carolyn mcgregor , andrew james, mike eklund, daby sow, maria ebling, marion blount
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Real-time Multidimensional Temporal Analysis of Complex High Volume Physiological Data Streams in the Neonatal Intensive Care Unit. Carolyn McGregor , Andrew James, Mike Eklund, Daby Sow, Maria Ebling, Marion Blount - PowerPoint PPT PresentationTRANSCRIPT
Real-time Multidimensional Temporal Analysis of Complex
High Volume Physiological Data Streams in the Neonatal
Intensive Care UnitCarolyn McGregor, Andrew James, Mike Eklund, Daby Sow, Maria Ebling, Marion
Blount
Canada Research Chair in Health Informatics, Professor, Associate Dean of ResearchFaculty of Business and IT, University of Ontario Institute of Technology
Outline
• Neonatal Big Data• Clinical Problem and Motivation• Artemis• LONS• Clinical Application
Neonatal Care
• Multiple devices are attached to the baby or humidicrib
• Medical devices output via serial port in a range of formats
• Indicative readings are recorded on paper every 30 or 60 minutes
• Cost of care per baby is approx $100-150K not including morbidity related carehttp://preemie.info/cms/modules/news/
Neonatal ICUBig Data
• Heart beats – Average 130/minute| 7800/hour
• Breathing– Average 35/minute | 2100/hour
• Blood oxygen levels– 60/minute | 3600/hour
Neonatal ICUBig Data
• Heart beats – 1 value /hour (7799 lost)
• Breathing– Average 35/minute | 2100/hour
• Blood oxygen levels– 60/minute | 3600/hour
Neonatal ICUBig Data
• Heart beats – 1 value /hour (7799 lost)
• Breathing– 1 value /hour (2099 lost)
• Blood oxygen levels– 60/minute | 3600/hour
Neonatal ICUBig Data
• Heart beats – 1 value /hour (7799 lost)
• Breathing– 1 value /hour (2099 lost)
• Blood oxygen levels– 1 value /hour (3599 lost)
Condition Onset Predictors
• Behaviour of physiological data streams that describe respiratory and cardiac function . . .
• Pneumothorax (McIntosh et al, 2000)• Nosocomial infection (Griffin and Moorman,
2001)• Periventricular leucomalacia (Shankaran et al,
2006)• Intraventricular haemorrhage (Fabres et al,
2006; Tuzcu et al, 2009) 9
Baby 1
Baby 3
Baby 2
Diagnosis
Absolute times16
/11/06
15/11
/06
Diagnosis
Diagnosis
10
LONS
Baby 1
Baby 3
Baby 2
Diagnosis
Absolute times16
/11/06
15/11
/06
Diagnosis
Diagnosis
11
LONS
Baby 1
Baby 3
Baby 2
Diagnosis
Absolute times16
/11/06
15/11
/06
Diagnosis
Diagnosis
Baby 1
Baby 3
Baby 2
Diagnosis
Relative times
Diagnosis
Diagnosis
LONS
12
Knowledge TranslationChallenge
• Retrospective Analysis• Not implemented in clinical practice• Not scalable• Either or combination of:
– Patient centric– Condition centric– Stream centric
HealthInformatics
Health andMedicine Experts
Information Technology and Computer Systems
Research
16
Data Integration MgrKnowledge Extraction
Data Miner HIRData Mover
InfoSphere Streams Runtime
Ontology DrivenRule Modifier
Deployment Server
Alert SinkOp
QRS
BP
RR PT
FA
WT
AR
SepsisBPA
EP
WTA
HR Source Op
SpO2 Source Op
BP Source Op
CIS Source Op
PatientStream
SPAD
E ID
E
USE
R IN
TE
RFA
CE
MedicalDataHub
CIS Adapter
ConfigurationServer
CapsuleTechServer
MP50
Babylog8000
ClinicalInformation
System
ECGSpO2 BP HRC
ognos
Data Aquisition
Online Analysis
Knowledge Extraction
(Re)deployment
ResultPresentation
Stream Persistency
Artemis
McGregor, C., Catley, C., James, A., Padbury, J., “Next Generation Neonatal Health Informatics with Artemis”, Medical Informatics Europe, Oslo, Norway, pp 115-119
Current Status of Artemis
• Deployed August, 2009
• The Hospital for Sick Children, Toronto
• Maximum 8 concurrent Neonatal ICU patients
• Enabling new Nosocomial Infection Clinical Researchhttp://www.youtube.com/watch?v=QVbnrlqWG5I
YouTube: IBM commercial data baby
Artemis• Upscaling to all
patients within SickKids NICU
• 2 Hospitals Online
• Cloud Computing Version
• Other conditions and events
• Expand to other ICUs beyond Neonatal
http://www.youtube.com/watch?v=QVbnrlqWG5I YouTube: IBM commercial data baby
Artemis
• Heart rate (HR) (1 Hz);• Transcutaneous blood oxygen saturation
(SpO2) (1 Hz)• Respiration rate (RR) (1 Hz)• Blood pressure [systolic, diastolic, and
mean] (BP) (1Hz)
LONS
• Phase 0: no infection present • Phase 1: infection present but no
detectable clinical symptoms and signs • Phase 2: subtle clinical symptoms and
signs present • Phase 3: definite clinical symptoms and
signs present • Phase 4: very obvious clinical symptoms
and signs present
LONS
• Phase 0: no infection present • Phase 1: infection present but no
detectable clinical symptoms and signs • Phase 2: subtle clinical symptoms and
signs present • Phase 3: definite clinical symptoms and
signs present • Phase 4: very obvious clinical symptoms
and signs present
LONS
• Phase 0: no infection present • Phase 1: infection present but no
detectable clinical symptoms and signs • Phase 2: subtle clinical symptoms and
signs present • Phase 3: definite clinical symptoms and
signs present • Phase 4: very obvious clinical symptoms
and signs present
• Level 0: No specified features present.• Level 1: Presence of features reporting
reduced heart rate variability (HRV), or bradycardia, or a significant downward drift of heart rate.
• Level 2: Presence of level 1 features plus the presence of a respiratory pause as determined by fall in respiratory rate below the defined threshold.
• Level 3: Presence of level 2 features plus a blood oxygen desaturation threshold breach or a significant downward drift of blood oxygen desaturation
• Level 4: Presence of level 3 features plus a blood pressure threshold breach on any of the readings or a significant downward drift of any of the blood pressure readings
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Hourly Rows Level=0 Hourly Rows Level=1 Hourly Rows Level=2 Hourly Rows Level=3 Hourly Rows Level=4
ArtemisClinical Partners
Nepean HospitalWestmead Hospital
Shenzhen Maternity & Child Health Hospital深圳市妇幼保健院
Funding Acknowledgements
TJ Watson Research Center, NY
Canada
TeamAcknowledgements
Dr Andrew JamesAssoc Prof Mikael EklundAssoc Prof Jennifer PercivalDr J. Edward PughDr Christina CatleyDr Nadja Mench-BressanShermeen NizamiRishikesan KamaleswaranAgam DhanoaKathy SmithAnirudh ThommandramWenlan HuangSascha TuuhaNathan Percival
Real-time Multidimensional Temporal Analysis of Complex
High Volume Physiological Data Streams in the Neonatal
Intensive Care UnitCarolyn McGregor, Andrew James, Mike Eklund, Daby Sow, Maria Ebling, Marion
Blount
Canada Research Chair in Health Informatics, Professor, Associate Dean of ResearchFaculty of Business and IT, University of Ontario Institute of Technology