IBM and Evidence Based Medicine Decision Support Systems

Jeffrey Betts from IBM makes a repeat appearance at the conference to discuss how the IBM Watson project can be leveraged for evidence based medicine and clinical decision support systems.

The Watson systems understands natural language, generates and evaluates hypothesis, and learns by homing its own decision algorithms. The solution has been developed hardware agnostic, but is generally run on parallel HPC systems for optimal response times.

The key point of this lecture is that computers are by default and historically poor at responding to unstructured data. Human minds have natural abilities to view unstructured data and identify patterns, and this is the goal of a true expert system such as Watson aspires to be.

Jeffrey takes us through screen shots of a case of an oncologist using Watson to assist with a consult. It was an interesting update for which no one in the audience had any questions.



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Location:Hwy 97 S,Kelowna,Canada

itManageCast Review of 12th Annual Western Cdn Health Summit

This week I've been in Kelowna attending my third Western Canadian Healthcare Summit, and while I have been blogging summaries of some of the more interesting sessions, this entry is intended to be an over-all review of the conference, venue, and most importantly, the value of the time spent in Kelowna.

Let me start by saying that I rarely if ever am disappointed to have to be in Kelowna. So Reboot Communications Ltd. couldn't pick a better city for this in my opinion. While the weather was crappy (like everywhere in BC) so far this week, and I still can't swing a golf club, my colleagues at UBCO, the UBC Southern Medical Program, and Interior Health make it worthwhile for me to be here, outside of the conference itself.

So what unholy deal exists between Carla Tadla and Keith Baldry? While I certainly don't have anything against Keith personally, it would be a nice change to have a fresh face for the event emcee/moderator. Not that he takes much speaking time, but it's just getting a little long in the tooth. Something that isn't long (enough) is the hashtag for the event - #HCYLW. I get what it means, because I'm here and I've thought about it a bit, but is it really a tag people would search on? I would suggest something a bit more descriptive like #WstrnHCSummit or some shorter variant that is slightly more self-explanatory.

And on the topic of technology, at the start of day two we have no conference wifi, and ergo, my blogging & tweeting will be restricted. Perhaps by design? :-) Those are some extreme measures to keep rogue bloggers like me under control. I'm thinking it's by design (or GE Healthcare only paid for one day?) as the passcode changed on the second day, but this wasn't announced until enough people complained around 10:00. I'd encourage the organisers to address that more quickly in the future, or at least let attendees know that it was a technical issue if that was the case. Otherwise, it just appears to be disorganisation, which my experience with Reboot would make me think that unlikely.

The theme for Tuesday seems to be big data, so I'm enjoying this, although I must admit I was surprised to see Jeffrey Betts from IBM presenting for the second year on IBM Watson. That said, it was interesting in so much that he was able to provide us with a case study of use in an oncological patient discussion to provide deep and wide evidence based patient care.

The big data panel discussion was excellent and was a highlight for me of the second day. Excellent panel, and great job by the conference planners.

However, since it's only 1.5 days of session content, I think the organisers should be more consistent with the level of speakers and topics. The audience seems to mostly be clinical administration, so I get that there needs to be logistics/supply chain discussions and I can tolerate that, but I get the feeling that some of the panels were really stuck for speakers as not all were of an equal calibre, or regarded by the audience as being the appropriate subject matter experts for their topic area.

If the organisers could get more content like we had on Monday morning and all day Tuesday, I'd encourage adding a half day to the conference. All in all, my biggest take away each year is the networking, and I have to thanks HP Canada in large part for their facilitation of that!


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Big Ideas About Big Data in Health Care

Lindsay Kislock, ADM in the BC Ministry of Health, introduced the panel and started the discussion on the premise that health has to be proactive with the data at our disposal, and be responsible and forward thinking about how we can turn health data into positive health outcomes.

Dr. Tom Karson spoke first, informing us that globally, we are in the zettabyte era, and we cannot do anything with this volume of data in healthcare without big data analytics. Genomic sequencing & epigenomic analysis are given as examples of big data that medical research and practice need to have and manage daily.

