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Showing posts with label Big Data. Show all posts
Showing posts with label Big Data. Show all posts

Saturday, June 30, 2018

Revolutionizing healthcare - reposted from Peter Diamandis

We are on the brink of a revolution in healthcare.
AI is making the drug discovery process >100X faster and cheaper, and 90% more likely to succeed in clinical trials.
Mobile health is predicted to become a $102 billion market by 2022, putting a virtual doctor, on-demand, in your back pocket.
And the cost of sequencing your genome (3.2 billion base pairs) has decreased 100,000-fold over 13 years, a staggering speed that is 3 times faster than Moore’s Law. 
Cost Per Genome
 Source: Social Capital via Medium
But humans have barely scratched the surface.
As exponential technologies explode onto the scene all at once, we are about to witness the unprecedented rise of personalizedubiquitous and intelligent healthcare.
In this blog, we’ll discuss how converging exponential technologies are enabling:
  1. Personalized medicine
  2. Delocalized (“everywhere”) care
  3. The new era of intelligent prevention
We are truly living in an era when anything is possible.

Personalized Medicine 

Currently, research focuses on one-size-fits-all solutions. Clinical trials aim to discover therapies for the general population — and can only introduce them after years of expensive initial research, lab testing, human testing clearance, multiple phases of patient testing and maybe ultimate approval.
But what if all treatments were targeted at your individual genome, from lab testing to ready product, and at a lower cost?
Using their powerful deep learning systems, NVIDIA aims to tailor treatments to an individual’s genomic makeup.
Others, like a team at the University of Toronto, are building genetic interpretation engines to pinpoint cancer-causing genetic mutations in individual patients.
Similarly, researchers at UNC’s Lineberger Comprehensive Cancer Center use cognitive computing to identify individually relevant therapeutic options based on one’s genetic profile.
But this is only the beginning. Take Harvard Wyss Institute’s organs-on-chips.
Containing microfluidic channels with living human cells and mechanical mimicry of an organ’s microenvironment, the Wyss Institute’s organs-on-chips can serve as micro artificial hearts, lungs, intestines and kidneys, among many other organs.
The biotech company Emulate has raised millions for use of these organs-on-chips to replace traditional animal testing and deliver personalized medicine. 
Organs on a Chip
Emulate uses organs-on-chips to accurately test drugs on individual, human organs. Source: Emulate
In the future, these could be your cells on a chip, tested with treatment after treatment until the right one sticks, tailored exactly to your genetic makeup.
But it doesn’t stop at genetically personalized treatments. Welcome to personalized diets. 
Each of us has about 40 trillion microorganisms that occupy our gut, and each microbiome — like our DNA — is distinct. Through a simple home kit, Viome applies machine learning to analyze your microbiome, recommending optimal, personalized nutritional recommendations for your gut. 
Bowhead Health tackles yet another approach to personalized medicine. With either saliva or a blood-prick test, Bowhead’s small home device reads this biometric data in real time and transmits the reading to doctors. As soon as key deficiencies are identified, your in-home Bowhead device dispenses a customized, vitamin-based pill, all your own.

Delocalized Care

Kaiser Permanente’s chairman and chief executive George Halvorson foresees plummeting healthcare costs as care migrates farther from hospitals and doctors’ offices and into any and every setting via the Internet.
The harbingers of “everywhere care” are so abundant, they deserve a blog of their own.
Here are the highlights:
(1) mHealth (or Mobile Health) has already grown beyond a $23 billion market, and by some estimates will surpass $102 billion by 2022.
Step aside, WebMD.
AI-powered medical chatbots are flooding the market. Diagnostic apps can identify anything from a rash to diabetic retinopathy. And with the advent of global connectivity, mHealth platforms enable real-time health data collection, transmission and remote diagnosis by medical professionals.
Already available to residents across North London, Babylon Health offers immediate medical advice through AI-powered chatbots and video consultations with doctors via its app. Babylon now aims to build up its AI for advanced diagnostics and even prescription. 
Others, like Woebot, take on mental health, using Cognitive Behavioral Therapy in communications over Facebook Messenger with patients suffering from depression.
New diagnostics and screening apps are also beginning to empower the next generation of patient-doctors.
In addition to phone apps and add-ons that test for fertility or autism, the now-FDA-approved Clarius L7 Linear Array Ultrasound Scanner can connect directly to iOS and Android devices and perform wireless ultrasounds at a moment’s notice. 
With mHealth platforms like ClickMedix, which connects remotely located patients to medical providers through real-time health data collection and transmission, what’s to stop us from delivering needed treatments through drone delivery or robotic telesurgery?
(2) AR/VR will revolutionize medical training, making it immersive and ubiquitously accessible. 
It’s no wonder the healthcare industry suffers from a shortage of doctors. Medical training is not only expensive, but its conventional methods also severely limit scalability.
With virtual and augmented reality, however, gone are the days of peering over a surgeon’s shoulder to learn from another’s experience.
Why not perform surgery on an annotated, virtual 3D body from anywhere in the world, for minimal cost, and do no harm?
Companies like Echopixel and 3D4Medical are achieving this delocalization and hands-on training with remarkable style, translating 2D scans and anatomy into live AR and VR patients.
Lung - 3D4Medical 2
3D4Medical translates 2D anatomical and brain scan diagrams into 3D AR realities.   Source: 3D4Medical
(3) AI-aided IoMT (Internet of Medical Things) may be one of the most exciting frontiers in healthcare.
Welcome to the age of intravenous nanomachines, electronic implants and pill-embedded sensors.
While wearables have long been able to track and transmit our steps, heart rate and various other health factors, smart nanobots and ingestible sensors will soon be able to monitor countless health parameters and even help diagnose disease.
But it doesn’t stop there. As nanosensor and nanonetworking capabilities develop, these tiny bots may soon communicate with each other, enabling the targeted delivery of drugs and autonomous corrective action.
Some companies, however, are working on high-precision sensors that need not enter the body. Apple, for instance, is reportedly building sensors that can noninvasively monitor blood sugar levels in real-time for diabetic treatment.
In last year’s Qualcomm Tricorder XPRIZE, we were proud to grant $2.5 million in prize money to the winning team, Final Frontier Medical Devices. Using a group of noninvasive sensors that collect data on vital signs, body chemistry and biological functions, Final Frontier integrates this data in their powerful, AI-based DxtER diagnostic engine for rapid, high-precision assessments. Their engine combines learnings from clinical emergency medicine and data analysis from actual patients.
IoT-connected sensors are also entering the world of prescription drugs. Just this winter, the first sensor-embedded pill — Abilify MyCite — was approved by the FDA.
Digital pills such as Abilify will now be able to communicate medication data to a user-controlled app, to which doctors may be granted access for remote monitoring.
But nanobots and IoT-connected sensors get a lot more exciting when they converge with 3D printers, AI supercomputers and the power of big data.

