1. Challenge 5: Towards Sustainable and Personalised Healthcare: Current State- of-the Art and Opportunities Within the FP7 ICT Call 1 Panagiotis BAMIDIS Lab of Medical Informatics, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece

2. 3RD KNOW HOW TRANSFER EVENT - SEPVE - Mar 2007 2 Talk Roadmap Healthcare in EU eHealth Before FP7 To FP7

3. 3RD KNOW HOW TRANSFER EVENT - SEPVE - Mar 2007 3 Challenges of Health Sector better, faster and more responsive health care services for the citizens more sophisticated and user friendly medical equipment, systems and tools for practitioners more efficient and cost effective management of services for managers faster and efficient supply of medical products for suppliers better co-ordination and management of health care services at European level for policy makers [Source: R. Zobel, eHealth 2003 Conference]

4. 3RD KNOW HOW TRANSFER EVENT - SEPVE - Mar 2007 4 What is eHealth? ICT for Health (also known as eHealth) describes the application of information and communications technologies across the whole range of functions that affect the health sector, from the doctor to the hospital manager, via nurses, data processing specialists, social security administrators and - of course - the patients. http://ec.europa.eu/information_society/activities/health/whatis_ehealth/index_en.htm

5. 3RD KNOW HOW TRANSFER EVENT - SEPVE - Mar 2007 5 eHealth support in EU eHealth is developing in at least three areas: research and technology development; policy; and applications and deployment. European Community research programmes have been supporting eHealth for the last two decades, co-financing research projects to the tune of €500 million. The European Union’s Member States are committed to sharing their best practices and experiences to create a European eHealth eHealth – which once had purely a research and development profile – is now moving ever closer to deployment and use of actual applications. (see the eTEN programme)eTEN programme http://ec.europa.eu/information_society/ activities/health/index_en.htm

6. 3RD KNOW HOW TRANSFER EVENT - SEPVE - Mar 2007 6 R&D activities at EC Medical Informatics - standalone PC era –Systems for the storage, retrieval, sharing and optimal use of biomedical data, information and knowledge Health Telematics - early telecommunication days –Regional health care networks, remote diagnosis and telemedicine applications eHealth - Internet era –Internet-based applications and services, medical content for prevision, intranets for the management of health services Personalised eHealth - Ambient Intelligence era –health knowledge infrastructure, wearable and implantable systems, Biomedical informatics for personalised health, Health GRIDs [Source: R. Zobel, eHealth 2003 Conference]

7. 3RD KNOW HOW TRANSFER EVENT - SEPVE - Mar 2007 7 R&D activities at EC (con’t) 19912002 FP2ESPRITFP3RACE/AIMFP4TELEMATICS FP5IST/HealthApplications 20M € 30 Projects Feasibility Study 100M € 63 Projects AIM Community 140M € 158 Projects 1st wave of products 200M € 125Projects EU Telematics Industry MedicalInformaticsHealthTelematicseHealthPersonalisedeHealth FP6eHealth Total600M€(15Years) [Source: R. Zobel, eHealth 2003 Conference]

8. 3RD KNOW HOW TRANSFER EVENT - SEPVE - Mar 2007 8 Bio Informatics Neuro-Informatics Medical Informatics  Electronic Health Records  Medical Imaging  Clinical Decision Support  Telemedicine  Functional Genomics  Proteomics  Computational Biology  Machine Learning  Knowledge Discovery  Human Computer Interfaces Personalized eHealth Personalised eHealth Knowledge [Source: R. Zobel, eHealth 2003 Conference]

9. 3RD KNOW HOW TRANSFER EVENT - SEPVE - Mar 2007 9 A relatively recent concept  Introduced in the 1990s  Place the individual citizen in the centre of the healthcare delivery process Key facilitators for:  Continuity of care  Preventive & personalised care  Citizen-centred care  citizen empowerment  preventive lifestyle & early diagnosis  disease management  independent living for ageing society [Source: Loukianos Gatzoulis, IST event 2006, Helsinki] Personal Health Systems - PHS

