North Locality Spoke Stakeholder Event Professor T.N. Arvanitis - 29/11/2013 How to innovate in healthcare through digital technologies and informatics Slide 1 Theodoros N. Arvanitis, RT, DPhil, CEng, MIET, MIEEE, AMIA, FSIM, FRSM Professor of e-Health Innovation Institute of Digital Healthcare, WMG, University of Warwick Birmingham Children’s Hospital NHS Foundation Trust

North Locality Spoke Stakeholder Event Professor T.N. Arvanitis - 29/11/2013 Digital Healthcare Digital healthcare is the application of appropriate digital technologies to the promotion of –wellbeing & prevention; –management of disease; –and delivery of health services that are effective, efficient and of high quality Challenges –Healthcare is the slowest adopter of digital technology –Big Data is coming – West Mids population 5.6m. –Fragmented landscape: many standalone digital applications from academia, industry, NHS –Need for interoperability –Need for translation and adoption Slide 2

North Locality Spoke Stakeholder Event Professor T.N. Arvanitis - 29/11/2013 WM AHSN Digital Work Streams On-line Healthcare and Clinical Delivery –real and tangible impact by delivering crucial on-line healthcare interventions Digital Innovation Management –an environment within which all innovations can be efficiently researched, prototyped, invested in, evaluated, commercialised and distributed Enabling Digital Communications –leverage the skills and abilities of its various partners, customers and consumers at scale Enabling Technology and Informatics –local, national and international innovations Digital investment, Commercial and Wealth Management –ability to attract new finance for digital investment, as well as create innovative partnerships Slide 3

North Locality Spoke Stakeholder Event Professor T.N. Arvanitis - 29/11/2013 Exemplars of healthcare innovation Two local exemplars with international impact Translating research knowledge to practice –TRANSFoRm Working with Big Data –Multimodal Imaging for Childhood Cancer Research and Practice Institute of Digital Healthcare Slide 4

North Locality Spoke Stakeholder Event Professor T.N. Arvanitis - 29/11/2013 The Institute of Digital Healthcare A world-class £4M 5-year funded partnership between the NHS, WMG, WMS and other relevant organisations Aims: to improve people’s health and wellbeing through the use of innovative digital technologies and methodologies We do this through high quality research, education and training capabilities Slide 5

North Locality Spoke Stakeholder Event Professor T.N. Arvanitis - 29/11/2013 Our USP WMG: Industry engagement WMS: Clinical need and relevance NHS: Reality check & ‘needs’ Slide 6

North Locality Spoke Stakeholder Event Professor T.N. Arvanitis - 29/11/2013 IDH – innovation and research I Biomedical & Health Informatics Clinical & Public Health Knowledge Clinical Trial Systems Patient & Population Data Deriving New Knowledge & Measure Performance Clinical Guidance & Decision Support Systems Slide 7

North Locality Spoke Stakeholder Event Professor T.N. Arvanitis - 29/11/2013 Brain imaging Clinical Imaging methodology and trials Neuro-imaging statistics Modelling Meta-analysis fMRI clinical trials In vivo metabolomics & Functional Imaging (childhood cancer, metabolic disease) Neuro-degenerative disease (epilepsy, sleep disorders) Human Brain Connectome IDH – innovation and research II Slide 8

North Locality Spoke Stakeholder Event Professor T.N. Arvanitis - 29/11/2013 Healthcare Technologies Biomedical Signal Processing Visualisation, Modelling and simulation Brain Electro- physiology (EEG) & BCI Physiological Monitoring – Healthcare Sensors IDH – innovation and research III Slide 9

North Locality Spoke Stakeholder Event Professor T.N. Arvanitis - 29/11/2013 eHealth Innovation Apps & Social Media Telehealth EvaluationImplementation IDH – innovation and research IV Slide 10

North Locality Spoke Stakeholder Event Professor T.N. Arvanitis - 29/11/2013 Health Systems Engineering & Modelling Care Quality Service Delivery Improvements Impact of Pathway Variation Analysis on Quality Threshold Impact of Pathway Variation Analysis on Patient Care Impact of Pathway Variation Analysis on cost: Hospital Operation IDH – innovation and research V Slide 11

North Locality Spoke Stakeholder Event Professor T.N. Arvanitis - 29/11/2013 Clinical Trial Management SystemsDevelopment of Clinical Trial Management Systems that provide, through an integrated infrastructure, a wide-ranging set of modular, interoperable and standards based tools designed to meet the needs of clinical trials Objectives of e-trials system implementation “computable” –To define a “computable” model representation that supports the entire life-cycle of clinical trials protocol, develop –To develop appropriate tools that use the model representation. translating research into clinical practice Slide 12

North Locality Spoke Stakeholder Event Professor T.N. Arvanitis - 29/11/2013 Specific research knowledge Actionable knowledge Routinely collected knowledge knowledge in healthcare Clinical trials Controlled populations Well-defined questions EHR systems Wide coverage Vast quantity May lack in detail and quality Distilled scientific findings Usable in clinical practice Decision support Slide 13

North Locality Spoke Stakeholder Event Professor T.N. Arvanitis - 29/11/2013 ePCRN and TRANSFoRm: US/UK perspective Slide 14

North Locality Spoke Stakeholder Event Professor T.N. Arvanitis - 29/11/2013 Informatics tower of Babel: the grand challenge Overwhelming volume of data Multitude of sources Each part of the health community speaks its own scientific “dialect” (e.g. lab values, genetic profile, clinical data) Lack of consensus on common standards and terms Lack of coordination across, and collaboration within, the cancer research enterprise Integration is critical to achieve promise of molecular medicine (personalised medicine) Slide courtesy of caBIG™ Slide 15