Intelligent Prevention

Take a minute to imagine this unprecedented convergence:
Nanobot sensors flowing through your bloodstream monitor different health parameters, measuring nutrient levels and keeping an eye on your cholesterol.
As data flows in, these connected sensors transmit your health data in real-time to a remote AI-powered supercomputer geared with all your genomics, microbiome and medical history data — access secured via blockchain, of course.
As abnormalities are detected, this AI-driven doctor sifts through tomes of data to identify an optimal, personalized treatment based on your genetic profile and real-time health data. Once vetted and approved, a prescription arrives at the dashboard of your in-home medical 3D printer.
With customized dosage, your 3D printer separates the drug’s active ingredients with micro-barriers and embeds a printed sensor to monitor variations in drug release and effectiveness.
Feedback is instantaneously communicated through IoMT, and AI again improves its personalized medicine for future treatment.
You might think that AI medical powerhouses and autonomous sensors leave human doctors out of luck. But many digital healthcare startups are in fact redefining and elevating the role of our doctors.
Take Forward, for example. A digitized doctor’s office geared with AI-driven diagnostics and personalized medicine, Forward is finding a way to liberate its doctors from many of the tedious necessities that so often constrain their ability to engage with patients. 
As medical AI enterprises like Microsoft’s Healthcare NExT and IBM Watson Health bring incredible power to diagnostics, drug discovery and genetic therapy development, doctors may be freed to take on consultative roles — educating patients, performing many more remote surgeries with the help of robotics, and aiding in preventive care.

Final Thoughts

Nowhere is convergence bringing greater breakthroughs than in healthcare.
As transformative technologies like CRISPR-Cas9 unlock our genetic potential, quantum computing massively ups the speed of AI-powered drug discovery, 3D printing places the power of preventive medicine in the hands of consumers, and next-generation implants enhance our minds, we are truly living in an era when anything is possible.

Join Me 

(1) A360 Executive Mastermind: This is the sort of conversation I explore at my Executive Mastermind group called Abundance 360. The program is highly selective, for 360 abundance and exponentially minded CEOs (running $10M to $10B companies). If you’d like to be considered, apply here.
Share this with your friends, especially if they are interested in any of the areas outlined above.
(2) Abundance-Digital Online Community: I’ve also created a Digital/Online community of bold, abundance-minded entrepreneurs called Abundance-Digital.0
Abundance-Digital is my ‘onramp’ for exponential entrepreneurs – those who want to get involved and play at a higher level. Click here to learn more.

Sunday, July 31, 2016

Eric Topols's NIH grant for Precision Medicine & Health Informatics Research

I have tried to read Eric Topol's classic books on digital medicine:  "The Patient Will See You Now: The Future of Medicine is in Your Hands" and the "Creative Destruction of Medicine: How the Digital Revolution Will Create Better Healthcare" but my local libraries don't seem to carry them. Not in the habit of buying every book I want to read on Amazon. I think Dr. Topol was a keynote at a nearby eHealth conference not long ago. Instead of attending, I subscribed to his Twitter feed which is well worth a look if you are not already inundated with more information feeds than a human could possibly digest in one lifetime.

The biggest news to come from Dr. Topol I may have first read in the San Diego Union Tribune, a news source I normally would never dream of reading, but for various disparate reasons (or algorithms) came to my attention from sundry WWW news sources. In fact I probably first read about it on the good doctors' Twitter posts.  Here is the link to the San Diego article, but it soon became apparent that the RSS was broadly distributed internationally. The Scripps Translational Research Institute, where Professor Topol works, just happens to be in San Diego:
http://www.sandiegouniontribune.com/news/2016/jul/06/NIH-scripps-topol/

The NIH doesn't often dole out $120 million grants for research. The last I heard of a grant with that largess was for research on the artificial brain, and I even blogged about that.  What I have not blogged about is precision medicine, which is defined well in this NIH Medline Plus article.  I am kind of wondering if precision medicine is just a plain English way of saying translational bioinformatics and health informatics all rolled into one.