10. 3RD KNOW HOW TRANSFER EVENT - SEPVE - Mar 2007 10 Personal Health Systems In the form of:  Wearable, implantable, portable systems  Point-of-care systems Non-/minimally-invasive monitoring  Remote and continuous health status monitoring  Personalised medical advice, recommendations and treatment as necessary Emphasis so far:  Physiological monitoring (vital signs)  Physical activity monitoring (body-kinematics)  Functional stimulation (post-event rehabilitation)  Molecular diagnostics for screening applications (e.g. cancer) [Source: Loukianos Gatzoulis, IST event 2006, Helsinki]

11. 3RD KNOW HOW TRANSFER EVENT - SEPVE - Mar 2007 11 ICT for health – FP6 focus Research funded under the eHealth Strategic Objective of the IST research programme aimed at – creating an 'intelligent environment' allowing ubiquitous management of each person's health status – assisting health professionals in coping with major health challenges. The focus was on: – key technologies (biosensors and secure communications, 'smart clothes' and implants, which help patients - and their doctors - monitor and manage health status) – software tools to help health professionals take the best possible decisions assuring patient safety – networking multidisciplinary researchers in the fields of bio- informatics, genomics, and neuro-informatics to help create a new generation of eHealth systems to assist the 'individualisation' of disease prevention, diagnoses and treatment

12. 3RD KNOW HOW TRANSFER EVENT - SEPVE - Mar 2007 12 ICT for health – FP6 calls Under the Sixth Research Framework Programme (FP6), the Commission has sought proposals for eHealth research projects twice: – the 1 st Call for Proposals, which closed on 24 April 2003;1 st Call for Proposals – the 4 th call for proposals, which closed on 22/03/05 (http://ec.europa.eu/information_society/activities/health/doc s/projects/fp6call4projects-studies.pdf)4 th call for proposalshttp://ec.europa.eu/information_society/activities/health/doc s/projects/fp6call4projects-studies.pdf – There was also a joint call on bio-sensors for Diagnosis and Healthcare in June 2004joint call on bio-sensors for Diagnosis and Healthcare – Call 6: The Strategic Objective 'Ambient Assisted Living (AAL) for the Ageing Society' (closed 25/04/2006)

13. 3RD KNOW HOW TRANSFER EVENT - SEPVE - Mar 2007 13 Personal Health Systems Examples of FP6 projects MYHEART (http://www.hitechprojects.com/euprojects/myheart/)http://www.hitechprojects.com/euprojects/myheart/ Wearable systems (intelligent textiles) for prevention, early diagnosis and management of cardiovascular diseases OFSETH (www.ofseth.org)www.ofseth.org Textiles with optical sensors for physiological monitoring HEARTFAID (www.heartfaid.org)www.heartfaid.org Knowledge-based platform for heart failure management SMARTHEALTH (www.smarthealthip.com) andwww.smarthealthip.com MICROACTIVE (www.sintef.no/microactive)www.sintef.no/microactive Point of care devices for cancer screening (breast, cervical and colorectal cancer)

14. 3RD KNOW HOW TRANSFER EVENT - SEPVE - Mar 2007 14 Challenges for European Health Systems Pressure on healthcare systems  Citizens’ expectations for high-quality care  Demographic changes  more people will require prolonged care  Increased prevalence of chronic diseases  substantial part of the overall healthcare costs  Medical accidents  Staff shortages  Reactive model of healthcare delivery  after appearance of symptoms  Rising healthcare costs  faster than the economic growth itself How to offer high-quality & affordable care? [Source: Gérard Comyn, IST event 2006, Helsinki]

15. 3RD KNOW HOW TRANSFER EVENT - SEPVE - Mar 2007 15 Strategic Directions Mix of policy and research actions:  Shift from hospital-centred to person-centred systems  Shift from reactive to proactive (preventive) healthcare  Policy instrument:  Action Plan for a European eHealth Area COM(2004) 356  Research instrument:  Seventh Framework Programme for Research (FP7) [Source: Gérard Comyn, IST event 2006, Helsinki]

