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eHealth: Big data,
sports analysis & clinical records

Leif Hanlen
Technology Director, NICTA
Assoc. Prof. ICT @ Australian National
University
Prof. Health @ University of Canberra

From imagination to impact
Conclusion
• “Big Data” in health is using existing/available information to
support better delivery of better care.
• It’s not special: it’s just health.
• It’s not how big it is, it’s how you use it.
The convergence of biology, informatics, and engineering is turning
healthcare into an information industry.
Mario Castañeda, CBET, BS, MBA, National Director of the Clinical
Technology Department at Kaiser Permanente

“[T]he effectiveness of telehealth is currently limited by
positioning telehealth outside the mainstream of healthcare”
Mitchell, DCITA report, 2
1999
From imagination to impact
Too much data, ill-used
“Current medical practice relies
heavily on the unaided mind to
recall a great amount of detailed
knowledge – a process which, to
the detriment of all
stakeholders, has repeatedly
been shown unreliable”
Robert M. Crane and Brian Raymond
The Permanente Journal
Winter 2003 Volume 7 No.1
Kaiser Permanente Institute for Health Policy
Emphasis added.

From imagination to impact

3
Who is NICTA?

• Australia’s ICT research center of excellence
– “Use inspired research”
• Making fundamental advances in ICT that can underpin
the development of globally competitive
products, processes and services.

– 700 people (300 research staff)
– 5 laboratories, 15 partner universities

From imagination to impact

4
We’ve launched a 15 startups in the last 10 years.

From imagination to impact

5
Transforming innovative technologies
to advance the understanding of
human diseases and to improve the
health and well being of Australians

From imagination to impact

6
Australia Health

AU$120b per annum
Where it goes

45,000
40,000
35,000

Series3

30,000

Series2

25,000

Series1

20,000

Expon. (Series1)

15,000
10,000
5,000

Src. AIHW

Expon. (Series2)
Expon. (Series3)

0
1

2

3

4

5

6

7

8

9

10

11

Hospital spending in $millions per year, by source
7

From imagination to impact
Healthcare: a systemic change is needed

40% : hospitals ($48b)

18% : medical services

5% : community health ($6b)

From imagination to impact

8
Healthcare: a systemic change is needed

Information shifts this balance

40% : hospitals ($48b)

20% : medical services

5% : community health ($6b)

Scaling status quo does not help
From imagination to impact

9
But: it’s not only “the system” at fault
“Health informatics has been technology driven
and IT creators have misconceptions about how
clinical work is done, what characterises workers
and their environment, what problems they
face, and how they will use the artifact.”

Redcliffe Hospital study, 2011

From imagination to impact

10
Meet the next ^ Chief Information Officer.
From imagination to impact

11
This is her office:

From imagination to impact

12
This isn’t her office.

It’s a conference room for clinicians

From imagination to impact

13
Where will the ‘health’ data come from?
“Gigabit person days”

Clinical notes analysis
2Mb per person per day
45% population

Implants
1 Gb per person per hour
0.001% population
Genomics
10 Gb per person
1% population
Wearables
1 Mb per person per day
25% population

From imagination to impact

Proteomics
10 Tb per person
0.01% population

14
Where will the ‘health’ data come from?
“Gigabit person days”
Improvements in clinician efficiency & effectiveness
Clinical notes

•
•
•
•
•
•

About 15k~20k providers (Health Info. Systems)
Limited interoperability incentive
Web-interface (PCEHR) but no analytics API
Privacy!
Access (clinicians  developers)
Adoption path: clinical champions, health systems

Huge potential for community engagement

Wearables

• About 15m~20m providers (sensors, software, apps)
• No interoperability incentive, no standards
• Privacy … but many people don’t care
• Access often local
• Adoption path: sports : wellness : community benefit
From imagination to impact

15
But delivery will be via mobile video

Video accounts for 37% of mobile data.
Ref: CISCO Systems 2011
From imagination to impact

16
eHealth is here.

Online image viewer

From imagination to impact

17
It's a very sobering feeling to
be up in space and realize
that one's safety factor was
determined by the lowest
bidder on a government
contract.