This research project, that involves tapping into the blood samples, DNA, social media, health apps, sensor data, Big Data analytics and health records of a million volunteers, reminds me of  The Canadian Longitudinal Study on Aging. It certainly does bring to mind a classic in health informatics and epidemiologial research - The Framingham Heart Study of 1948 - which is still providing data for researchers. One can only imagine how the data generated from this research will be analyzed sixty years from now. Artificial Intelligence tools like IBM Watson and Alpha Go, which will probably be employed to help the data scientists, are just in the teething stage, compared to what their exponential computer grandchildren will be able to byte off.







Sunday, May 1, 2016

South Korean eHealth Connections


Today's post is about recent random connections between eHealth and South Korea.

I came across a South Korean eHealth company called Health Connect, which is collaboration between one of the largest telecommunication companies SK Telecom and the premier university in South Korea - Seoul University. Seoul University Medical Centre is one of the top NIH funded clinical trial research centres in the world. I like their website design. 


Earlier last year I was contacted by someone at Samsung Medical Centre about eREB (Research Ethics Board) online systems. They developed one of their own in-house systems for online research ethics review and I have a research interest in "in-house" eREB systems development ( having programmed and designed one myself). Too bad my Korean is still not good enough to understand everything on their website in Korean, even though I lived in Korea for almost 4 years, have a Korean family, and still watch Korean TV dramas every day!


I would like to bring to your attention the prevalence of the Fitbit device. I went to a Health & Safety meeting and noticed that half of the people were wearing Fitbits on their wrists. There are activity competitions with teams at work and people are buying more Fitbits because the cheap pedometers reset unexpectedly and data is lost. A year or so ago I read an article that Fitbit was a fading fad, but that just does not seem to currently be the case. Outside of work, I am seeing more and more people wearing and connecting to these devices. Some days they even look ubiquitous.

Now here is the surprising Korean connection - the President and inventor of the Fitbit, James Park, is Korean!


One of the major problems I am having now with my Fitbit device is Ubuntu. The Fitbit dongle and sync tracking isn't supported for Linux or Ubuntu. A program called Galileo was written for free by Benoit Allard. I had it working just fine when I was using Ubuntu 14.0 but then I just upgraded to Ubuntu 16 and it isn't working. I am hopeless trying to share two Fitbits on the Mac and the iPad so I really need to try to get this working again on Ubuntu 16 so I can sync and see my online data. I have started to sink my toes into the murky depths of the Ubuntu Galileo setup, without too much hope. Posted the bug on the Allard Galileo website though.

An interesting direction for Googles' Deepmind appeared in the news & I immediately tweeted it out on my eHealth Twitter feed: "Why does Google want British patients' confidential records"?  

I have blogged about Deepmind before < http://earthspiritendless.blogspot.ca/2014/02/ethics-boards-for-googledeepmind-end-of.html >. Deepmind recently was the technology behind Alphago, an artificial intelligence Go program that beat the best Go player in the world. The best Go player in the world is the South Korean Lee, Seodol, fitting for this slightly Korean blog post. It doesn't surprise me that Deepmind is following the way of IBM and Watson, using AI to find discoveries using big health data.

Well that is the South Korean eHealth Connection for now. 


Wednesday, July 1, 2015

Fitbit and Personal Health Informatics

A surprise gift for father's day was a Fitbit ChargeHR. The HR stands for Heart Rate, that measures beats per minute (BPM). It doesn't measure blood pressure, and I don't think any device like this on the wrist will be able to do that soon. I have been counting my walking distances, steps up stairs, calories and sleep activity for about a week now. It feels good to have entered the world of the "quantified self "and big data personal health informatics at more than just a theoretical level, as I have been doing on this blog for the past 4 years. I actually have a blog post about Fitbit from 3 years ago <here>!

The data is sent wirelessly to a small "dongle" on my MacBook anytime I am within 20 feet of it. I was surprised to see how this data easily integrated with Telus (Microsoft) Health Space (Healthvault) from the Fitbit.com login settings account. The power of the API is truly awesome.

As I knew before when I was looking at reviews for smart watches, the Fitbit ChargeHR is not a great watch for telling the time. However, one advantage is I find myself saving a lot of time by not looking at my watch to find out what time it is so often. All in all, I find myself wanting to wear it more than the old watch.

Sleeping with the watch is perfectly unobtrusive. There are continual double green sensor lights flashing for the BPM readings but it is hidden under the wrist. At a different viewing angle you can see the green lights. Double tapping at night will illuminate the clock (and day of the month) but during the day it is very difficult to see the digital time in glare of light of day. When you wake in the morning, sleep activity data is automatically transmitted to the MacBook or the Fitbit app on the iPad. via the dongle. The sleep data is a bit hard to interpret. Did I really only get 5 hours sleep? Anyway, I am starting to make some sense of the times I may have been awake or restless.

If you set a goal for 10,000 steps it will buzz on your wrist when you achieve the goal. You are also sent an email congratulating you, which is repeated in the weekly email data digest updates. I tracked food consumption for data on calories, sodium levels, etc. for a few days, and this is very interesting information for me. Since I have not really changed weight since I was a teenager, I don't really have any weight goals, but I know I can align readings from the gym equipment which tracks BPM and calories burned with the Fitbit. When I am not going to the gym, I can utilize those readings. But like I said, watching calories burned is not a science I follow much because of my metabolism.

