Presentation by Prof. Fernando Martin-Sanchez at the "Carlton Connect" Interdisciplinary conference in Melbourne, 2012. http://www.carltonconnect.com.au/Conference/Conference.html

1. Health
informa.cs
Fernando
Mar*n-­‐Sanchez
Ins$tute
for
a
Broadband-­‐Enabled
Society
&
Melbourne
Medical
School

2. Introduc$on
• Broadband
can
provide
many
opportuni$es
for
the
health
sector:
– Improving
youth
mental
health
and
aged
care
services
– Monitoring
health
condi$ons
– Enabling
shared
electronic
health
records
• Broadband
technologies
are
revolu$onising
the
delivery
of
health
care.
Convergence
with
other
technologies
towards
Digitally
Enabled
Personalized
Medicine

3. Aging
Well
– Mobile
and
broadband
technologies
for
ameliora.ng
social
isola.on
in
older
people
– Smart
Homes
for
the
Elderly
–
recent
developments
in
Korea
Youth
Mental
Health
− HORYZONS:
Online
Recovery
for
Youth
Onset
Psychosis

4. Telehealth
– Individual
Electronic
Health
Records
– The
Telestroke
Study
– Hap*c
Tele-­‐Rehabilita/on
– Teleden/stry
– Virtual
visits:
Inves*ga*ng
the
acceptability
of
webcam
consulta*ons
for
young
adults’
sexual
health
– Wireless
broadband
monitoring
of
knee
osteoarthri/s
– Overcoming
geographical
barriers
for
community
health
– Interpreter
mediated
cogni*ve
assessments
using
video
conferencing
soFware
– SeeCare
IPTV:
Personalised
Health
Literacy
Demonstrator
– Mobile
Augmented
Reality
– Interpreter
mediated
cogni/ve
assessments
using
video
conferencing
soFware
– High
resolu*on
monitoring
of
atmospheric
pollutants
to
iden*fy
their
impact
on
popula*on
health
– Overcoming
geographical
barriers
for
community
health
– Using
video-­‐conferencing
to
pilot
an
educa*on
and
clinical
support
package
for
rural
GPs
in
Mildura

5. Health Informatics:
Towards
Digitally Enabled
Personalised Medicine

6. Current challenges in Medicine
• Need
of
earlier
diagnosis
• More
personalized
therapies
• Risk
profiling,
disease
predic$on
and
preven$on
• Improve
disease
classifica$on
systems
• Control
health
system
costs
• Clinical
trials
and
the
development
of
new
drugs
need
to
be
more
agile
and
effec$ve.
• Ci$zens
could
take
more
responsibility
for
the
maintenance
of
their
own
health.
• Shortage
of
health
professionals

7. The Digitalization of Medicine
• Digital
revolu$on
in
other
domains
(banking,
insurance,
leisure,
government,…)
• The
incorpora$on
of
digital
systems
in
healthcare
is
lagging
behind
other
sectors:
– Reasons:
complexity,
privacy,
volume
of
data,
lack
of
demand
– It
has
greatly
affected
healthcare
at
the
hospital
or
research
centre
level.
– The
digital
revolu$on
has
not
yet
reached
medicine,
at
the
pa$ent/ci$zen
level
• BUT
THIS
IS
STARTING
TO
HAPPEN
NOW
!!!

8. Enabling scientific and
technological advancements
• New
converging
areas
make
feasible
for
the
first
$me
the
idea
of
an
integrated
digital
infrastructure
for
medicine,
reaching
the
ci$zen,
that
will
make
feasible
the
concept
of
personalized
medicine
– Nanotechnology
– Biotechnology
– Informa$on
Technologies
– Cogni$ve
science

9. Enabling scientific and
technological advancements
• Broadband
technologies
and
networks
• High
performance
compu$ng
(and
A.I.
systems)
• Ubiquity
of
smartphones,
tablets,
…
• Sensors,
imaging
and
wearables
• Personal
genome
sequencing,
gene$c
tes$ng
and
epigene$cs
• Metagenomics
and
the
Human
Microbiome
Project
• Social
networks
and
the
Quan$fied
Self
• Knowledge
management
on
gene$c
diseases
and
systems
biology
modelling

10. Smartphone apps
• Smartphone
ECG
system
to
provide
physicians
and
pa$ents
with
hospital-­‐quality
heart
rhythm
monitoring
outside
of
the
hospital
se`ng

11. Advances in genomic
technology
• Benchtop
Ion
Proton™
Sequencer
–
designed
to
sequence
the
en$re
human
genome
in
a
day
for
$1,000

12. Graphs of my total cholesterol (blue), my “bad” LDL cholesterol (red),
and my “good” cholesterol (green) over a decade.
(Larry Smarr, CalTech)

13. Remote
pa$ent
data
monitoring
and
data
collec$on
Environmental sensors Genomic sensors
Phenomic sensors
Environmental risk factors Biomarkers (DNA sequence,
(pollution, radiation, toxic agents, …) proteins, gene expression, epigenetics
Physiological, biochemical parameters
(cholesterol, temperature, glucose, heart rate…)
Integrated personal health record