Dr. Karson clarified the reality in our healthcare systems where there is no governance or standardisation of the data sets that individual groups within the provincial health system, and that this is the lowest step of the DELTA five stage maturity model for data analytics. dr. Karson's point was that we need to evolve through this maturity model to better use the data, but that we cannot do that without in parallel establishing and maturing governance over this data.

Additionally, Dr. Karson insisted that we must develop, recruit, and educate the appropriate talent pool to manage big data, and be able to turn data to information, and then to insight.

Julie Lockner from Informatica followed to discuss how we prepare our data centres for big data. The questions came up around pure capacity, security and governance, and obtaining the skills needed to manage these systems.

When asked what is stopping people from dealing with big data better they say: "Time constraints on business analysts and lack of skills for staff in how to manage big data."

We are next introduced to the concept of hadoop, which allows for real-time massive data processing on standard hardware platforms, as an Open Source solution.

Our last speaker on this topic is Rachel Debes, a biostatistics researcher from Cerner. Rachel states that the two biggest drivers towards big data solutions is electronic medical/health records, and the emergence of an accountability framework for the Canadian healthcare system. I would suspect that she is overlooking medical research requirements and data generation/analysis, but I'll assume she's targeting the clinical administrative audience here.

ADM Kislock asked the panel "is big data bad?" and the response was that it is not, but it's all about the governance and skills to handle that big data responsible and effectively.

A question came up from the audience as to whether the protections we put in place around big data in the possession of healthcare are nullified by patients and the general populations freely placing health and health-care information in the public domain via social media, which can be mined by anyone who wishes to invest in that.
My thoughts are that people will place this information in the public domain along with all kinds of other things that if that data were placed into government care we would be held accountable, and the fact that people are irresponsible with their information, or that people on an individual level doesn't feel that certain information is actually "private" doesn't absolve us of our responsibility to protect the data given into our care. If the public voice eventually changes the definition of what is "private" or "personal information"
then we will adapt our levels of governance accordingly.

Dr. Karson provided an answer to this question that mostly aligned with me thoughts, and cited the regulations we work under in the healthcare industry.

Dan Gonos from HP asked the panel their thoughts on the challenges with mining unstructured data. Dr. Karson answered that unstructured data is best mined if you have discrete unstructured data and you understand the data sources, so that the algorithms can be modified to assume contexts. Julie added that certain vernacular can complicate free-form data, further to Dr. Karson's point.



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Location:Hwy 97 S,Kelowna,Canada

Innovating in Health Care While Managing Fiscal Constraints

Ida Goodreau, Board of Directors, Genome BC & Adjunct Professor, Sauder School, UBC

Premise is that public sector always views innovation as something that drives up costs. Private sector doesn't see it that way, because of what innovations they allow into the business.

Ironically, while health care costs across the Western developed world are increasing rapidly, hospital spending specifically has trended down in the last 12 years. The well known and discussed paradox is the demand for high quality care within a fiscally sustainable system. Patients (who are taxpayers) want improvements in life expectancy and functionality, while taxpayers (who are also patients) want greater system efficiencies at lower costs.

The definition targeted is a diminished gap between GDP and health care spending within 20 years.

Innovation in health care over the past twenty years an be measured as successful if we use extended life expectancy as a metric, but not if we measure it against the cost. It seems cold to put a price against the length of a life, but this is the reality that the population wants, per the paradox we discussed earlier.

So the crux is how to adapt innovations that improve health outcomes at reduced costs. The innovations in question are technology devices, drugs, and information, process redesign, and over-all system redesign. We know what all these innovations can and should look like. We need a model for cost-effective integration of these innovations, and an agreed upon set of metrics for measuring progress and assessing risks.

Ida suggest we need to look at systems around the globe where healthcare is privatized, as those are driven by business economics to be the most innovative. The key factors to be considered are:
Lower cost and consumer direct payment
Simplification
Closer to the patient
Re-invention of delivery by use of existing technologies
Right-skilling the workforce
Standardised operating procedures
Copying and then building

Ida proposes also that innovations should be frugal to deliver superior value at a fraction of the costs typically seen, and new technologies should be designed to work within an integrated continuum of care.

Ida re-iterates that the core issue with Canada's healthcare system and why we cannot make the urgent changes needed to innovate cost effectively is that "no one is really in charge."