Even though the data is integrated into the Telus HealthSpace, which is a free personal health record if you have a Microsoft login, I still don't find myself using the personal health record that much (yet). I also have a McMaster PHR (former MyOSCAR) and a Health and Wellness Companion PHR through my employer's health insurance company, in both of which I have just stepped into the shallow end of the pool. I tend to keep a Word document log and paper file of health related events a lot more. If the PHR was integrated with our family health team, I am sure I would use it more.

So, I think we are still a way off from wider adoption of personal health records as integrated tools for the physician's electronic medical record. A lot depends on more research, and of course evolving software breakthroughs like APIs. I am a community volunteer with the McMaster University Family Medicine TAPESTRY program, and I can see first hand the uptake on PHRs and how much education and training is required before they are being used effectively. On our visits to seniors in our communities we also help promote the use of the McMaster PHR. Like any technology, and the toothbrush comes to mind, use comes from developing good habits, as well as promotion from health care professionals.

Because we have entered a digital culture, many people will be entering a personal health record, not through their family medicine clinic, but through some form of personalized health informatics, like Fitbit data, or smart phone apps. There will be a point when physician medical practices will want to buy into accessing or making that data available.


Thursday, December 5, 2013

Data in Electronic Health Records for Medical Research

The Institute for Ethics and Emerging Technology had an excellent article by Donna Hanrahan entitled "Data Mining, Meaningful Use, Secondary Use, & Potential Misuse of Electronic Health Records". It has an excellent synopsis of what many clinical researchers, ethicists, and privacy experts have been saying for many years, about how data in the EHR can be used for medical research purposes.

There are ways to do that, like consent management, audit record logs, and increasingly better means to de-identify data and prevent it from being re-identifed. This latter work is really being pioneered by Dr. Khalid El-Emam. That is, before one would be able donate the data in the EHR to science, post-mortem.

I will copy in here just the section on how data in EHR can be used for medical research:

Beneficence of Electronic Data in Medical Research
Despite the ethical concerns addressed above, the use of electronic health data is critical to ensuring patient health, improving our healthcare system, and making new scientific discoveries in this technological age. Critics may question whether EHRs are truly meaningful or whether it is an “excessive bureaucratic requirement to spend public dollars on doctors’ computer systems.”xxxii This answer to this question can be discussed through the principle of justice. It is ethical, one could argue, to expend public funds for EHR systems that provides for the greater good and benefits for the public as a whole. Having data that is structured and easily retrievable benefits clinicians, patients, and the greater population. These benefits include safer prescribing, prevention of medication errors, epidemiological tracking to protect population health, and public medical error reporting. Furthermore, there is a clear need to switch from outdated, burdensome, and inefficient clinical charting traditions to electronic format.
EHR adoption aims to reduce cost, which is a primary goal of health reform in the United States. The increase in information available to clinicians can help prevent redundant or unnecessary tests and imaging. Furthermore, EHRs can provide point-of-care clinical decision support (CDS) as doctors prescribe tests, medications, and imaging requests, which can also help reduce costs. Lastly, “shared savings,” or “gain-sharing,” allows hospitals and healthcare providers to collaborate to reach quality metrics.xxxiiiAccordingly, EHRs enable users to measure desired outcomes and report this data more quickly and easily, saving both time and money. With regard to the costs associated with EHRs, studies have documented the strong return on financial investment that may be achieved following EHR implementation.xxxiv Other financial benefits include increased revenues due to improved care coordination, averted costs of paperwork, chart pulls, and billing errors, and fee-for-service savings including the rate of new procedures and charge capture. Furthermore, the secondary use of health record information is anticipated to become one of the healthcare industry’s greatest assets and the key to greater quality and cost savings over the next five years.xxxv In fact, a recent report by the McKinsey Global Institute, estimates the potential annual value to the healthcare industry at over 300 billion dollars.xxxvi These savings in cost benefit both the patient and provider.
There are also several patient-centered benefits that result from the “meaningful use” EHR data. Perhaps one of the most promising results of EHR data mining is the use of predictive modeling techniques to identify medical conditions and promote interventions before the onset of symptoms. Furthermore, retrospective analysis of the health data mined from EHRs could expedite scientific discovery in medicine by providing valuable information for research. In addition, physicians’ access to data and analysis could demonstrate the efficacy of different treatment options across large populations, which could help treat and prevent chronic conditions. Lastly, such data can be used to identify evidence-based best practices, identify potential patients for clinical trials, and monitor patient compliance and drug safety. These measures show beneficence towards the patient by providing better more individualized care.



Thursday, May 9, 2013

Consumer health information discoveries

I have been finding a lot of consumer health information websites, both local and international - a whole bunch of them - and I think it all started when I went to the announcement yesterday for the CISCO/McMaster University Professorship in Integrated Health Biosystems, as well as a Research Chair in Bioinformatics. This doesn't have a consumer health informatics label on it, but should have a Big Data one and be a separate post. Patients come into it when data from clinical trials will finally not go to waste but will be cross-linked with research databases to be put to use for medical research. If personal health records ever catch on, and patients consent to have data (whether de-identified or not - but probably de-identified) used for research, this would also be a mine of information as the original vision for PHR was to include genomic records, the intent being the development and perfection of personalized medicine.

