An EVIDENCE-ENHANCED HEALTHCARE ECOSYSTEM for Cancer: I/T perspectives

Transcription

1 An EVIDENCE-ENHANCED HEALTHCARE ECOSYSTEM for Cancer: I/T perspectives Chalapathy Neti, Ph.D. Associate Director, Healthcare Transformation, Shahram Ebadollahi, Ph.D. Research Staff Memeber IBM Research, USA IBM Corporation 1

2 Early Diagnosis and Intervention Improve Outcomes and Lower Costs Decision Support Tools to Help Assess Risk Refine Assessment Predict/Diagnose Monitor Progression Predict Events Inform Therapeutics Disease Burden Baseline Risk Initiating Events Earliest Proteomics Molecular Detection Functional Earliest Typical Imaging Clinical Current Detection Intervention Cost 1/reversibility Sources of New Biomarkers Baseline Risk Stable Genomics Single Nucleotide Polymorphisms (SNPs) Haplotype mapping Gene Sequencing Preclinical Progression Dynamic Genomics Gene expression Proteomics Metabolomics Molecular imaging Clinical Risk Models Time Disease Initiation and Progression Treatment Decision Support 2 Source: Ralph Synderman, MD 2009 IBM Corporation 2

3 Challenges are Data Explosion and Cognitive Overload Facts per Decision US CT/day 1M proteins Diagnostic Imaging: Functional and Anatomical Proteomics and other effector molecules Functional Genetics: Gene expression profiles Human Cognitive Capacity K genes Structural Genetics: e.g., SNPs, haplotypes Decisions by Clinical Symptoms Source: William Stead, MD 2009 IBM Corporation 3

4 Cognitive Overload => Reduced Quality and Utility Compliance Regulation Conflicting evidence liability affordability Evidence at the point of care Data (imaging, genomics, proteomics, labs, ) Treatment and therapeutic options Today Tomorrow 2009 IBM Corporation 4

5 Health System Optimization Through Technology Cognitive support and decision intelligence Evidence in the context of care delivery process Meaningful use Anticipate the need, tailor delivery Collaboration Evidence Enhanced Point of Care Improve care delivery through consumable evidence at the point of care Evidence Generation Enable transformation of Data to Evidence Practice-based Evidence / Comparative Effectiveness Cloud and Data Trusts at the infrastructure level Analytics on federated data structures Novel security paradigms Modeling workflow Business process transformation New delivery models Information in context Feedback loop Service Quality Orchestrate an efficient workflow to increase saftey and reduce errors Novel Payment Models Provide incentives to enhance patient outcome and reduce cost Evidence and outcome based payment models Optimization Tailoring payments to disease categories 2009 IBM Corporation 5

6 Evidence generation - Challenges RegulateMonitor (FDA,NIH, ) EHR Centralized vs. Federated? Evidence quality Claims patients providers payers NIH/FDA/ Data Collection and Curation Trials Articles Comparative Effectiveness Engine Evidence Repos. Evidence Registry Issues: Data representation Standard nomenclature Data formats & standards Federated data access Standard nomenclature Content analysis Data mining Evidence synthesis Evidence registry Evidence retrieval Evidence use feedback 2009 IBM Corporation 6

7 Evidence usage - Challenges PCP/Nurse/Specialist/Patient User context Process context Information need analysis Care process analysis Evidence Input Role- and process-aware evidence collection Consumable evidence delivery Evidence use monitoring Issues: Evidence subscription Query formulation Task/evidence matching Evidence communication Evidence summarization Intelligent evidence prefetch Evidence visualization 2009 IBM Corporation 7

8 2009 IBM Corporation 8

9 Federated Clinical Data Warehouse Architecture for Analytics Local Site Data* Data Conditioning Data Reduction Site 1 Site 2 Site 3 Site 4 Site 5 Site 6 Site 7 Site 8 Site N Secure Communication Layer Source Data Connectivity & Adapters Business Rules and Consolidation Clinical Data Model Common Medical Vocabulary Data Profiling Common Transformat ion Rules Data Quality Metrics Data Mapping and Transport Data Mapping ETL and Federation Real- Time, Near-Real Time Data Delivery Target Connectivity VDW Staging Reference Master Reference Data Data Marts Cubes Descriptive Analytics Predictive Analysis Presentation & Information Delivery Portal Reports Ad-hoc Workflow & Approval Business Process Mgt Auditability & Data Lineage Metadata Management Data Quality Management * All site data will be relational (DB2, Oracle, Sql Server or Netezza) Identity Management & Security Infrastructure Services Data Oversight/Stewardship 2009 IBM Corporation 9

10 Open Standards and Open Platforms are Key for the Evidence-enhanced Healthcare Ecosystem Open Standards for omics and advanced imaging beyond HL7 Multiple formats and usage modes Connect the dots (bubble-up versus side-by-side) Open Standards for analytics How to present data for analysis and be able to consume it post analysis International Classification of Diseases (ICD 10), annotations, Open Platforms for large-scale data and analytics sharing and collaboration E.g. Open standard platform like we CaBIG, XIP/AIM, i2b2, etc, 2009 IBM Corporation 10