Big Data and Predictive Medicine Prof., PhD University Hospital Zurich University of Zurich Higher School of Economics Moscow, Russia June 19, 2014
Progress toward data-based predictive medicine! Why is this important? " Event anticipation and timely intervention for prevention " New prevention guidelines " Optimal management of chronic disease " Huge economic relevance! Why now? " Paradigm shift - Vigorous involvement of hard-science community - Gradual acceptance from medical community " Availability of inexpensive remote biosensors " Potential for collaborative modeling using very large data " Commercial interest is widespread and growing 1
The costs of chronic disease Heart disease and stroke Diabetes Lung disease Alzheimer's US$432 B/y US$174 B/y US$154 B/y US$148 B/y 2
Cost of multiple chronic conditions 3
Effects compounded by aging population 4
Example: diabetes global prevalence growth 5
Some facts on diabetes! (Adults US 2011) " 25.8 M " Leading cause of - kidney failure - non-traumatic lower limb amputations - new-case blindness " Major risk factor for heart disease and stroke " Seventh leading cause of death in the US " Costs - Direct medical $116 B (~2.3 times higher than non-diabetic) - Indirect $58 B (disability, work loss, premature mortality) 6
Confronting the problem! Current medical practice cannot cope with growth in load! Society cannot afford the costs! Target: prevent chronic and acute complications! Few alternatives " Prevention Lifestyle modification " Scientific breakthroughs " More efficient (and effective) chronic disease management methods 7
Remote management Several attempts at intelligent remote management systems in the past have had mixed results What has changed? 8
State of the art Single-lead EKG Heart Rate Heart Rate Variability Respiratory Rate Skin Temperature Body Posture Fall Detection/Severity Steps Stress Sleep Staging 9
Data acquisition from sensor 10
Data acquisition from sensor 11
Revolutions! Technology health solutions! Availability of inexpensive biosensors! Smartphones! Internet everywhere availability of high-quality rich health-related data multiple continuous, time-dependent biomarkers continuous learning accurate predictive disease progression models accurate predictive event models! Technology devices + modeling " Legal (regulatory) obstacles " Ethical issues 12
Evolution! Sensor evolution! From bulky kg-scale devices (1970s) to implantable, continuous measurement devices (~2015) unattended, hassle-free continuous measurement from occasional snapshots to continuous time metric evolution! Intelligence evolution! From simple, snapshot-based, linear models to complex pattern discovery, detection, abstraction, and generalization Critical alert triggering 13
Sensor science and technology explosion 14
The (near) future! Non-invasive measurement methods " Ultrasound " Electromagnetic " Thermal " Saliva " Tears! Implantable multiparameter measurement " Nano particles " Carbon nanotubes " Graphene " Electrospun nanofibers " Quantum dots " 15
Diabetes remote management platform goals! Calculation, evolution, and display of instantaneous, historical, and forecast patient glycemic curve! Tracking and displaying lifestyle variables in real-time that influence risk of incident DM, as well as consequences of existing DM! Optimization of metabolic control variables using real time feedback-loop messaging and gaming elements! Calculation and display of alert points in the glycemic curve, and how glycemic control correlates with real-time tracked nutrition and physical activity 16
Platform output! Output integrated into contextual gaming and social network engines " Real time feedback lifestyle effect on glycemic curve! Real-time user (and, selectively, healthcare provider) output " Medication adherence score " Prescribed activity and metabolic response scores " Scores measuring real-time evolution of disease risks " Glycemic response curves and related scores " Real-time alerts and notifications 17
When?! Platform available now! Clinical and field trials in design stage or in progress 18
Where do we go from here?! Multiple ongoing clinical trials " Heart Failure " Diabetes " COPD " Parkinson s 19