challenge 5: towards sustainable and personalised healthcare: current state- of-the art and...

Challenge 5: Towards Sustainable and Personalised Healthcare: Current State-of-

the Art and Opportunities Within the FP7 ICT Call 1

Panagiotis BAMIDISLab of Medical Informatics,

Medical School,Aristotle University of Thessaloniki,

Thessaloniki, Greece

3RD KNOW HOW TRANSFER EVENT - SEPVE - Mar 20072

Talk Roadmap

Healthcare in EU eHealth Before FP7 To FP7


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]


What is eHealth?

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


eHealth support in EU

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

http://ec.europa.eu/information_society/activities/eten/index_en.htm




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]


R&D activities at EC (con’t)

1991 2002

FP2FP2ESPRITESPRIT

FP3FP3RACE/AIMRACE/AIM

FP4FP4TELEMATICSTELEMATICS

FP5FP5IST/Health IST/Health ApplicationsApplications

•20M €

•30 Projects

•Feasibility Study

•100M €

•63 Projects

•AIM Community

•140M €

•158 Projects

•1st wave of products

•200M €

•125Projects

•EU Telematics Industry

Medical Medical InformaticsInformatics

Health Health TelematicsTelematics

eHealtheHealthPersonalisedPersonalised

eHealtheHealth

FP6FP6eHealtheHealth

TotalTotal600M€600M€

(15Years)(15Years)



Bio InformaticsBio Informatics

Neuro-InformaticsNeuro-Informatics

Medical InformaticsMedical InformaticsElectronic Health Records

Medical Imaging

Clinical Decision Support

Telemedicine

Functional Genomics

Proteomics

Computational Biology

Machine Learning

Knowledge Discovery

Human Computer Interfaces

Personalized eHealthPersonalized eHealth

Personalised eHealth Personalised eHealth Knowledge Knowledge



• 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

citizen empowerment preventive lifestyle & early diagnosis disease management independent living for ageing society

[Source: Loukianos Gatzoulis, IST event 2006, Helsinki]

Personal Health Systems - PHS


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: 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]


ICT for health – FP6 focus

Research funded under the eHealth Strategic Objective of the IST research programme aimed at

– creating an 'intelligent environment' allowing ubiquitous management of each person's health status

– assisting health professionals in coping with major health challenges. The focus was on:

– 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 bio-informatics, genomics, and neuro-informatics to help create a new generation of eHealth systems to assist the 'individualisation' of disease prevention, diagnoses and treatment


ICT for health – FP6 calls

Under the Sixth Research Framework Programme (FP6), the Commission has sought proposals for eHealth research projects twice:

– 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/docs/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)

http://fp6.cordis.lu/fp6/call_details.cfm?CALL_ID=1






http://ec.europa.eu/information_society/activities/health/docs/projects/fp6call4projects-studies.pdf

http://ec.europa.eu/information_society/activities/health/docs/projects/fp6call4projects-studies.pdf

http://fp6.cordis.lu/fp6/call_details.cfm?CALL_ID=136#infopack


Personal Health Systems

Examples of FP6 projects

• MYHEART (http://www.hitechprojects.com/euprojects/myheart/)Wearable systems (intelligent textiles) for prevention, early diagnosis and management of cardiovascular diseases

• OFSETH (www.ofseth.org) Textiles with optical sensors for physiological monitoring

• HEARTFAID (www.heartfaid.org)Knowledge-based platform for heart failure management

• SMARTHEALTH (www.smarthealthip.com) and MICROACTIVE (www.sintef.no/microactive) Point of care devices for cancer screening (breast, cervical and colorectal cancer)

http://www.hitechprojects.com/euprojects/myheart/

http://www.ofseth.org/

http://www.heartfaid.org/

http://www.smarthealthip.com/

http://www.sintef.no/microactive


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]


Strategic Directions

• 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)

[Source: Gérard Comyn, IST event 2006, Helsinki]


FP 7 - Challenge 5

ICT WP 2007-08 - Strategic Objective:

“Personal Health Systems for Monitoring and Point of Care diagnostics”

Strategic Research Orientations: Personal Health Systems

Patient Safety

Virtual Physiological Human


FP7 Objective 3.5.1.1

Focus on:

(a) Personalised (health status) monitoring 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 aid diagnosis user support

Interoperable with electronic medical records


FP7 Objective 3.5.1.1 - (2)

Focus on:

a1) Chronic disease management 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 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


FP7 Objective 3.5.1.1 (3)

Focus on:

(b) Point-of-Care diagnostics 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



(c) Additional Support Actions on:

1) R&D roadmap on Personal Health Systems emerging technologies and potential applications user demand and business aspects ethical and legal considerations

2) Wireless transmission of health-related information reliability aspects need for exclusive radio frequency bands?