This made me think of Dr. Danny Sands who teaches Medical Informatics at Harvard and is working for CISCO. He had a presentation at a conference (AHIC) where I was also delivering my first student paper presentation. Anyway, I read Danny's bio at CISCO which lead me to a blog he participates in called e-patients.net. It has interesting links to the Society for Participatory Medicine, and the Journal of same.

Impressed with that find, I came across by happenstance the meforyou.org website - a website that can cure you. For some reason this site reminded me about some research and journal articles I read, on how intercessory prayer doesn't work scientifically speaking.  It is a website inspired by Facebook new media but created by U of San Francisco:

UC San Francisco is the only university exclusively focused on human health. For 150 years, we've tackled the world's most vexing health issues, from diabetes and malaria to AIDS and cancer. We are driven by the idea that when the best minds come together, united by a common cause, great breakthroughs can be achieved. Because we believe it is perhaps the greatest single breakthrough that can be achieved, we have committed ourselves thoroughly to the realization of precision medicine. We began this movement knowing that we could not do it alone, and continue assured that we will do it together. Join us.

And then I found this surprising and local "searchless" health information website - hi - consumerhealthinfo.ca (a URL I wished I could have claimed). You can't not appreciate the layout, and user interface (think old people with no time to read extensively.) I think Dr. Mike Evans  ( Dr. Mike Evans curates the best health information found online. ) contributes to this site which lead me to his blog and website, which is simply brilliant, and this viral video!




And finally after this amazing journey just seemed to be beginning, Dr. Evans recommended the ultimate consumer health informatics website NHS.UK  I had recently read on a Yahoo website the UK's National Health Service was in the top ten biggest employers in the world! Well, a lot of them were busy preparing this website, and I relish reading their entire medical encyclopedia someday.

Monday, January 28, 2013

GeoCities is ReoCities?

In 1995 I was taking a career college diploma in Visual Basic/C Language programming wondering why we weren't learning HTML instead because something called the Internet was just starting to take off like crazy and soon websites (that require HTML to create) would be appearing all over the place. Well, it wasn't until about 3 years later when I was in South Korea teaching English as a Second Language did I finally find the time to learn HTML By that time everybody and his dog were starting to make websites.

The other day I did some google searching and actually found some of the first websites I had made. Let this be a lesson - everything posted on the internet lives forever, and Big Data has a long memory. I had thought GeoCities, the free website hosting service owned by Yahoo had disappeared into the trash heap of the WWW, but it has reappeared in the form of ReoCities. WTF is ReoCities?

Turns out ReoCities (RIP GeoCities) appears to be a sincere attempt to salvage the treasures that were Geocities, but sadly, much has been lost.

If you want to see the ridiculous website on Holistic Health in Canada (created in South Korea) here is the ReoCities link to it < Here >. Well, they say ex-pats  become the worst patriots or something like that. How best to observe and reflect on the doings one's fellow countrymen than from afar. And let that be an OM.



Saturday, November 17, 2012

Now that's getting personal: how small data is the new oil

I am not sure what to make of the personal.com company and application. There is a health information component, making it relevant to this blog. I am not sure I am so hyper concerned about personal information that I would use the personal login to access my facebook account. I suppose I am more of an exponent of open data, and even big data for that matter. Don't get me wrong. I understand the need for privacy and security of data. But "small data is the new oil"? They really might have something here:


Small data puts the power and tools of big data into the hands of people. It is based on the assumption that people have a significant long-term competitive advantage over companies and governments at aggregating and curating the best and most complete set of structured, machine-readable data about themselves and their lives – the “golden copy”. With proper tools, protections and incentives, small data allows each person to become the ultimate gatekeeper and beneficiary of their own data.
Built on privacy by design and security by design principles, small data can help people become smarter, healthier, and make better, faster decisions. It can help people discover new experiences more easily, reclaim time in their busy lives, and enjoy deeper, more positive relationships with others.

Saturday, November 10, 2012

Should diabetics eat grapes?


I was listening to an acquaintance of mine talk about her mother who was recently diagnosed with diabetes. She was debating with her whether or not grapes could be part of the diabetic diet. Where to get an answer on that one? Yes, make an appointment with a professional dietician, which is what she recommended to her mother.

But what do most people do? Right, they google. And, what do they find? Research has shown that most people will click on the first five search return links that come up (thus the lucrative power of Search Engine Optimization or SEO). But when searching for health information, which is one, if not the highest usage for internet searching, do most people know if they are getting reliable or trustworthy information? Anyone even heard of Health on the Net?

I just searched on "should diabetics eat grapes?" and I did not see some of the more trustworthy internet health sites out there, like mayoclinic.com or medline. I don't know if Canadians automatically go to their provincial health authority website to seek this information. There is a lot of research on health information seeking behavior, and what patients print off before they visit their family physician.

What I am getting at, is that the trend towards personalized medicine should be able to answer this question in the context of their personal health record system (which ideally has been prescribed or recommended to them by their personal family physician).  You could have a Dr. Watson type search engine answer the question. You could have data crunchers analyzing health information in the health record, comparing to the ocean of health data that could be analyzed. Genetic information could be a factor for grapes, blood type, and insulin levels. Socio-economic factors loom large, for example, what is a grape in a food desert?

But what I think the reality is, most people don't have personal health records or know how to set them up, and the personal health records that do exist, won't be able to automatically answer this type of question, though we all speculate that it should. The family physician should be answering this question, either through a referral to a nutritionist, or a diabetes guidance counsellor. 