14. Digitally
enabled
personalised
medicine
• Personalized
medicine
refers
to
the
tailoring
of
medical
treatment
to
groups
of
pa$ents
with
similar
gene$c
or
molecular
profiles.
• Ultra
high
speed
broadband
networks
will
be
required
to
transmit
enormous
volumes
of
data
from
pa$ents’
homes
to
health
prac$$oners
and
vice
versa
in
a
$mely
manner,
and
to
enable
the
processing
of
this
deluge
of
data.
• Personalised
medicine
offers
enormous
opportuni$es
for
improving
preven$ve,
diagnos$c
and
therapeu$c
solu$ons
à
improving
healthcare
outcomes,
reducing
costs
and
increasing
pa$ent
safety.

15. Digitally
enabled
personalised
medicine

16. Patient Data (sensors and imaging)
Sensors
Genomic Phenomic Environmental
Integrated Personal
EHR Health Record
Module 1 Health Profile GWAS
Assessment
Tables (weighted factors)
Modelling Risks
Diagnosis Personal
Health Profile
CDSS
Health Profile
Module 2 Improvement Trialbanks
NBN
Risk reduction Decision matrix, protocols
Follow-up Personalised
Therapy Health Recommendations

17. Social
media
and
biomedical
and
clinical
research
• We
are
witnessing
a
transi$on
from
research
informa$on
systems
centralized
at
hospitals
and
clinical
research
centres
to
distributed
systems
that
reach
out
to
the
residence
of
any
ci$zen
/
pa$ent
who
opts
in.
• Social
media
as
a
research
tool
• Clinical
Research
with
the
pa$ents,
not
on
the
pa$ents
• Examples
– 23andMe
–
Parkinson’s
Disease
–
PLoS
Gene$cs,
2
new
gene$c
associa$ons
– Pa$entsLikeMe
–
Nature
Biotech.
Self-­‐reported
data
from
600
pa$ents
on
the
use
of
lithium
for
Amyotrophic
Lateral
Sclerosis
(ALS)

18. Pa$ent
empowerment
Current NBN-enabled Driving forces: patient empowerment,
networks personalized medicine, social networks
EHR – Personally Citizens are able to maintain and control
Electronic Controlled EHR their own health information
Health Record
Gene-disease Personal Citizens ask for genetic analysis of their
association genomics DNA through the Internet and receive
studies reports on various aspects of their health
Clinical trials Crowdsourced The patient voluntarily shares information
clinical trials on treatments and evolution of his/her
illness with other patients

19. Barriers
• New
regulatory
framework
(new
models
of
clinical
trials)
• New
informa$cs
methods
to
compile
and
interpret
all
the
informa$on
• Educa$on
of
pa$ents
and
health
professionals
• Ethics,
data
security
and
confiden$ality
issues
• Wide
availability
of
clinical
decision
support
systems
at
the
point-­‐of-­‐care
• New
cost-­‐effec$veness
assessment
and
financial
models
of
care
• Need
to
prove
clinical
effec$veness
before
DTC
services
are
offered.

20. Conclusions
• The
rou$ne
applica$on
of
personalised
medicine
is
s$ll
a
long
way
ahead,
however
we
have
now
all
the
ingredients
to
make
it
happen.
• The
convergence
of
medicine
and
the
digital
revolu$on
will
produce
an
informa.on
ecosystem
that
will
facilitate
the
advent
of
safer
and
more
efficient
preven$ve,
diagnos$c
and
therapeu$c
solu$ons.
• The
ci$zen
will
have
access
to
her
gene.c
profile
and
clinical
record,
and
will
monitor
and
adjust
her
health
using
next
genera$on
sensors
and
social
networks
to
share
this
informa$on
with
peers,
clinicians
and
researchers.
Virtual
pa$ent
–
Pa$ent
avatar

21. Conclusions
• But
all
of
this
will
only
be
possible
if
we
realise
that
it
is
.me
for
us
to
take
responsibility
for
our
own
health.
– “The
Crea$ve
Destruc$on
of
Medicine”
(Topol),
–
“Networked
individualism”
(Rainie),
or
–
“P4
Medicine”
(Hood).
• We
prefer
the
term
“Digitally
enabled
personalized
medicine”
and
have
already
started
research
work
in
several
areas:
clinical
genomics,
modelling
and
the
use
of
social
media
for
biomedical
research.
• We
believe
that
the
synergy
between
Health
Informa$cs
and
the
broadband
network
in
the
context
of
mul$disciplinary
collabora$on
and
innova$on
offered
by
Carlton
Connect
will
contribute
to
accelerate
the
advent
of
personalised
medicine.

22. Thank
you
oms@unimelb.edu.au
www.healthinforma$cs.unimelb.edu.au
Twiqer:
@ibeshbir