3) Interoperability of Personal Health Systems with other eHealth systems promotion and recommendations for continuous care



• Expected Impact Higher quality care at the patient location

Better support and reassurance to people at risk

Stabilise the cost of health delivery systems

Reinforce leadership of the EU Personal Health Systems industry • Call 1 funding:


More on ICT WP 2007-08Challenge 5

“Advanced ICT for Risk Assessment and Patient Safety”

Objective IST-2007.5.2


a) Advanced computerised adverse event systems:

• 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.

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): • new risk prediction, assessment and management

tools for preparation, surveillance, support and intervention in case of large adverse health events.

• complement DG SANCO Health Emergency Operations Facility



c) Specific International Cooperation Actions (SICAs) with Latin America countries

• foster cooperation, transfer of technology and undertake demonstration activities in the area of alert and decision support systems based on Electronic Health Records.


Funding in Objective IST-2007.5.2


ICT in support of patient safety and risk management in healthcare

ICT

re

se

arc

h

nanosystems

genomics proteomicsdata mining

modelling

Emerging technologies

cognition

simulationbiochipsmolecularimaging

biobanks

ICT

ap

pli

ca

tio

ns

ICT in clinicalsettings

CIS, EHR

CPOE

DSS ( scores,reminders,alarms, clinicalpathways )

eMedication

EMS IT, eICU

. . .

Personal ICTtools

Biomedicalsensors

Telemonitoringdevices

Personal toolsfor diagnosticsand treatment

. . .

Public Healthapplications &secondary use

Event reports

Alert systems

Crisismanagementtools

bioserveilance

. . .

Other tools(not for

medical useonly)

Barcodes

RFID

Smart cards

Systemsengineeringtools

. . .

[Source: Symbion & Communications- and Technology Research, IST event 2006, Helsinki]


ICT in support of patient safety and risk management in healthcare

ICT in Clinical SettingsICT 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]


More eHealth in FP7…

The Virtual Physiological Human(VPH)...

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, …

Biomedical informatics background

[Source: Joël Bacquet , IST event 2006, Helsinki]


BMI enables integration of biomedical data for better health (Molecular medicine)

Population

Patient

Tissue, organ

Cell

Molecule

Health Information levels

INFO

RM

ATIC

SPublic Health Informatics

Medical Informatics

Bioinformatics

Based onFernando Martin Sanchez

Synthesis of all “Health information levels”


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

The Virtual Physiological Human - concept

[Source: Joël Bacquet , IST event 2006, Helsinki]


Animal Experiments

Multi-parameter Analysis

Imaging Modalities

3d visualisation

Brain maps -Atlases

Neurotransmitter studiesTransmitter-Receptoc Fingerprints

Molecules AnatomyCytoarchitectonic info

Single neuron recordings

EPSPs IPSPs

Multi neuron recordings

EEG MEG

Other functional Neuroimaging(Blood flow)

PET fMRI

Behavioural/Cognitive/SocialStudies

Search for biologicalbasis of social cognition

Genetic Studies

Bridge gap b/w morphology & physiology inconsistencies

Functional Neuroimaging of genetic variation


Imaging Genomics

•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.

genes cells systems behaviour

Complex functional

interactions&

Behavioural phenotypes


Objective 3.5.2.1 – Virtual Physiological Human

• 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



• 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



• 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



d) Networking action (NoE):• in multilevel modelling and simulation of human physiology

sharing of knowledge multidisciplinary training programmes reusable software tools

e) Coordination & Support Actions1. 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


Funding for Objective 3.5.2.1

• When : Call 2

• Instruments (Draft not yet agreed): (a-c) CPs 62M€ (minimum 22M€ for IP and

Minimum 22M€ for STREPs)

(d) Integrating action: NoE max 8M€

(e) Coordination & Support Actions: CSAs Max 1M€ per action


The future will tell…


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

challenge 5: towards sustainable and personalised healthcare: current state- of-the art and...

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