16. 3RD KNOW HOW TRANSFER EVENT - SEPVE - Mar 2007 16 FP 7 - Challenge 5 ICT WP 2007-08 - Strategic Objective: “Personal Health Systems for Monitoring and Point of Care diagnostics” Strategic Research Orientations:  Personal Health Systems  Patient Safety  Virtual Physiological Human

17. 3RD KNOW HOW TRANSFER EVENT - SEPVE - Mar 2007 17 FP7 Objective 3.5.1.1 Focus on: (a) Personalised (health status) monitoring  For people at risk or chronically ill  Wearable or portable/mobile ICT systems  Enable remote monitoring & care  Multi-parametric information (physiological; biochemical; activity, location, social and environmental context)  Intelligent systems to correlate multi-parametric data with expert biomedical knowledge  aid diagnosis  user support  Interoperable with electronic medical records

18. 3RD KNOW HOW TRANSFER EVENT - SEPVE - Mar 2007 18 FP7 Objective 3.5.1.1 - (2) Focus on: a1) Chronic disease management  intelligent closed-loop approaches  detect and assess trends and episodes  facilitate adaptive care  remote management, avoiding hospitalisation  promote doctor-patient interaction  potential for integration in the healthcare process a2) Preventive monitoring for people at risk  identify evolving patterns/trends in health & lifestyle parameters  indicate elevated risks of disease development  reveal episodes at early stages  facilitate personalised guidance  encourage citizen compliance  prompt for early medical intervention

19. 3RD KNOW HOW TRANSFER EVENT - SEPVE - Mar 2007 19 FP7 Objective 3.5.1.1 (3) Focus on: (b) Point-of-Care diagnostics  Multi-analyte screening at primary care (GP offices)  Portable or handheld devices (based on LoC, microarrays, etc.)  Multiple tests (e.g. genome, proteome, metabolome levels)  Identify disease predisposition  Early diagnosis of diseases & their recurrence  Assistance to treatment dosage advice suitability of drug use  Significant advances in: sensitivity and specificity data processing, analysis and quality control  Interface with hospital and laboratory information systems & electronic medical records

20. 3RD KNOW HOW TRANSFER EVENT - SEPVE - Mar 2007 20 FP7 Objective 3.5.1.1 (4) (c) Additional Support Actions on: 1) R&D roadmap on Personal Health Systems  emerging technologies and potential applications  user demand and business aspects  ethical and legal considerations 2) Wireless transmission of health-related information  reliability aspects  need for exclusive radio frequency bands? 3) Interoperability of Personal Health Systems with other eHealth systems  promotion and recommendations for continuous care

21. 3RD KNOW HOW TRANSFER EVENT - SEPVE - Mar 2007 21 FP7 Objective 3.5.1.1 (5) Expected Impact  Higher quality care at the patient location  Better support and reassurance to people at risk  Stabilise the cost of health delivery systems  Reinforce leadership of the EU Personal Health Systems industry Call 1 funding:

22. 3RD KNOW HOW TRANSFER EVENT - SEPVE - Mar 2007 22 More on ICT WP 2007-08 Challenge 5 “Advanced ICT for Risk Assessment and Patient Safety” Objective IST-2007.5.2

23. 3RD KNOW HOW TRANSFER EVENT - SEPVE - Mar 2007 23 a) Advanced computerised adverse event systems: New tools for identification, prediction, detection and monitoring of adverse events and other relevant information. – Based on innovative data mining and integration techniques of existing databases and specific applications. – Emerging technologies like semantic mining should be explored through multimedia databases. – Include validation leading to quantitative benefits. Research proposed in Objective IST-2007.5.2

24. 3RD KNOW HOW TRANSFER EVENT - SEPVE - Mar 2007 24 Research proposed in Objective IST-2007.5.2 b) New risk prediction for large scale events -local, regional or even global adverse health events (infectious outbursts, bioterrorism): new risk prediction, assessment and management tools for preparation, surveillance, support and intervention in case of large adverse health events. complement DG SANCO Health Emergency Operations Facility

25. 3RD KNOW HOW TRANSFER EVENT - SEPVE - Mar 2007 25 Research proposed in Objective IST-2007.5.2 c) Specific International Cooperation Actions (SICAs) with Latin America countries foster cooperation, transfer of technology and undertake demonstration activities in the area of alert and decision support systems based on Electronic Health Records.

