Presentation on theme: "Data Warehousing for Telehealth/Telemedicine 2001 Symposium on Applications & the Internet (Saint 2001) San Diego, CA January 10, 2001 Rose Cintron-Allen,"— Presentation transcript:
Data Warehousing for Telehealth/Telemedicine 2001 Symposium on Applications & the Internet (Saint 2001) San Diego, CA January 10, 2001 Rose Cintron-Allen, MHP Warren Sterling, PhD
Agenda Data Warehouse Definition Building a Warehouse Warehouse Uses in Telehealth/Telemedicine National Medical Knowledge Bank (NMKB) Project NMKB Features Virtual Healthcare Events Intelligent Agent-Based Active Learning Framework Case Finder Evidence Finder Summary & Conclusions
What is a Data Warehouse? Data Warehousing is a process, not a product Source: NCR Corporation (and Teradata Corp.) Copyrights All rights reserved. It is a process for properly assembling and managing data from various sources for the purpose of answering business questions and making decisions that were not previously possible.
Building a Warehouse ¶ Define Business Opportunity & ROI · Sourcing the Data ¸ Planning and Design ¹ Physical Implementation º Operation & Maintenance » Leverage Lessons Learned & ROI Evaluation
Telehealth/Telemedicine Uses Distance Healthcare Education Teleradiology Telepathology Healthcare Informatics Patient Medical Record
National Medical Knowledge Bank An Advanced Technology Program Joint Venture Allegheny-Singer Research Institute, Pittsburgh PA Millennium Healthcare Solutions, Edison NJ NCR Corporation, Dayton OH MCP Hahnemann University, Philadelphia PA AT&T Government Markets, McLeansville NC Sponsored by: The United States Department of Commerce National Institute of Standards and Technology
What is It? The National Medical Knowledge Bank is an advanced repository of specialized medical experience and knowledge, featuring easy capture of information, with massive storage and links to a vast selection of supporting resources enabling users to retrieve, collaborate, and learn, anytime and place.
NMKB Consortium Focus Medical Videos Digital Content Acquisition Validation Data Integrity Medical Sounds Health Care Delivery Initial & Continuing Medical Education Patient Education Medical Texts Medical Images Virtual Medical Environments Parallel Object/Relational Database (TOR) Multimedia-based medical information services three key markets.
National Medical Knowledge Bank Features Web-based Architecture Targeted to healthcare practitioners Integrated applications –Virtual Medical Conferences –Nursing Training –Case-Based Retrieval for Diagnosis/Treatment Determination –Disease Domain-specific Literature Search Offers Continuing Education credits Designed to use an object relational database as a scalable, parallel data warehouse
What is an Object Relational Database? Patient Patient Account MRI Doctor Angio- Work Transcribed Name Age Balance Scans Comm. gram Location Dr. Comm Object Relational Table Alphanumeric Attributes Object Columns (SDTs) Char (n) Integer Float Image Audio Video Point Text Account Account Balance Face Voice ATM Home Transcript Name ID Print Print tnx Location Last Call Alphanumeric System/User Defined Functions (SDFs/UDFs) System Defined Types (SDTs) Integer Character Date Float Audio Image Video Geospatial Document/Text Audio/Video matching; Voice Recognition Iris Scan; Tumor Classification Playback/Fast-forward; Retrieval Map-overlay; Distance computations Word-Recognition/Translation New Data Traditional Data +
Virtual Healthcare Events: Virtual Conferences Grand Rounds
Asynchronous, discretionary viewing Lower cost option (travel, time) Concept searching CME credit, including JE/JIT Indexed presentation outlines for fast navigation Streaming video/audio with synchronized slides Brain Attack Conference - Video with Slide Indexing
Primary Care Grand Rounds - Contents and Presentation
Intelligent Agent-based Active Learning Framework
Delivers personalized, active education experience Problem-based learning At convenience of student schedule; can complete in multiple sessions Certified CNE credit Reusable framework; lowers production cost Agent technology - lesson planning; student model; tutor; ontology Applicable to other domains Intelligent Agent-based Continuing Education - Activity Menu
