1、Health Information Database Application巨量医疗健康生活数据分析与应用Big Data for Biomedical Applications,1,2015-06-26徐州医学院急诊医学两岸学术交流综合论坛,Chien-Yeh Hsu 徐建业 PhD台北护理健康大学信息管理系所 National Taipei University of Nursing and Health Sciences 台北医学大学医学信息研究所Taipei Medical University台湾医学信息学会Taiwan Association for Medical Inform
2、atics TAMI,2,Roadmap for ICT Development in Taiwan,行政院,m-Taiwan（2005）,NHIP & U-Taiwan （2008）,Ubiquitous e-Service,Mobile Services,Web GovernmentServices,Web HealthcareServices,HealthInsuranceIC Card,HIS,HIN,NII,Tele Medicare,Construct Healthcare Informatics Infrastructure,PersonalHealthcareRecord,20
3、02,2005,2008,ElectronicMedicalRecord,2011,Governmente-Service& e-indus-trialization,International Trend,Application Trend,Development Trend of Taiwan Health Systems,4,The NHI VPN国家卫生基础设施,HIN,NHI VPN,IDC,NHI local offices,NHI head-quarter,CDC,17,000Clinics,DOH,SC,Admin,BOH,HCA,600Hospitals,5,000Pharm
4、acy,Other 100HIS,IDC Internet Data CenterSC Service CenterHIN Health Information NetworkNHI VPN Virtual Private Network, 【1-1】个人健康照护信息整合云端服务执行单位 医学信息学会,卫生健康云规划, 【3-1】远距健康照护服务计划执行单位 卫生署照护处、工研院, 【2-1】诊所病历云端备份服务执行单位 卫生署医事处、工研院,数据源：资策会-创研所整理, 2010,1-1 个人健康照护信息整合云端服务2-1 诊所病历云端代管及备份服务2-2 署立医院医疗照护云端服务3-1 远
5、距健康照护服务计划4-1 健康数据加值中心网络化服务, 【2-2】署立医院医疗照护云端服务计划执行单位 卫生署医管会、署立医院、资策会,【4-1】健康数据加值中心网络化服务执行单位 卫生署统计室、资策会,Medical services,Rehabilitation &Follow-up services,Healthcare services,from Dr. Hsu, Min-Huei, DOH, Taiwan,Big Data and Information,Innovation, Social NetworkingWellness, travel, sport, dietary,Val
6、ue of service mode, Need more evidence, Insurance,7,HCA Card医事人员卡及医保卡,RSA Card issues from HCAto health professionals,non-RSA Health insurance IC Card for all citizens,8,Establishing EMR in Taiwan,Vision: At any hospital, a patient can get his/her integrated medical records using the health insuranc
7、e IC card under the agreement and authorization of the patient.Goal: By 2012, 80% hospitals(400, no clinics) DICOM and report, Test reports, and medications, 60% hospitals can exchange EMRs。By 2014-(2016) complete EMR and exchange for all hospitals,9,Medical Information Exchange Center MIEC 2000,10,
8、Hospital Information System,LaboratoryInformation Systems,TMT mini-server,个人化健康信息整合架构TMT File Exchange Pathway,Hospital Information System,Paperless server,TMT mini-server,LaboratoryInformation Systems,1,2,3,TMT viewer,Pre-Authorized,4,Internet Health and Life Supporting Data Bank,EMR Exchange Cente
9、r,National EEC Center,EMR providing Hospitals,EMR Reading Hospitals,Download, Querying, and Reading,12,Ministry of HealthImage Exchange Center,Health Insurance Center,Hospital A,Hospital B,Index Server,CPOE,CPOE,Download image,Download image,Radiology,Radiology,Image Report Database,Image Report Dat
10、abase,eSignature,Dual Card system and inform consent,Dual Card system and inform consent,Request for image,Request for image,134 hospitals, 2010-2011 upload index 2,168,063 request: 6,592 download: 81,108,Lets ask google about “big data”,What Is Big Data?,High-volume (大量)High-variety (多种类)High-veloc
11、ity (快速)sources such as online personal activity, commercial transactions, and sensor networksRelating to health is a component of a growing field.e.g., e-health, m-health, digital health, health information technology, health 2.0, e-medicine, etc.Nilsen W, et al. J Health Commun, 2012. Laney D. MET
12、A Group, 2001.Kumar S, et al. Computer, 2012,Bio-Medical and Health Informatics needs Analytics,医院信息系统快速的发展,各类数具快速大量的累积,需要分析数据来改善健康照护,What is BIG DATA?,Wikipedia: a collection of data sets so large and complex that it becomes difficult to process using on-hand database management tools. The challeng
13、es include capture, curation, storage, search, sharing, analysis, and visualization. The trend to larger data sets is due to the additional information derivable from analysis of a single large set of related data, as compared to separate smaller sets with the same total amount of data, allowing cor