The innovations and the cost reductions are both necessary, and have been put off for years, but time is running out, as we are approaching a tipping point. Ida proposes that Canadian health care leaders must align, and agree on how to make the public system leverage the optimizations that privatized health care solutions use.


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Location:Water St,Kelowna,Canada

Complexity Exceeds Cognition - How Analytics Will Transform Healthcare

Dr. Graham Hughes, Chief Medical Officer, SAS

We are challenged to provide meaningful and useful health care information available online to every Canadian. Big data is about how much data we are getting from where, how quickly, and how to turn it into meaningful information.

This was an interesting exploration of one of the Game Changing technology disruptors, and how it can, should, and is being leveraged to improve health outcomes.

Health information is still in silos, and needs to be integrated or federated in meaningful ways to enable clinical decision support systems (CDSS). Carolina's Health Systems in North Carolina has been innovative in this area.

Structured and unstructured data continues to expand rapidly, and not all of it is electronic, and most of it continues to grow in the silos. Data-intensive mega trends such as population based patterns, personal signatures, genomics, home monitoring, mobility, & social media.

Home Depot in the US expects to have an aisle dedicated to home medical monitoring systems in two years.

IT consumerisation and mobility have provided us a platform for ubiquitous bidirectional access to health care resources. We are introduced to fitbit which provides 24x7 wearable health monitoring. This is worthy of further investigation. Health oriented apps are growing rapidly, allowing EMR access by patients. Telemedicine continues to evolve and reduce the demand for face-to-face health care provisioning. Gaming theory continues to improve the engagement of people in preventative healthcare and wellness. The immediate impact and benefit that might be missing in personal engagement of wellness is provided by gamification of peoples health monitoring. Influence networks leveraging social media provides a platform for quicker responsiveness to health care interactions.

The price for sequencing the human genome is below $1k, this is an example of how meaningful use of health care information is being made affordable, but the challenge is to use these innovations to improve specific patient outcomes through primary care and wellness. Again, we create mounds of data, but need to turn this into useful information accessible to patients and health care providers in a proactive manner.

Predictive analysis feeding into CDSS allows us to better understand risks in individual and population level health actions. We can identify potential patient cohorts who need intervention based on health habits and target them with the appropriate wellness services. At an individual level, we can better understand how our individual health situation may be impacted by various health care or wellness decisions. Treatment sequences by populations demographics can ensure better medical outcomes in clinical situations.

The problem is we are going to be over-whelmed by a tidal wave of data, the opportunity is that we will have the information we need to improve health outcomes.




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Location:Water St,Kelowna,Canada

Healthcare Success Stories from Western Canada

Western Cdn Healthcare Summit 2012

Healthcare leaders from the Yukon, Alberta and British Columbia shared their stories of challenges and visions in the search for effective and efficient healthcare delivery throughout Western Canada.

Introduced by: Donna Lommer, VP Residential Services & CFO, Interior Health Authority of B.C.
Speakers:
Graham Whitmarsh, Deputy Minister of Health, Province of British Columbia
Chris Mazurkewich, EVP & COO, Alberta Health Services
Stuart Whitley, QC, Deputy Minister of Health & Social Services, Government of Yukon

Chris spoke first, shared some statistics about the scope and depth of AHS (Alberta Health Services). AHS is down the road that HSSBC is taking, and has insight to share for BC folks. A key comment is that the merger was done, and the details are being worked out post-change.

A primary metric that AHS uses to measure success is hip and knee elective primary replacements per annum. The integration of EMS is a current large initiative, and response times are publicly available to ensure transparency and availability. EMS has been a stand-alone entity, but this is changing. This allows the EMS responders to have greater support and options and provision deeper care quicker.

AHS believes that having a deeper and wider integration of clinical services across the province allows for quicker innovation and response to discovered administrative or clinical challenges.

AHS has asked clinicians and staff to identify game changers in health care, and some identified are standardized discharge methodologies and metrics, allowing communities and families to be better prepared for when patients are discharged back into the communities.

Wellness is a major push, with high profits and demand from private sector to license a successful regionalized program. AHS feels they are ready to move their primary care networks to the next level, but have identified that good governance is vital to that success. What that next level really looks like was not described.