And this has made me think that what we need are more self-tracking stations. These would be counselling services where people can go to learn and maybe even procure self-tracking technologies, like fitbit, personal health records, mobile smartphones with blood pressure cuffs, etc.  What if there could even be fMRI, ultrasound, and Transcranial Magnetic Stimulation machines in these stations. This would be one way to deconstruct medicine, and I would like to venture on this idea in a future post on practising medicine without a license. There are so many medical and other devices which can be used to support healthy living. Maybe the model of the York University "Health Coach" would fit this idea, or the Self-Tracking Station counsellor.



Wednesday, October 31, 2012

Let's pool our medical data and use consent in the EHR

This is a brilliant TED talk by John Wilbanks advocating for a voluntary big data commons for medical research. The < website > they have is fascinating from a bioethics/research ethics/consent point of view. Unfortunately, I would have to disagree that such a mechanism is necessary if more people were able to consent to have their medical data released for research through the Electronic Health Record or their Personally Controlled Health Record. I have looked for some sort of venue where citizens could donate their medical data to science, instead of just their mortal remains.
Uploaded by eHealthInfoLab on Jan 5, 2012 "EHR systems offer enormous potential to improve Canada's health system; however, privacy-related information governance issues must be resolved so that personal health information continues to be handled securely, confidentially and in compliance with legal and ethical standards. Joan Roch describes the work of the Canada Health Infoway-sponsored pan-Canadian Health Information Privacy (HIP) Group to resolve these issues. She focuses on privacy issues that emerge as EHR information moves across Canadian jurisdictions, and has developed a series of 'common understandings' to support such movement in an appropriate and privacy-protective manner. Ms. Roch is Chief Privacy Strategist at Canada Health Infoway." And here is the problem for the personal health information flow to medical research - privacy and security regulations. It is not an insurmountable problem, as data de-identification becomes more rigorous, and the mechanisms of online consent become more robust.

Saturday, October 20, 2012

Paging Dr. Watson


I did watch Watson defeat the best Jeopardy players in the world, when - last year or so - and of course as an eHealth student, I knew this would be a fantastic machine to program for medicine, in particular, diagnosis.  I knew about other attempts at artificial intelligence for diagnosis like Isabel.  Isabel is one of the leading "differential clinical decision support" tools for physicians.  There were many early experiments in artificial intelligence for medicine, and I believe the editor our our Biomedical Informatics textbook, Edward H. Shortliffe, was also an early pioneer, as the chapter would attest. The writer on this article on "Paging Dr. Watson" mentions a book called "How Doctors Think".  I read it, and it is excellent.  Another book that is relevent is "Every Patient Tells a Story" by Lisa Sanders, who advised on the House TV series.  One theme of the book is the loss of skill in the physical exam by physicians and the over reliance on technology for diagnosis.  I am just saying. 

 

 

Paging Dr. Watson: artificial intelligence as a prescription for health care

October 18, 2012

(Credit: IBM)
“It’s not humanly possible to practice the best possible medicine. We need machines,” said Herbert Chase, a professor of clinical medicine at Columbia University and member of IBM’s Watson Healthcare Advisory Board, Wired Science reports.
“A machine like [IBM's Watson], with massively parallel processing, is like 500,000 of me sitting at Google and Pubmed, trying to find the right information.”
Yet though Watson is clearly a powerful tool, doctors like physician Mark Graber, a former chief of the Veterans Administration hospital in Northport, New York,  wonder if it’s the right tool. “Watson may solve the small fraction of cases where inadequate knowledge is the issue,” he said. “But medical school works. Doctors have enough knowledge. They struggle because they don’t have enough time, because they didn’t get a second opinion.”
According to Chase, doesn’t fully appreciate Watson’s value in bias-free second opinions. “The machine says, you thought of 10 things. Here are the other five,” he said. “You’ve probably seen Jerome Groopman’s book, How Doctors Think, about the mistakes doctors make. A simple one is anchoring: You get stuck to some diagnosis. We’ve all had that experience. A machine can change its diagnostic profile on a dime based on new information. One of the things a machine is not is biased.”
Graber warned that doctors will need to guard against a new source of bias: over-reliance on Watson. “When I use my GPS too much, I never really learn the layout of a new city,” Graber said. “Same story.”
He and Chase also disagree on the implications for health costs. Chase sees Watson helping doctors and patients reduce eliminate unnecessary tests and treatments, whichnow cost $750 billion per year. Graber fears that Watson’s ability to identify many possible diagnoses will encourage patients to ask for even more tests and procedures, setting off a cost-inflating “diagnostic cascade.”  …
(more)

Monday, September 24, 2012

Quantum Computing and eHealth

If you want a glimpse of the future, subscribing to IEET is probably the best way to go, though I think many writers tend to be overly optimistic.  This article on Quantum Computing and the future of health in 20 years might be one such, but who knows. I didn't know that a Canadian company D-Wave, developed the first QC machine.  Their website has an interesting article on how QC programming is different from regular programming, which reminds me a little about Bell's theorum.


Quantum Computers: Headband Telepathy, Medical Advances, and more!