From imagination to impact

18
IT innovation: Old vs new

• IT solutions in-house or
procured
• Data never leaves
– Security by lock down

• National (central)
innovation applied
locally

• IT solutions by
community; in-house
evaluation
• Data security, open design
• Innovation local, grows
nationally

From imagination to impact

19
Health data (old)

Design system
Predict queries
Hope
(and wait)

(and pay)

From imagination to impact

20
Old way: Lots of data stores, no interoperability

From imagination to impact

21
New way: Keep the data, use it better

Restful services
Eg. BioGrid in AU
Cluster analysis for enterprise
From imagination to impact

22
Secure data, real time, useful.

From imagination to impact

23
Interoperability, technology adoption, community care

NATIONAL E-HEALTH LIVING LABORATORY
Embedding ICT in the next generation’s workflow

From imagination to impact

24
U. Canberra

AIS

1km
Aged care

Tertiary Hospital

ANU
From imagination to impact

NICTA
Sod turning, Feb 2013, opening Feb 2014

From imagination to impact

26
Why?
• Change the culture of care delivery: ICT part of the oxygen
• Encourage bottom-up innovation
– Matched to strategic (top-down) goals

• Co-design, co-develop, co-deploy.
– And then scale

• No “death by pilot-itis”
• No faith-based system changes
“Scientists reproduce results; engineers build impressive and
enduring artifacts; and theologians muse about what they
believe but can’t see or prove.”
Ted Pederson, Empiricism is not a matter of faith
From imagination to impact

27
The Lab Philosophy
• Everyone’s skin in the game
– No cash for “research pilots”.
– Unsustainable business models need not apply.

• Open. Web based. HTML 5.
– No lock-in. Open source, open access, achieve standards
– Restful API’s, open data standards, privacy built in (not locked)

• Mobile by defaults
• Keep it real
– Lab has consumers, practitioners, developers, researchers, students
all co-located. No room for “not-invented-here”
From imagination to impact

28
Health challenge: 10 bed hospital
• What would a health-system look like if
– 10-beds were the “norm” for hospitals?
– In-home was the “norm” for care?
– Tertiary hospitals were the “weapon of last resort?”

From imagination to impact

29
Health challenge: 10 bed hospital

From imagination to impact

30
Social media: monitoring health socially

Australia/NZ has 29% of google pharmaceutical searches

From imagination to impact

31
Clinical Information Processing

Use the data that is already
captured; to trigger early
warnings.

From imagination to impact

32
From imagination to impact

33
Technology demonstrator
• Testing with partners
– Use clinical notes to
improve detection
– Web-app visualization
– Mobile data

• Keep it useful for
clinicians and then
– Get the data we need.

From imagination to impact
http://nicta-ifi.s3-website-ap-southeast-2.amazonaws.com/

34
Clinical Information Processing
Nurses,
Are you tired of wasting time
writing handover notes?
Just talk.
Let the computer sort it out.

From imagination to impact

35
Nursing handover
• Social: nurses talk, in a group, at bedside
• Information passed at shift-change
– And recorded on paper records 8+ hours later

• Information is lost
– Errors: adverse events, medication errors, omissions etc.

• Workflow is inefficient
– Time wasted, frustrating

Nurses want to have speech recorded, but not like this.
From imagination to impact

36
Technology demonstrator
•

Proof-of-concept
•

In 3 major teaching
hospitals & 6 ward/units
within
•
•

•

South West Sydney
Local Health District
Sydney Local Health
District

Web-based HTML5 app

From imagination to impact

http://nicta-stct.s3-website-ap-southeast-2.amazonaws.com/

37
Sports analysis: gateway drug for population health

“The stats of exercise are really important to me to check out my
performance”
Cross-country skier Colby Rook uses the device for training
From imagination to impact
From engagement to solution
• Problem “how can we track performance?”
– Approached by Australian Institute of Sport to quantify training
– Paper notes are impossible to search, time-consuming to fill and often
missing records.

AIS logbooks circa 1958

AIS logbooks circa 1998
From imagination to impact

AIS logbooks circa 2010
Technology demonstrator

• In use at Aust. Institute
Sport for last 18 months
• Commercialisation
under way
– Consumer technology
with web-app
integration

From imagination to impact
Next steps?
• Expertise in data mining and machine learning
– Including text processing

• Range of projects, interested in developing new collaboration
• Also developing community for ICT development/adoption.