North Locality Spoke Stakeholder Event Professor T.N. Arvanitis - 29/11/2013 TRANSFoRm Itegrated VS The TRANSFoRm Integrated Vocabulary Service is designed to allow end users to search and retrieve clinical vocabulary concepts and associated content –a web interface and a web service API –the service uses the LexEVS (version 5.1) technology to access a backend UMLS vocabulary database –the service uses direct Java Database Connectivity (JDBC) to access other vocabulary databases (e.g. Read Codes V2, ICPC2) Slide 16

North Locality Spoke Stakeholder Event Professor T.N. Arvanitis - 29/11/2013 RCD v2/ICPC2 Read Codes (RCDv2) and International Classification of Primary Care (ICPC2) corpus of terms and their associated mappings –created to cater for the initial need of the existence of specific primary care oriented terminologies. The UK NHS Connecting for Health Terminology Centre - mappings from Read Codes version 2 to SNOMED CT. The Read Codes v2 database in Transform VS is set up based on this mapping so that Read Codes 2 concepts can be linked to a UMLS search. Similar approach for ICPC2. ICPC2-ICD10 Thesaurus and mappings - Transition University of Amsterdam The TRANSFoRm team is updating the ICPC2-ICD 10 mapping and Thesaurus ICPC3: new initiative UMLS Metathesaurus Read Codes v2 Codes SNOMED CT Codes ICPC2 Codes ICD-10 Thesaurus/Codes UMLS Metathesaurus Slide 17

North Locality Spoke Stakeholder Event Professor T.N. Arvanitis - 29/11/2013 TRANSFoRm Integrated VS Server Architecture Slide 18

North Locality Spoke Stakeholder Event Professor T.N. Arvanitis - 29/11/2013 A screenshot of the vocabulary service web-based interface Slide 19

North Locality Spoke Stakeholder Event Professor T.N. Arvanitis - 29/11/2013 Finding prevalent cases for trials Slide 20

North Locality Spoke Stakeholder Event Professor T.N. Arvanitis - 29/11/2013 acknowledgments: TRANSFoRm Consortium Slide 21

North Locality Spoke Stakeholder Event Professor T.N. Arvanitis - 29/11/2013 BIG Data: multi-modal imaging Investigating children’s cancer using functional imaging Metabolite maps Metabolite profiles Diffusion imaging Tractography Perfusion Quantitative imaging Slide 22

North Locality Spoke Stakeholder Event Professor T.N. Arvanitis - 29/11/2013 Powerful Computation Slide 23

North Locality Spoke Stakeholder Event Professor T.N. Arvanitis - 29/11/2013 large data sets Slide 24 HR-MAS NAA Cho Cr mI Lip+Lac 2 1H2 1H2 1H2 1H  1 13 C 1 H- 13 C HSQC 1 H- 13 C HSQC

North Locality Spoke Stakeholder Event Professor T.N. Arvanitis - 29/11/2013 agent-based classifiers Slide 25

North Locality Spoke Stakeholder Event Professor T.N. Arvanitis - 29/11/2013 acknowledgments: cancer research Investigators –Andrew Peet – UB PI, oncology, MRS –Theo Arvanitis – UW bio-informatics –Richard Grundy – UN oncology, biology –Martin Leach – ICR MR Physics, perfusion –Chris Clark – ICH MR Physics, diffusion –Franklyn Howe – StGUL MR Physics, MRS Collaborators Professor Dr Dorothee Auer University of Nottingham Dr Thomas Barrick St George's Hospital Medical School Mr David Collins Royal Marsden Hospital Dr Daniel Ford University Hospital Birmingham Dr Darren Hargrave Royal Marsden Hospital Mr Donald Macarthur Nottingham University Hospitals NHS Trust Dr Lesley MacPherson Birmingham Children’s Hospital NHS Trust Dr Paul Morgan University of Nottingham Dr Kal Natarajan University Hospital Birmingham Dr Oystein Olsen Great Ormond Street Hospital Dr Geoffrey S Payne The Institute of Cancer Research Professor Andy Pearson Royal Marsden Hospital Dr Sucheta Vaidya St George's Hospital Medical School Dr Tim Jaspan, University Hospital, Nottingham Dr Dawn, Saunders, Great Ormond Street Hospital Research Group: Nigel Davies, Martin Wilson, Kal Natarajan, Yu Sun, Eleni Orphanidou, Lisa Harris, Greg Reynolds, Sim Gill, Alex Gibb, M. Saleh, Suchada Tantisatirapong, Ben Babourina-Brooks, Jan Novak Slide 26

North Locality Spoke Stakeholder Event Professor T.N. Arvanitis - 29/11/2013 Digital Healthcare Define/identify healthcare problem Research/innovation Design & develop solution Evaluate & generate evidence Support innovation research and innovation Slide 27

North Locality Spoke Stakeholder Event Professor T.N. Arvanitis - 29/11/2013 realising our imagination: facing challenges Slide 28 "Leave the beaten track occasionally and dive into the woods. Every time you do so, you will be certain to find something that you have never seen before. Follow it up, explore all around it, and before you know it, you will have something worth thinking about to occupy your mind. All really big discoveries are the result of thought." Alexander Graham Bell: "electrical speech machine" of 1876

North Locality Spoke Stakeholder Event Professor T.N. Arvanitis - 29/11/2013 Thank you Slide 29