Challenge 5: Towards Sustainable and Personalised Healthcare: Current State-of-the Art and Opportunities Within the FP7 ICT Call 1

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Challenge 5 Towards Sustainable and Personalised
Healthcare Current State-of-the Art and
Opportunities Within the FP7 ICT Call 1

• Panagiotis BAMIDIS
• Lab of Medical Informatics, Medical School,
• Aristotle University of Thessaloniki,
• Thessaloniki, Greece

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Talk Roadmap

• Healthcare in EU
• eHealth
• Before FP7
• To FP7

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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

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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

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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 Unions 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

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RD 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
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RD activities at EC (cont)
FP2 ESPRIT
FP3 RACE/AIM
FP4 TELEMATICS
FP5 IST/Health Applications
FP6 eHealth
Medical Informatics
Health Telematics
eHealth
Personalised eHealth
1991
2002
Total 600M (15Years)

• 20M
• 30 Projects
• Feasibility Study

• 100M
• 63 Projects
• AIM Community

• 140M
• 158 Projects
• 1st wave of products

• 200M
• 125Projects
• EU Telematics Industry

Source R. Zobel, eHealth 2003 Conference
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Personalized eHealth
Medical Informatics
Bio Informatics

• Electronic Health Records
• Medical Imaging
• Clinical Decision Support
• Telemedicine

• Functional Genomics
• Proteomics
• Computational Biology

Personalised eHealth Knowledge
Neuro-Informatics

• Machine Learning
• Knowledge Discovery
• Human Computer Interfaces

Source R. Zobel, eHealth 2003 Conference
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Personal Health Systems - PHS

• 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

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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
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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

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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-s
  tudies.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)

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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)

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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

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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
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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

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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

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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

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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

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FP7 Objective 3.5.1.1 (4)

• (c) Additional Support Actions on
• RD roadmap on Personal Health Systems
• emerging technologies and potential applications
• user demand and business aspects
• ethical and legal considerations
• Wireless transmission of health-related
  information
• reliability aspects
• need for exclusive radio frequency bands?
• Interoperability of Personal Health Systems with
  other eHealth systems
• promotion and recommendations for continuous care

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FP7 Objective 3.5.1.1 (5)

• 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

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More on ICT WP 2007-08Challenge 5

• Advanced ICT for Risk Assessment and Patient
  SafetyObjective IST-2007.5.2

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Research proposed in Objective IST-2007.5.2

• 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.

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Research proposed in Objective IST-2007.5.2

• 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

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Research proposed in Objective IST-2007.5.2

• 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.

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Funding in Objective IST-2007.5.2
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ICT in support of patient safety and risk
management in healthcare
Source Symbion Communications- and Technology
Research, IST event 2006, Helsinki
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ICT in support of patient safety and risk
management in healthcare
ICT 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

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More eHealth in FP7

• The Virtual Physiological Human(VPH)...

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Biomedical informatics background

• Biomedical information is collected, stored and
  processed on/at
• Different Levels molecule, cell, tissue, organ,
  patient, population
• Different Context - care, research, education,
  policy/management
• Different Representation format, structures,
  ontologies,..
• 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,

Source Joël Bacquet , IST event 2006, Helsinki
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Synthesis of all Health information levels
BMI enables integration of biomedical data for
better health (Molecular medicine)
Public Health Informatics
Population
Patient
INFORMATICS
Medical Informatics
Tissue, organ
Cell
Bioinformatics
Health Information levels
Molecule
Based on Fernando Martin Sanchez
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The Virtual Physiological Human - concept
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
Source Joël Bacquet , IST event 2006, Helsinki
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Neurotransmitter studies Transmitter-Receptoc
Fingerprints
Animal Experiments
Molecules
Multi-parameter Analysis
AnatomyCytoarchitectonic info
Ontologies for semantic deposit and extraction of
knowledge
Single neuron recordings
EPSPs
IPSPs
Multi neuron recordings
EEG
MEG
Behavioural/Cognitive/SocialStudies
Other functional Neuroimaging(Blood flow)
Genetic Studies
Search for biologicalbasis of social cognition
PET
fMRI
Functional Neuroimaging of genetic variation
Bridge gap b/w morphology physiology
inconsistencies
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Imaging Genomics
Complex functional interactions Behavioural
phenotypes
genes
cells
systems
behaviour

• 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.

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Objective 3.5.2.1 Virtual Physiological Human

• Technical focus on
• 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

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Objective 3.5.2.1 Virtual Physiological Human

• Technical focus on
• 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

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Objective 3.5.2.1 Virtual Physiological Human

• Application focus on
• 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

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Objective 3.5.2.1 Virtual Physiological Human

• Networking action (NoE)
• in multilevel modelling and simulation of human
  physiology
• sharing of knowledge
• multidisciplinary training programmes
• reusable software tools
• Coordination Support Actions
• Enhancing security and privacy in modelling and
  simulation addressing
• patient data processed over distributed networks
• use of genetic data
• Trustworthy environment
• International cooperation on health information
  systems based on Grid capabilities

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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

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The future will tell
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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 bamidis_at_med.auth.gr http//l
omiweb.med.auth.gr