14、relations to be found to spot business trends, determine quality of research, prevent diseases, link legal citations, combat crime, and determine real-time roadway traffic conditions”.,http:/ about human brain? The Human brains memory storage capacity compares to something closer to around 2.5 petab
15、ytes (or a thousand Terabytes); which hold three million hours of TV shows. You would have to leave the TV running continuously for more than 300 years to use up all that storage.,How Big is BIG DATA?,Database Size,Mb,Gb,Tb,Pb,Eb,Human brain capacity 2. 5 Pb,NIH BTRIS DW 42K patients with 4 billion
16、rows; 1 Tb,Human Genome (compressed) 10 million articles 100 research papers a year,健康加值数据的价值,Secondary Use(加值应用或二次运用)去识别化之健康资料为世界趋势美国早已在20年前开放全国住院数据供研究者使用新的治疗方式、疾病的诊断、药物之副作用、疾病之关联性等若没有完整开放健康加值资料将严重损害广大病人之权益,From Prof. Jack Li,健康数据加值应用思维健康与社会关联,社会结构(Social structure),物质环境(Material factors),劳动环境(Work
17、),心理环境(Psychological),社会环境(Social environment),健康行为(Health behaviors),生理病态的变化(Pathophysiological changes)器官损害 (Organ impairment),健康 (Well-being)罹病 (Morbidity)死亡 (Mortality),脑(Brain)神经内分泌与免疫系统的反应(Neuroendocrineand immune response),幼儿期环境(Early life),遗传因素(Genes),文化因素(Culture),数据源(Source)：Social determi
18、nants of health,2006,33,Cross-databank analysis,Databank A downloadingEncryption of individual data,Databank B downloadingEncryption of individual data,Generating processed collective results,Abolish the downloaded database, only collective results can be taken out from isolated area,Algorithm of Cr
19、oss-databank Analysis With Physical Isolation,35,健康数据加值应用,世代追踪应用,From 卫生署统计室,健康数据加值应用,健康与社会的关联社会经济、劳动条件、幼儿期、遗传、文化等对健康的影响,卫生政策的评估医疗、保健、防疫、全民健保政策实施成效的衡量、评估与建议,数据整合应用,36,From 卫生署统计室,Examples of value-added application,Cohort Study for Hemodialysis,38,Source: Translated from Huang SM,Suicide vs. Psychot
20、ropic Medication,39,Medical visit in same year: 83.2%,No medical visit in same year: 16.8%,Psychiatric visit38.3%,Non-psychiatric visit44.9%,No1.3%,Yes17.6%,Never psychiatric medication: 1.3%,Suicide no. (2002-2005): 10,945,PsychotropicDrugs, yes:37.0%,Ever psychiatric medication: 35.7%,No27.4%,Sour
21、ce: Translated from Huang SM,20 80 Rule?,Gini coefficientY2008 = 0.711Y2003 = 0.696,23% patients account for 80% expense,*X-axis shows cumulated medical expenditure, Y-axis shows cumulated patient number (both by % of total)Source: Translated from Huang SM,41,集成健康加值应用中心Application of Health Databank
22、s,Phase 1,Phase 2,Distant User,台北醫學大學健康暨臨床研究資料加值中心平面圖與現況圖Taipei Medical University,42,左側隔間使用者坐位8個，2名管理人員坐位(左邊隔間左下角以及右邊隔間左下角),Health Insurance DB,Cause of Death DB,Cancer Register DB,Household (census) Register DB,Integrated Data Center for Bio-medical Informatics,Public Health Administration,Epidemi
23、ology,Health CareManagement,Others, ,Limited Data Set,Continuity Research,Tool Kits,User,主動式具有分析評估能力的主題式資料架構 2010Data Architecture by Subjects with Active Analysis and Assessment,Regular Data Released,Provide Data,Redundant /Feedback,未通過專法，本中心不直接釋出資料,De-identification,Data Released after IRB approva
24、l,資料庫,生統報表資料集:報表資料/彙整資料集,臨床研究資料集:線上即時分析報表,次級資料/資料超市,連結資料庫,ETL工具,資料查詢與維護,行政院衛生署統計室,糖尿病確診後罹患為肝癌之預測模型-預測表現,糖尿病確診後罹患為肝癌之預測模型應用系統,CLOUD COMPUTING FOR PERSONALIZED HEALTH CARE Achieving Meaningful Use of EMR/PHR,Meaningful Use of Health/Medical Information - 4P Medicine,PersonalizationParticipationPredict
25、ion PreventionMore PsHealthcare PromotionPrecision medicinePayment system,Dr. Leroy E. Hood,49,A Definition of Personalized Medicine,Personalized medicine is the use of information from a patients Phenotype/genotype to: initiate a preventative measure against the development of a disease or conditio
26、n, or select the most appropriate therapy for a disease or condition that is particularly suited to that patient.,Definition paraphrased from www.wikipedia.orgOther sources: Jones, D. Nature Reviews Drug Discovery 2007; 6:770-771; Katsanis et al. Science 2008; 320(5872):53-54; Feero et al. JAMA 2008
27、; 299(11):1351-1352,健康照護雲端運算服務-A Personalized Wellness Ecosystem on Cloud,50,個人健康管理議題是全球健康醫療關注的焦點Pervasive Personal Health Management ServiceContext aware health monitoring健康監測Personal Health-aware devices個人裝置Intelligent alert management智慧管理Pervasive lifestyle incentive management生活方式Pervasive acces
