
 assessment of efficacy/safety of drugs
 Use patient specific computational models to assess the drugs.
 Alternative screening for clinical trials
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Objective 3.5.2.1 –
Virtual Physiological Human
d) Networking action (NoE):
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in multilevel modelling and simulation of human physiology
 sharing of knowledge
 multidisciplinary training programmes
 reusable software tools
e) Coordination & Support Actions
1.
Enhancing security and privacy in modelling and simulation
addressing
 patient data processed over distributed networks
 use of genetic data
 Trustworthy environment
2.
International cooperation on health information systems
based on Grid capabilities
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Funding for Objective 3.5.2.1
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When :
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Instruments (Draft not yet agreed):
Call 2
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(a-c)
CPs 62M€ (minimum 22M€ for IP and
Minimum 22M€ for STREPs)
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(d)
Integrating action: NoE max 8M€
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(e)
Coordination & Support Actions: CSAs
Max 1M€ per action
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The future will tell…
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Thank you for your attention and time!
Panos Bamidis, Ph.D.
Lecturer in Medical Informatics
Lab of Medical Informatics, Medical School,
Aristotle University of Thessaloniki,
Thessaloniki, Greece
[email protected]
http://lomiweb.med.auth.gr
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