From imagination to impact

41
From imagination to impact

42
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Work with us

Change this:

From imagination to impact

43

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eHealth: Big Data, Sports Analysis & Clinical Records

  • 1. eHealth: Big data, sports analysis & clinical records Leif Hanlen Technology Director, NICTA Assoc. Prof. ICT @ Australian National University Prof. Health @ University of Canberra From imagination to impact
  • 2. Conclusion • “Big Data” in health is using existing/available information to support better delivery of better care. • It’s not special: it’s just health. • It’s not how big it is, it’s how you use it. The convergence of biology, informatics, and engineering is turning healthcare into an information industry. Mario Castañeda, CBET, BS, MBA, National Director of the Clinical Technology Department at Kaiser Permanente “[T]he effectiveness of telehealth is currently limited by positioning telehealth outside the mainstream of healthcare” Mitchell, DCITA report, 2 1999 From imagination to impact
  • 3. Too much data, ill-used “Current medical practice relies heavily on the unaided mind to recall a great amount of detailed knowledge – a process which, to the detriment of all stakeholders, has repeatedly been shown unreliable” Robert M. Crane and Brian Raymond The Permanente Journal Winter 2003 Volume 7 No.1 Kaiser Permanente Institute for Health Policy Emphasis added. From imagination to impact 3
  • 4. Who is NICTA? • Australia’s ICT research center of excellence – “Use inspired research” • Making fundamental advances in ICT that can underpin the development of globally competitive products, processes and services. – 700 people (300 research staff) – 5 laboratories, 15 partner universities From imagination to impact 4
  • 5. We’ve launched a 15 startups in the last 10 years. From imagination to impact 5
  • 6. Transforming innovative technologies to advance the understanding of human diseases and to improve the health and well being of Australians From imagination to impact 6
  • 7. Australia Health AU$120b per annum Where it goes 45,000 40,000 35,000 Series3 30,000 Series2 25,000 Series1 20,000 Expon. (Series1) 15,000 10,000 5,000 Src. AIHW Expon. (Series2) Expon. (Series3) 0 1 2 3 4 5 6 7 8 9 10 11 Hospital spending in $millions per year, by source 7 From imagination to impact
  • 8. Healthcare: a systemic change is needed 40% : hospitals ($48b) 18% : medical services 5% : community health ($6b) From imagination to impact 8
  • 9. Healthcare: a systemic change is needed Information shifts this balance 40% : hospitals ($48b) 20% : medical services 5% : community health ($6b) Scaling status quo does not help From imagination to impact 9
  • 10. But: it’s not only “the system” at fault “Health informatics has been technology driven and IT creators have misconceptions about how clinical work is done, what characterises workers and their environment, what problems they face, and how they will use the artifact.” Redcliffe Hospital study, 2011 From imagination to impact 10
  • 11. Meet the next ^ Chief Information Officer. From imagination to impact 11
  • 12. This is her office: From imagination to impact 12
  • 13. This isn’t her office. It’s a conference room for clinicians From imagination to impact 13
  • 14. Where will the ‘health’ data come from? “Gigabit person days” Clinical notes analysis 2Mb per person per day 45% population Implants 1 Gb per person per hour 0.001% population Genomics 10 Gb per person 1% population Wearables 1 Mb per person per day 25% population From imagination to impact Proteomics 10 Tb per person 0.01% population 14
  • 15. Where will the ‘health’ data come from? “Gigabit person days” Improvements in clinician efficiency & effectiveness Clinical notes • • • • • • About 15k~20k providers (Health Info. Systems) Limited interoperability incentive Web-interface (PCEHR) but no analytics API Privacy! Access (clinicians  developers) Adoption path: clinical champions, health systems Huge potential for community engagement Wearables • About 15m~20m providers (sensors, software, apps) • No interoperability incentive, no standards • Privacy … but many people don’t care • Access often local • Adoption path: sports : wellness : community benefit From imagination to impact 15
  • 16. But delivery will be via mobile video Video accounts for 37% of mobile data. Ref: CISCO Systems 2011 From imagination to impact 16
  • 17. eHealth is here. Online image viewer From imagination to impact 17
  • 18. It's a very sobering feeling to be up in space and realize that one's safety factor was determined by the lowest bidder on a government contract. From imagination to impact 18