28、s to healthcare information健康資訊Preventive Care & Chronic Disease Mgmt疾病管理Social Health Promotion社會健康,Source：Pervasive Healthcare as a Scientific Discipline, Methods Inf Med 2008.,The importance ofthis projectBuild infrastructure so that citizens own their health record and receive basic healthcare s
29、ervices at the right time and right placeFee for illness Fee for healthBenefitReduce the waste in medical resourcesImprove healthcare qualityPromote the health for all citizens,Meaningful Use of EMR,51,Business Model Focus on healthcare industry,Interventions to improve disease risk factors,To help
30、person achieve these goals.In the past a brief word of advice from ones physician at the annual checkup. e.g., avoid smoking, exercise, and eat healthy foods.Big data offeroutside of the clinic in a personalized manner.more sophisticated program would include algorithms that provide personalized fee
31、dback to assist with behavior modification at key moments of decision making.e.g., suggesting healthy recipes while the patient is shopping; encouraging exercise at the end of the workday, or giving a personalized warning about location based environmental triggers for asthma,Example 1: Big Data and
32、 Physical Activity,Smartphone apps that have the potential to passively and continuously track physical activity.More detail datahow physical activity is affected by the social and environmental context.Directly help real-time reminders to increase physical activity before the end of an unusually se
33、dentary day to avoid missing ones daily activity target.linking groups in order to increase motivation.Donaire-Gonzalez D, et al. J Med Internet Res, 2013,Example 2: Big Data and Asthma,Sensor snaps onto asthma metered-dose inhalers, that passively captures the time, location, and GPS coordinates of
34、 inhaler use by communicating with a smartphone.App allows users to provide further contextual information, such as symptoms, perceived triggers, activity at time of use, and whether.Creating a data feedback loop to improve adherence behavior.Reducing asthma symptoms and improved control.city of Lou
35、isville, Kentucky, has adopted this technology to address their elevated asthma burden.Van Sickle D, et al. Resp Drug Delivery Europe, 2013MacDonald C. The Environmental Magazine, 2012,PERSONALIZED MEDICINE,It is estimated in 2014, a personal Genome can be sequenced under $1,000 USD3 billion DNA and
36、 33K genes more than 100K proteins metabolic pathways all the functions of body,From Jack Li, TMU,Cloud computing will quickly change the use of medical information,The fact that Google and Microsoft are heavily invested “in the cloud” extends to their new offerings for medical records services, suc
37、h as Microsofts HealthVault and Google Health.Google 23andMe, 3.9 million USD and more, The integration of biological information, the use of new technology to establish a standardized DNA database, work with pharmaceutical and biotech industry to develop new drugs and personal medicine, Alzheimers
38、foundation, Direct-to-Consumer research: recruit 10,000 patients with Parkinsons disease to enroll. Brins Search for a Parkinsons Cure, Brin proposes a different approach, one driven by computational muscle and staggeringly large data sets. For example, a mutation to the GBA gene is 5 times more lik
39、ely to have Parkinsons 23and Me: Parkinsons Genetics initiative1. Tool Construction: Survey 2. Recruitment: 10,000 subjects with Parkinsons. 3. Data aggregation: Community members DNA analyzed and surveys. 4. Analysis: database query based on 3,200 subjects. The results are returned in 20 minutes. 5
40、. Presentation: People with GBA are 5 times more likely to have Parkinsons. Total time elapsed: 8 monthsTraditional Model1. Hypothesis: 2. Studies: 3. Data aggregation: 5,500 subjects 4. Analysis: 5. Writing: 6. Submission: 7. Acceptance: NEJM 8. Publication: The paper notes that people with Parkinsons are 5.4 times more likely to carry the GBA mutation. Total time elapsed: 6 years,