Patient interview video vignettes (streaming video) Student selects questions and orders them Student evaluated on question choice and order Patient interview video vignettes (streaming video) Student selects questions and orders them Student evaluated on question choice and order Intelligent Agent-based Continuing Education - HPI Video Interview
Uses Case-Based Reasoning to Find Similar Cases Eases clinicians burden of reading and recalling cases Saves clinician time Web-based; works with any ODBC database Matches complex data Case Finder - Retrieval of Similar Cases
Medical Ontology Case Finder uses the Unified Medical Language System (UMLS) with >700K concepts and 1.5M concept names –allows matching at the concept level cva = stroke = brain attack –identifies relationships between concepts embolic stroke is a kind of stroke
Evidence Finder: Query Enter words or phrases, separated by commas: glucophage Study Method Randomized Trial Population Study Guidelines Review Article Meta-Analysis Cost Benefit Analysis Cost-Effectiveness Key Disorders Diabetes Lipid Disorders Stroke Asthma Osteoporosis A I D S Pneumonia Heart Failure Hypertension Preop Consults Epidemiology Prevention Diagnosis Screening Treatment Non-pharm Rx Outcomes Subtopic Case Study Essence of the essence of recent published literature: abstracts and pearls Evidence-based; categorized by evidence quality Reduces need for colleague consultation Accessible, intuitive, relevant Think with me functionality
Evidence Finder: Results You matched 6 out of 121 documents Presented by James Gavin, M.D. at MCP Hahnemann University on 3/3/99 [0 CME credits] In obese patients with poorly controlled type 2 diabetes on diet alone, use of metformin titrated to maximal dosage or fasting plasma glucose of <140 mg/dl resulted in significantly improved average glycemic control, compared to placebo. … 1 Efficacy of metformin in patients with non-insulin- dependent diabetes mellitus. The Multicenter Metformin Study Group 6 Minority Issues in the Management of Diabetes Mellitus - Recommendations
Evidence Finder: Results Efficacy of metformin> n patients with non-insulin- dependent diabetes mellitus. The Multicenter Study Group><> EVIDENCE BASED MEDICINE INDEXED DOCUMENT RETRIEVAL EVIDENCE BASED MEDICINE INDEXED DOCUMENT RETRIEVAL Treatment Pharmacologic (Randomized Control-Certified) Pearl In obese patients with poorly controlled type 2 diabetes on diet alone, use of titrated to maximal dosage or fasting plasma glucose of (titrated as above) compared to those remaining on glyburide alone (hemoglobin A1C 7.1% vs. 8.7%, respectively). Patients changed from maximal glyburide to titrated dose had minimal improvement in average glycemic control. Abstract BACKGROUND: Sulfonylurea drugs have been the only oral therapy available for patients with non-insulin-dependent diabetes mellitus (NIDDM) in the United States. Recently, however, has been approved for the treatment of NIDDM. …
Evidence Finder: Results MULTIMEDIA DOCUMENT RETRIEVAL, WITH CME CREDIT, INDEXED BY PRESENTATION SEGMENT
What the Warehouse Holds NMKB Content Index for all current and potential content for all applications - based on Dublin Core Evidence-based medicine abstracts and pearls All exemplar cases for CaseFinder application Digital video and slides/images for all virtual events All content for Active Learning Framework training modules Unified Medical Language System ontology Student history User data Potential content for the NMKB
Summary and Conclusions The NMKB project sponsored by NIST ATP was successfully completed The NMKB will support innovative interactive multimedia-enabled medical applications. Goal is to commercialize the NMKB or pieces of it. The data warehouse of a commercial NMKB must be supported by object relational database technology Scalable growth is required as content base grows. Parallel database operation is required for sophisticated CBR searching and concurrent access by large numbers of users.