Stuart shared an anecdote that illustrated that it is important to focus on need by examining where risk is.

Stuart asked us rhetorically how we innovate and transform health care in Canada. We are referenced to the innovations happening in EU Nordic countries. Extraordinary technological innovations are occurring daily, but the cost to accommodate and implement these are barriers to adoption. Transformation therefore must occur in the management and funding, as well as the current culture of health care. Negotiations with practitioners is the beginning place.

Acute disorders are stealing attention from the chronic issues which Canadians are increasing with high-risk health behaviours increasingly dramatically in school aged children. Interventions must start here, and we must look further upstream to be more preventative and intervene before conditions become acute, and warrant more expensive treatment.

Top 30 users of the Yukon health care system, on average, incur more than $150k each year. A key issue in their acute issues is prolonged alcoholism.

Many small, simple innovations focussed on the upstream aspects of the health care system will (and have been proven in the Yukon) reduce the costs and improve delivery of health care.


Graham Whitmarsh presented the innovation and change agenda diagram. The three pillars of the program are:
1. Effective health promotion & prevention
2. Integrated & targeted primary & community health care
3. High quality hospital services

A series of metrics were shared for each of these three pillars to identify what is working in the past year, and what isn't, and where to focus efforts this year. Over $250M in savings is expected from HSSBC next year.

Royal Columbian & St. Paul's improvements are planned and committed to.

ThinkHealthBC is where this strategy is shared with the public. We are provided a teaser, but if you are interested in learning more about the strategy, current results, and next steps, you should check out the site.



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Navigating Internet Privacy

Shifts in the modern Internet landscape are creating new challenges and business imperatives for security, IT and legal professionals. Join our panel of experts as they examine the legal, regulatory and public policy initiatives that are impacting online businesses, Internet usage and Internet security today, and tackle the most pressing questions in today's marketplace, including: prospects for new privacy legislation; the potential impact on how companies operate and design products; conflicts that may arise with the development of cloud computing; legal jurisdiction over international data flows in "the cloud?"; the progress of online tracking and advertising; the impact of increasing calls for Privacy by Design from policymakers and organizations; and the rise of rise of class action lawsuits in the privacy sphere.
Justin Weiss, Senior Director, International Privacy and Policy, Yahoo and
Trevor Hughes, President and CEO, IAPP

We started with the topic of kids. The COPA is currently under review, including verifiable parental consent issues. The business consent mechanism for that consent is payment card requirements.


I asked about teen use of social media, and the right to be forgotten. Particularly when teens post things online that they might regret later. The answer from Trevor was started with the fact that Social media adoption by youth was higher than any any other age group last year, for under thirteen, the parents are complicit in kids getting onto facebook. As a society we are evolving in how we think about our personal histories. We cant teach our kids how to use social media, they will teach us. The answer is that our perception of personal pasts is shifting with this young generation in North America, and it doesn't mean the same thing to us as adults that it will to the next group of adults. So we told that teens wont regret later what they post today. I don't really agree with this moral philosophy standpoint, but it is interesting that privacy experts are using this as an argument.

Next we discussed the right to be forgotten specifically in the EU. This includes the portability of your data, and that implies that social network providers would allow you to vote with your data. The expectation currently does not exist that you can control information about you on the Internet; but how much of this was uploaded by you? How much information about you is uploaded by someone else? Who owns this, and who has the right to remove it? The contra to this is that just because it is difficult to do doesn't mean that it shouldn't be done. The thought came up that more practical than the right to be forgotten is the right to know what is online about yourself. Trevor & Justin indicated that there are already business coming online to purge and/or correlate aggregated public information about you. Last question on this topic was what happens when you die? When you die, your data and how your data is handled should be the responsibility of your estate, but compliance regulation is not enforcing this - yet.