Dick Pelletier
Dick Pelletier
Positive Futurist

Posted: Sep 22, 2012
Quick: without grabbing your cell phone, tablet or PC, when did Earth population reach 7 billion? In the near future, the answer might be immediately whispered into your ear, “October 31, 2011.”
Any query you can think of will soon be answered with a headband that gathers data from the Internet and feeds it directly into your brain, say Peter Schwartz and Rita Koselka in this Fortune Magazine article
Stuart Wolf, Nanostar director at University of Virginia predicts an even more Earth-shaking change. Within 20 years, he says, instead of cell phone conversations, we will have “network-enabled telepathy;” communicating directly to another person’s headband, using just our thoughts.   
Recognizing thoughts instead of ‘voice-speak’ may be confusing at first, experts say, but with training, “thought-talking” could one day become the preferred way for humans to communicate with each other.   
How do quantum computers think? This 5 minute video explains. The world’s first QC, D-Wave One, was made and sold by D-Wave Systems to Lockheed Martin, to solve security issues. The 7-minute video below offers more details on this groundbreaking project:
  
QCs will accelerate advances in medical technologies. In a paper published recently in Nature Scientific Reports, Harvard researcher Alan Aspuru-Guzik presented results of the largest protein folding problem solved to date using a quantum computer. QCs will accelerate advances in many areas of life sciences, including drug and vaccine design, Aspuru-Guzik says.   
The following scenario imagines what life could be like in tomorrow’s quantum computer future:   
“It’s the year 2030, and as I glance around my bedroom, I feel secure knowing that microscopic sensors embedded throughout the house constantly monitor my breathing, heart rate, brain activity and other vital health issues. For example, blood extracted last night by the bathroom sink checked for free-radicals and precancerous cells, and then ordered all the necessary preventative drugs from the home nano-replicator. 

  
As I step into the shower, wall tiles display the day’s top headlines: ‘Mars mission launches ahead of schedule;’ ‘Military drones destroy another terrorist training camp using ‘smart dust;’ and ‘today is the 20th anniversary of the first quantum computer.’
Glancing in the mirror, I find it hard to believe that I will celebrate my 100th birthday later this year. Having recently opted for total body rejuvenation, my reflection displays the image of a healthy twenty-something, with wrinkle-free skin, perfect sight, original hair color, strong muscles and bones; and an enhanced brain that, although it took some getting used to, has greatly increased my intelligence.
Getting ready to fly to a conference, my auto-drive electric car rolls its top down on this warm day. I manually drive to the electronic roadway on-ramp, and then relinquish the wheel to the vehicle. Arriving at the airport, my ‘smart’ car drops me off at the terminal, and then returns home. An ‘intelligent cam’ scans my mind and gives an instant approval, no waiting for ticket-check or security.
While boarding the plane, I see a familiar face. My headband immediately flashes his identity data and displays it on my eyes. Dr. Jones, I call out. It’s so nice to see you again. How was the conference? Only a slight flicker of Jones’ eyes betrays that he is Googling my details too. Hi Dick; the conference was great; and congratulations on your Estonia presentation.”
Welcome to the future! Headbands, because they can access all of the information on the Internet, enables us to think of any issue; then immediately receive data pertinent to that issue in our eyes or ears.
In another application for the technology, the necessity to learn languages would disappear. This would allow more friendships to develop; and if the devices were cheap enough, which experts claim will be a certainty with nano-replicators expected in this future time, headbands would be affordable for everyone.
These techno-wonders hold great promise to improve relationships. No more forgetting names and details, plus increased intimacy generated by thought-talking could bring people around the world closer together, creating a Global Village; a society acting as one voice to advance peace. Comments welcome.

Dick Pelletier is a weekly columnist who writes about future science and technologies for numerous publications. He's also appeared on various TV shows, and he blogs at Positive Futurist.

Monday, July 30, 2012

Tetherless World Constellation

http://tw.rpi.edu/web/

This educational and research program at Rensselaer University is fascinating.  The name of the program - Tetherless World Constellation - itself is intriguing. Yes, the WWW is anything but tethered. There are health informatics programs of study here, though it is just one of the X in what they call Xinformatics - general areas of informatics study.   I notice that the template for the website is the garland theme in Drupal, one I used to use, and I like the way they have designed the navigation.

Wednesday, May 9, 2012

Two ehealth mysteries

One well known ehealth mystery is typified in the Infoway TV commercial called "Knowing is Better" but takes that scenario one step further.  The comatose patient arrives in the ER with absolutely no identification. How should medics treat the patient?  RFID chip implants was proposed as one solution and there are cases where this may have saved patients. For many reasons the implant idea is not catching on. Nanotechnology might be able to create an identification code, written into our cells, that when scanned leads to a "break the glass in case of emergency" login to an EHR. Research has shown that most patients want the ER to have their health information in an EHR if they were to arrive there from out of the blue.  The same high percentage is equally concerned about the privacy and security of their health information.

The next ehealth mystery is one that is actually being developed now, but by small increments.  It is the scenario of ubiquitous computing, where any contact with the healthcare system generates digital information which is potentially transportable and interoperable through the Health Information Access Layer (HIAL) to a personal health record (PHR).  Everything would be interconnected through Service Oriented Architecture (SOA).  I have heard citizen advocates for PHR say that all forms of healthcare and wellness should be integrated.  That means anytime you visit the dentist, naturopath, personal gym trainer,  use a mobile device like fitbit, nutritionist, physiotherapist, psychologist, data from that interaction is captured, transported, tracked and analyzed in the PHR.  This is a Big Data world where public health and research have consent access to de-identifiable information. This is also the world where the "virtual self" continues to exist long after one is gone. 

