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Up2013 hie cloud_kamran_ghane
- 1. Improving Healthcare through Healthcare Information Exchange and Analytics Using Cloud Kamran Ghane Anagira, Inc. December 3, 2013 12/4/2013 1
- 2. Healthcare Information Actors Complexity : Owners / Regulations / Standards 12/4/2013 HL7 CDA DICOM LOINC SNOWMED CT ASTM CCR CCD HIPAA ICD-9/10 CPT-4 RxNorm NCPDP CMS PQRI CVX ANSI X12 2
- 3. Healthcare Information Control/Exchange • Financial Scope/Drive • $3 trillion spent annually on health care in the U.S. • Location / Exchange • • • • EMR/Multiple Providers (Primary, Specialists, Hospitals, …) Laboratories (RIS, PACS, Genetics, ..) Insurance Company Records Pharmacies • Control • Healthcare Provider Entities, Data Creator / Data Center 12/4/2013 3
- 4. Cloud Roles • Facilitating Interoperability and Healthcare Information Exchange (HIE) • Storage • Cloud benefits such as Scalability, TCO, CapEx, etc. • Medical Imaging Data Storage • DNA Sequencing (Data Storage, Intensive Computations) • • • • 12/4/2013 Burst Computing (Life Science) Analytics Data Mining Mobility Support 4
- 5. Cloud Implementations • Approaches: • Public • Infrastructure As A Service (IAAS): • Network, Storage, Computing Resources and Virtualization Technology • Platform As A Service (PAAS) • Automation, Database, Middleware, Tools • Private • Hybrid • Factors: • Security and Regulatory Compliance • Control of Data, Liability • Total Cost of Ownership (TCO) 12/4/2013 5
- 6. Healthcare Information Exchange (HIE) in Cloud • Cloud as Intermediary/Clearing House • Cloud provided Security/Access Control • Users of the same solutions in the cloud (not statistically significant at present) • Implementation of Standards (HL7, DICOM, ...) • Coding (LOINC, SNOMED, etc.) • Master Data Management 1) Health Level 7 2) Digital Imaging and Communications in Medicine 3) Logical Observation Identifier Names and Codes 4) Systematized Nomenclature of Medicine-Clinical Terms 12/4/2013 6
- 7. Cloud Storage / Processing • Scalibility, TCO, CapEx, etc. • Medical Imaging Data Storage • Size of Image • Number of Images • DNA Sequencing Data Storage • Volume of Data • Processing Time • Security • Control 12/4/2013 7
- 8. Analytics in Cloud • Data Warehouse in Cloud • Collection of Anonymized/De-identified Data • • • • 12/4/2013 Reducing Errors and Improving Quality of Care Improved Risk Management Regulatory Compliance Prevention, Disease Management 8
- 9. Data Mining in Cloud • Decision Support for • Diagnosis • Treatment • Privacy • Informed Consent Form (ICF) • De-identification (Re-Identification problem) • Cyber Security 12/4/2013 9
- 10. Mobility Support in Cloud • • • • • 12/4/2013 Data Access Security/Access Control Mobile Device Management (MDM) Mobile Application Management (MAM) Bring Your Own Device (BYOD) Support 10
- 11. Next Generation DNA Sequencing • DNA Sequencing changing healthcare • Improving and becoming cheaper rapidly • Mapping Genetics to Disease • Genome-Wide Association Studies (GWAS) • Risk models powered by • • • • demographics genomics, lab tests, billing records • Protection by Genetic Information Nondiscrimination Act (GINA) 12/4/2013 11
- 12. Big Data => Big Information • High Information Content => Knowledge • Hereditary Diseases • Genome-wide association using DNA sequencing • Skewed by common ancestors • Linear Mixed Models (LMMs) • Clinical Data: E.g. Drug-to-Drug Interaction • Statistical Methods • Hypothesis Free (Cause & Effect vs. Correlation) • Mix of Clinical Data and Genomic Data • Bucketing people much harder (than Amazon like data) 12/4/2013 12
- 13. Summary • Cloud Roles: • • • • • 12/4/2013 Healthcare Information Exchange (HIE) Medical Imaging Data Storage/Retrieval Facilitating Mobility Genomic Data Storage/Processing Analytics/Data Mining (Diagnosis/Treatment Support) 13
- 14. Thanks for Listening Kamran Ghane Anagira, Inc. kghane@anagira.com 12/4/2013 14
Notes de l'éditeur
- Traditional Sequencing: 96 sequencing reactions carried out per run.Next Generation Sequencing: 52 million reactions per run.Sequencers are improving at a faster rate than computers are. Computing, not sequencing, is now the slower and more costly aspect of genomics research. both better algorithms and a renewed focus on such “big data” approaches as parallelization, distributed data storage, fault tolerance, and economies of scale.
- Personalized MedicineInformed Consent Form(ICF)Let subjects or patients know that their privacy information might be informed by researchersDe-identificationA process by which a collection of data is stripped of information which would allow the identification of the source of the dataRe-Identification technology moves faster than de-Identification
- Mount Sinai Medical Center: 1406 beds plus medical school treating half a million patients per year, biobank with 26,735 patient DNA and plasma samples$3M supercomputer, $120M EMRReference GenomeOnly bases that are distinct from the reference need to be saved0.1% of the data are different from referenceGenetic Information Nondiscrimination ActOfficially enact in 2008An act to prohibit discrimination on the basis of genetic information with respect to health insurance and employment
- Heart Disese, Asthma, many forms of cancerThis skews research results because certain positive associations between specific genes and the disease are false positives—the result of two people sharing a common ancestor. And at Medco, big data analytics has already reaped dividendsby uncovering drug-drug interactions. For example,clopidogrel (Plavix™) is a widely used drug that preventsharmful blood clots that may cause heart attacks or strokes.However, researchers were concerned that certain otherdrugs—proton-pump inhibitors used to reduce gastric acid production—might interfere with its activation by the body.Using their database, Medco looked for differences in two cohorts:those on one drug and those on the two drugs that potentiallyinteract. The study revealed that patients taking bothPlavix and a proton-pump inhibitor had a 50 percent higherchance of cardiovascular events (stroke or heart attack).A similar study showed that antidepressants block the effectivenessof tamoxifen taken to prevent breast cancer recurrence.Patients taking both drugs were twice as likely toexperience a recurrence.“Both of these studies are prototypical of the kinds of questionswe can ask in our database where we can correlate pharmacydata with clinical outcome data,” Frueh says.GNS Healthcare