  • 19. IT innovation: Old vs new • IT solutions in-house or procured • Data never leaves – Security by lock down • National (central) innovation applied locally • IT solutions by community; in-house evaluation • Data security, open design • Innovation local, grows nationally From imagination to impact 19
  • 20. Health data (old) Design system Predict queries Hope (and wait) (and pay) From imagination to impact 20
  • 21. Old way: Lots of data stores, no interoperability From imagination to impact 21
  • 22. New way: Keep the data, use it better Restful services Eg. BioGrid in AU Cluster analysis for enterprise From imagination to impact 22
  • 23. Secure data, real time, useful. From imagination to impact 23
  • 24. Interoperability, technology adoption, community care NATIONAL E-HEALTH LIVING LABORATORY Embedding ICT in the next generation’s workflow From imagination to impact 24
  • 25. U. Canberra AIS 1km Aged care Tertiary Hospital ANU From imagination to impact NICTA
  • 26. Sod turning, Feb 2013, opening Feb 2014 From imagination to impact 26
  • 27. Why? • Change the culture of care delivery: ICT part of the oxygen • Encourage bottom-up innovation – Matched to strategic (top-down) goals • Co-design, co-develop, co-deploy. – And then scale • No “death by pilot-itis” • No faith-based system changes “Scientists reproduce results; engineers build impressive and enduring artifacts; and theologians muse about what they believe but can’t see or prove.” Ted Pederson, Empiricism is not a matter of faith From imagination to impact 27
  • 28. The Lab Philosophy • Everyone’s skin in the game – No cash for “research pilots”. – Unsustainable business models need not apply. • Open. Web based. HTML 5. – No lock-in. Open source, open access, achieve standards – Restful API’s, open data standards, privacy built in (not locked) • Mobile by defaults • Keep it real – Lab has consumers, practitioners, developers, researchers, students all co-located. No room for “not-invented-here” From imagination to impact 28
  • 29. Health challenge: 10 bed hospital • What would a health-system look like if – 10-beds were the “norm” for hospitals? – In-home was the “norm” for care? – Tertiary hospitals were the “weapon of last resort?” From imagination to impact 29
  • 30. Health challenge: 10 bed hospital From imagination to impact 30
  • 31. Social media: monitoring health socially Australia/NZ has 29% of google pharmaceutical searches From imagination to impact 31
  • 32. Clinical Information Processing Use the data that is already captured; to trigger early warnings. From imagination to impact 32
  • 33. From imagination to impact 33
  • 34. Technology demonstrator • Testing with partners – Use clinical notes to improve detection – Web-app visualization – Mobile data • Keep it useful for clinicians and then – Get the data we need. From imagination to impact http://nicta-ifi.s3-website-ap-southeast-2.amazonaws.com/ 34
  • 35. Clinical Information Processing Nurses, Are you tired of wasting time writing handover notes? Just talk. Let the computer sort it out. From imagination to impact 35
  • 36. Nursing handover • Social: nurses talk, in a group, at bedside • Information passed at shift-change – And recorded on paper records 8+ hours later • Information is lost – Errors: adverse events, medication errors, omissions etc. • Workflow is inefficient – Time wasted, frustrating Nurses want to have speech recorded, but not like this. From imagination to impact 36
  • 37. Technology demonstrator • Proof-of-concept • In 3 major teaching hospitals & 6 ward/units within • • • South West Sydney Local Health District Sydney Local Health District Web-based HTML5 app From imagination to impact http://nicta-stct.s3-website-ap-southeast-2.amazonaws.com/ 37
  • 38. Sports analysis: gateway drug for population health “The stats of exercise are really important to me to check out my performance” Cross-country skier Colby Rook uses the device for training From imagination to impact
  • 39. From engagement to solution • Problem “how can we track performance?” – Approached by Australian Institute of Sport to quantify training – Paper notes are impossible to search, time-consuming to fill and often missing records. AIS logbooks circa 1958 AIS logbooks circa 1998 From imagination to impact AIS logbooks circa 2010
  • 40. Technology demonstrator • In use at Aust. Institute Sport for last 18 months • Commercialisation under way – Consumer technology with web-app integration From imagination to impact
  • 41. Next steps? • Expertise in data mining and machine learning – Including text processing • Range of projects, interested in developing new collaboration • Also developing community for ICT development/adoption. From imagination to impact 41
  • 42. From imagination to impact 42
  • 43. Like this? Work with us Change this: From imagination to impact 43