The Broadband and E-Health December 2009

Australian e-Health Research Centre

The Australian e-Health Research Centre

• Joint Venture between CSIRO and the Queensland Government (2003)

• Leading national research facility in ICT for healthcare innovations

• Aims to improve the quality and safety of healthcare for individuals and communities through an ICT research program focused on applied outcomes and active adoption by the health system

• Multi-disciplinary team ~ 50, including researcher scientists, software engineers and PhD students:

• Brisbane• Sydney• Melbourne• Adelaide

• Research focus:• Biomedical Imaging• Health Data and Smart Methods

Australian e-Health Research Centre

Broadband and health – a great mixture

• Health is a knowledge business – communications technologies can deliver better access to knowledge by:

bringing expertise to remote locations via tele-medicine, tele-presence and remote training

providing enhanced community care and in-home monitoring for the elderly and chronically ill

enabling improved techniques for analysis and standardisation medical data.

Australian e-Health Research Centre

Remote check-ups and consultations• Tele-psychology consultations via video link • Remote eye-care – sharing retinal scans and voice• CSIRO RIDES technology –immersive consultation environment

Tele-medicine, tele-presence and remote training

Remote medical training • optimising use of limited skilled trainers• enabling career development for clinicians in rural areas• CSIRO haptic workbench allowed temporal bone surgery training

Remote emergency room conferencing• overcoming distance: bringing expertise to rural communities• providing rapid expertise: linking virtual teams across cities• CSIRO VICCU technology – combining video and data

Through the use of telemedicine, all members of society, wherever they are located, can access the same standard of care

Australian e-Health Research Centre

VICCU

• The Virtual Critical Care Unit (ViCCU®) which permits specialists based at a tertiary referral hospital (Nepean, on the outskirts of Sydney) to guide a team based in a regional hospital (Katoomba) caring for patients in the Emergency Department, using an advanced telemedicine system

Australian e-Health Research Centre

ECHONet

• The ECHONET system which assisted bedside assessments, guided echocardiography and case-based education by linking an intensive care unit in north west Tasmania to major ICU and Cardiology Departments at a city hospital.

Australian e-Health Research Centre

In-home monitoring for the elderly and chronically ill

Cardiac rehabilitation using tele-medecine solutions• ambulatory monitoring and remote mentoring using mobile phone• improving access and quality of life for recipients• partnering with Queensland Health / PA hospital

Delivering improved care and decision support

Australian e-Health Research Centre

Care Assessment Platform

Web portal

Diary data Measurement data Health Reports

Diary entries

Video & SMSmessages

Videoconference

Personal devices at home

HealthInformation

Data display for self management

Treatment & counselling

feedback via phone

1) Movement activity and Heart Rate2) Blood Pressure3) Weight scale

Mobile Phone

Data to server:

Measurement Devices

Web-based GUI

Measurementdata

Bluetooth andmanual entry

Community Care Team

Data in graphical format andhealth report view

Feedback tools:

Server

Diary & data synchronisation,photos

Service Provider

Additional reports uploaded to the system

Motivational SMS & VideoRelaxation audio

Diet photos

Server

Australian e-Health Research Centre

Improved patient safety• Coordinated care - GPs and hospitals have same information• Reducing repeated testing on admission and discharge• Faster access to data, when and where required

Sharing medical data

Reduced healthcare costs• reduced labour, storage compared to paper records• reduced cancellations due to missing / delayed test results • consistent data terminology reduces mistakes in patient handover

Better quality decision support• Eliminating prescription mix-ups and adverse drug interactions• Easily and reliably view a patient’s (& family) medical history• More effective disease surveillance – eg predicting flu outbreaks

Electronic health records provide step gains in care and connectivity, reducing repeat testing and

Australian e-Health Research Centre

Hosp Admin

HospAdmin

Hosp Admin

Surgical Records

Surgical Records Surgical

Records

Private hospital Regional hospitalLarge teaching hospital

SurgicalRecords

Chemo Records

Example Scenario – Integrating data across hospitals

HDIDomain(Host)

HDIDomain

(Remote)

HDIDomain

(Remote)

CRC Surgical Data

Chemotherapy Record Data

Link Table

CRC Surgical Data

Chemotherapy Record Data

Australian e-Health Research Centre

Australian e-Health Research Centre

SNOMED CT Extensions: using current data

• Hypothesis: Can we use SNOMED CT as a base ontology and add “new bits of knowledge” to fully describe data which is collected using other terminologies?

SNOMED CT

Terminology fordata set A

Terminology for data set B

Australian e-Health Research Centre

Extracting Meaning from Data - Cancer StagingHISTORY

Left upper lobe and partial chest wall.

MACROSCOPIC

One specimen received.The specimen is labelled "left upper lobe and partial chest wall" and consists of a left upper lobe measuring 155 x 100 x 45 mm. On the lateral aspect of the lung there is attached chest wall and ribs measuring 60 x 60 mm. Deep to this on sectioning, there is a white sclerotic mass measuring 45 x 42 x 40 mm. Surrounding the tumour there is obstructive pneumonitis. No other lesions are identified on sectioning of the lung. The chest wall will be decalcified and a further report will be issued.

MICROSCOPIC

Sections show a poorly differentiated adenocarcinoma which in most areas comprises sheets of large cells with vesicular nuclei, prominent nucleoli and moderate amounts of eosinophilic cytoplasm. Focally within the tumour there is a cribriform architecture and occasional cells contain mucin vacuoles. Areas of necrosis are present. Tumour invades the overlying thickened pleura and foci of lymphatic permeation are noted within this pleural tissue. Lymphatic invasion is also noted within pulmonary parenchyma. However no metastases are found in peribronchial lymph nodes. No vascular invasion is seen, although thrombus is noted within a vascular space towards the inferior aspect of the tumour. Tumour does not appear to extend up to chest wall structures, but a further report will follow when sections of these are examined. Distant lung parenchyma shows mild centriacinar emphysema.

Pathology Report Staging Guidelines

Australian e-Health Research Centre

Average NC Average MCI Average AD

Alzheimer’s Disease Average thickness templates

5 mm

0 mm

3 mm

Australian e-Health Research Centre

Approach:

• Standardise subjects brains (using registration to an atlas)

• Statistical analysis (PCA)

• Classification of new subjects.

Statistical analysis of Amyloid deposition in PIB PET images of Alzheimer’s disease, mild cognitive impairment and normal control, consistent with

histological analysis

Goal: Combining molecular information from PIB PET with anatomical information from MR to generate a computational model of PIB-PET images

Evolution of amyloid deposits in AD from autopsy. Adapted from Braak H, Braak E 1997.Courtesy of Department of Nuclear Medicine, Centre for PET, Austin Health, Australia.

Alzheimer’s Disease Building a statistical Atlas of Amyloid deposition