We move to the discussion about the e-privacy directive and cookies, and tracking. This concept originally came about because of the stateful nature of the web. Cookies have become much more sophisticated and dangerous, and easily abused. Any modern website can contain 16-20 cookies on their front page. This number is more than likely on the very small side of the average. The EU is proposing informed consent for each cookie. Alternative state management and information grooming tools are being developed to proactively circumvent any legislation.
So we need to clarify that there is a difference between tracking technologies and cookies. By focussing the issue on cookies we are looking at the more transparent technology, but others that are far less transparent do not use cookies to track you. So the legislators and the public need to be aware of this difference. The caveat considered is "unless the tracking is expressly requested by the consumer of the online service." Advertisers and third party data collectors should and are be the ones who are targeted by this legislation.
Browsers are the interface here, and we have four or five real vendors of note here, and it may well be that browser settings will be the key to finding a solution here. In the end we come back to the risk of technology specific legislation, versus focusing on principles of privacy. The case of browsers including "private browsing" options is shown as a case in point of how the market can respond to demand by simplifying the interface to give us what we actually want.

Trevor explains that OBA (online behavioural advertising) is intended to be targeted to ensure that it is beneficial to you, but often comes across as invasive and creepy. Other privacy issues are starting to over take this one, as industry slowly starts to self-regulate. Its not by any means a perfect state, but it is progress. Yahoo provides icon solutions to let users know which ads are targeted and which are not.
There is a scope creep issue here, because cookies are often involved in gathering the data for OBA, so law makers need to approach this topic, once again, very carefully to not paint any forthcoming legislation into a toothless corner.
I asked about the scenario where facebook provides hook-up and dating site advertisements to 14 year old boys, and this became an interesting conversation around whether the advertisers or the host holds responsibility for the advertisements, and if they are allowed to have enough information to know your age. My opinion is that since facebook has this info about us already,

Justin's prediction on the headline for online privacy for this year will be "a google technology team bypassed default preference settings in Safari browser" which was todays headline. This will continue to fire the flame on regulation because it is apparent that self regulation isn't working.

trevor expects a $20M settlement over a privacy issue n the US that will drive more compliance.


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Location:13th Security & Privacy Conference

Game Changers - A Day of Innovation Keynote Summary

Sukhi Gill, CTO EMEA & HP Fellow

The idea is to gauge innovation value by how excited the business units outside of IT get with the concepts. Conversations are sparked by discussing major disrupters and how to get budget to keep the lights on and innovate.

Case in point, the new Galaxy phone is equivalent computing power to a rack of servers and storage from 2000. How do we get the business to take the "cool" things like incredible hand-held power, pervasive network access, and social media and get them to fund IT to enable those things they want to use to be usable.

Adopting new technologies without a business model to support them is setting yourself up for failure. In most organizations, IT innovation lags behind business, and we're constantly playing a game of catch-up.

So what are the top three disruptors?
Consumerisation of IT, or BYOD as it's more familiarly known in our industry. Start with allowing email access through consumerised devices, then address the mobility challenges of which apps should be allowed, and which should not. Virtualisation and mobile delivery of the core user functions of business applications is where we should focus our attention.

Cloud is continuing to pervade, and the convergence of clouds will make public cloud offerings more appealing. The IT department will have to change, as they are more so brokers of movement to cloud services, and must manage the IT supply chain with extreme diligence.

Big Data and real-time analytics. 85% of organisational data is not formatted in a way that meta-data is available to readily locate and understand the context of the data. We are increasingly forced to understand unstructured data by legislation, and the pure quantity. Sukhi provided the idea of placing sensors in our luggage to track where it is via our mobile devices, where most of the actual information is available, and the technology is all about, but the data isn't used,mor even understood where to be found. This example is how a consumer demand drives business technology change.

If we as IT leaders lead budget conversations with infrastructure upgrades and software revisions, we won't make our case. If we talk about real business problems, and how we can address them with game changing technologies, we are more likely to get the funding needed to balance operations and innovation. Identify the biggest business problems, break down the complexity of the problems, and look for options to solve those components. We must be bold in addressing the disruptive technologies with the business.

Consider writing a business briefing document that poses "what if our competitors did this before us?"

Have an annual budget planning meeting with the business units where you share a roadmap with the business units on how your business could be disrupted, and spark a conversation you've prepared for on how to adapt proactively. Scenario planning is vital, as is holding workshops using demonstrations. As an example, corning.com and hp.com have public domain videos of what the future technologies they are developing are like.
Combine innovation in infrastructure refresh projects.








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