Friday, April 20, 2012

Sample Kurzweil Accelerating Intelligence Weekly NewsFeed


Honeywell and Inmarsat to modernize global in-flight connectivity
Researchers boost efficiency of multi-hop wireless networks
Disruptive innovation — in education
Photoreceptor transplant restores vision in mice
New free online computer-science courses from Princeton, Stanford, UMich, Penn start Monday
Breakout Labs announces first grants to support radical scientific innovation
Brain-activated muscle stimulation restores monkeys’ hand movement after paralysis
How the presence of water changes the structure of an antibiotic
Low-cost mini-sensor measures magnetic activity in human brain
Nanomaterials offer new hope for cerebral palsy
Neal Stephenson on science fiction, building towers 20 kilometers high … and insurance
New microscope captures nanoscale structures in dazzling 3D
Serious Blow to Dark Matter Theories?
A statistical model of the network of connections between brain regions
Iris recognition report evaluates ‘needle in haystack’ search capability
Page, Cameron, Simonyi, Perot to back launch of new space venture to ‘ensure prosperity’
Spoiler alert: Your TV will be hacked
Fine-scale analysis of the human brain yields insight into its distinctive composition
Tim Berners-Lee tells U.K. that its latest snooping bill is ‘destruction of human rights’
Google Drive detailed: 5 GB for free, launching next week for Mac, Windows, Android and iOS
Nanotube electrodes may lead to solar cells at a fraction of the current cost
Nanocrystal-coated fibers might reduce wasted energy
Computer scientists build computer using swarms of crabs
Powerful X-ray technique reveals structure of printable electronics
Boron-treated carbon nanotubes soak up oil from water repeatedly
Scientists create nanoparticles that image brain tumors, increasing accuracy of surgical removal
Free videos for new iPad apps programming course at CMU now available
Fullerene C60 administration doubles rat lifespan with no toxicity
Designing the interplanetary Web
Mavericks invent future Internet where Cisco is meaningless
Homegrown labware made with 3D printer
Web freedom faces greatest threat ever, warns Google’s Sergey Brin
Is there a Japanese plan to evacuate 40 million people? [Disinformation]
Will a Dutch discovery lead to understanding dark matter and a real quantum computer? UPDATE APR 17
UCLA-engineered stem cells seek out and kill HIV in living organisms
New genes linked to brain size, intelligence
Baboons can learn to recognize words
Discovery could help to develop new drugs to treat organ transplant and cancer patients

Thursday, March 15, 2012

Embedding Privacy into the Design of EHRs to Enable Multiple Functionalities

I like to follow the Information & Privacy Commissioner for Ontario, because of the insights into leading edge healthcare technology, of course in the context of privacy and security. The topic of this paper, co-written with the Infoway President is quite good. What struck me in the article was the reference to "Big Data". Is this going to become a common way of calling research using regression analysis and evidence-based medicine? "Big Data" goes far beyond just healthcare: http://www.ipc.on.ca/images/Resources/pbd-ehr-e.pdf
"As we move into an era of “Big Data,” PbD offers a holistic, proactive approach to privacy protection that can help to anticipate and address the “big harms” to privacy that are a foreseeable danger of Big Data. At the same time, PbD recognizes and aims to facilitate the benefits of harnessing Big Data for socially useful applications. In the context of designing and implementing EHR systems, PbD seeks to protect the privacy of individuals whose personal health information is contained in EHRs while enabling multiple goals – privacy and security, individual and societal benefits, confidentiality and data quality. In this way, PbD facilitates access to health information for secondary purposes while at the same time protecting the privacy and confidentiality of health information held in the EHR. This is accomplished by embedding privacy and security directly into EHR systems, through the routine de-identification of personal health information for secondary purposes, end-to-end security, and other mechanisms discussed elsewhere in this paper. PbD offers a means of elevating privacy in the Big Data world to an effective countervailing force that we are calling “Big Privacy” – a method of ensuring that privacy is embedded as a first consideration in all Big Data transactions. Consistent with PbD, the Pan-Canadian Health Information Privacy Group proactively considered the privacy implications of secondary use in its paper outlining general principles for information governance in the EHR environment."
http://www.ipc.on.ca/english/Home-Page/

Sunday, March 11, 2012

HL7 and NCI collaborate on clinical trial link to EHR

The HL7 group is trying to do UML models for almost anything that has health related data. This new initiative is a hat tip to Big Data and Public Health. The patient, the little guy in the whole operation, might even benefit. Hopefully, there will no longer be a disconnect between the evidence collected through participation in clinical trials, and electronic medical records. That goes as well for Personal Health Records. Both record systems are potentially rich sources of evidence based medical data, if only there were more efficient ways to capture it, without jeopardizing the autonomy and consent of patients. http://www.fiercehealthit.com/story/hl7-and-nci-collaborate-clinical-trial-link-ehrs/2012-02-28

Tuesday, February 28, 2012

What do predicting wine quality and evidence-based medicine have in common?

The answer is McMaster University and a book by Ian Ayers, called "SuperCrunchers, Why Thinking-by-Numbers Is the New Way to Be Smart" Through regression analysis and crunching the numbers, the quality of wines can be predicted just as well as by expert wine tasters - in advance of the harvest. There is a chapter on how McMaster University medicine developed the science of evidence-based medicine - also by looking at the numbers. This is the dawning of the age of Big Data, as we all should know.