26. 3RD KNOW HOW TRANSFER EVENT - SEPVE - Mar 2007 26 Funding in Objective IST-2007.5.2

27. 3RD KNOW HOW TRANSFER EVENT - SEPVE - Mar 2007 27 ICT in support of patient safety and risk management in healthcare [Source: Symbion & Communications- and Technology Research, IST event 2006, Helsinki]

28. 3RD KNOW HOW TRANSFER EVENT - SEPVE - Mar 2007 28 ICT in support of patient safety and risk management in healthcare ICT in Clinical Settings EHR (Electronic Healthcare Record) CPOE (Computerized Prescription Order Entry System) DSS (Decision Support tools) EBM (Evidence Based Medicine, guidelines) [Source: Symbion & Communications- and Technology Research, IST event 2006, Helsinki]

29. 3RD KNOW HOW TRANSFER EVENT - SEPVE - Mar 2007 29 More eHealth in FP7… The Virtual Physiological Human (VPH)...

30. Biomedical information is collected, stored and processed on/at: 1)Different Levels – molecule, cell, tissue, organ, patient, population 2)Different Context - care, research, education, policy/management 3)Different Representation – format, structures, ontologies,.. 4)Different places: - Clinical info resources: health records, clinical research databases, pharma databases … - Biomolecular info resources : DNA & protein sequences, microrarray data, protein interactions, human genome annotations.. - Public health info resources : epidemiological data and studies, national and WHO databases on diseases, … Biomedical informatics background [Source: Joël Bacquet, IST event 2006, Helsinki]

31. 3RD KNOW HOW TRANSFER EVENT - SEPVE - Mar 2007 31 BMI enables integration of biomedical data for better health (Molecular medicine) Population Patient Tissue, organ Cell Molecule Health Information levels INFORMATICS Public Health Informatics Medical Informatics Bioinformatics Based on Fernando Martin Sanchez Synthesis of all “Health information levels”

32. 3RD KNOW HOW TRANSFER EVENT - SEPVE - Mar 2007 32 Basis is the International physiome project www.physiome.org Computer models of the human physiology, which includes the interaction across temporal and spatial scales from molecules to cells, tissues, organs, up to the whole human body New basis for: Personalised (Patient-specific) healthcare solution Early diagnostics & Predictive medicine The Virtual Physiological Human - concept [Source: Joël Bacquet, IST event 2006, Helsinki]

33. 3RD KNOW HOW TRANSFER EVENT - SEPVE - Mar 2007 33 Animal Experiments Multi-parameter Analysis Imaging Modalities 3d visualisation Brain maps - Atlases Neurotransmitter studies Transmitter-Receptoc Fingerprints Molecules Anatomy Cytoarchitectonic info Single neuron recordings EPSPsIPSPs Multi neuron recordings EEGMEG Other functional Neuroimaging (Blood flow) PETfMRI Behavioural/Cognitive/Social Studies Search for biological basis of social cognition Genetic Studies Bridge gap b/w morphology & physiology inconsistencies Functional Neuroimaging of genetic variation

34. 3RD KNOW HOW TRANSFER EVENT - SEPVE - Mar 2007 34 Imaging Genomics Increasingly divergent path from genes to behaviour. Need estimation of genetic effects at the level of brain information processing, which represents a more proximate biological link to genes and behaviour. genescellssystemsbehaviour Complex functional interactions & Behavioural phenotypes

35. 3RD KNOW HOW TRANSFER EVENT - SEPVE - Mar 2007 35 Objective 3.5.2.1 – Virtual Physiological Human Technical focus on: a)Patient-specific modelling and simulation  Target: molecular, cell, tissue, organs or systems  Modelling & simulation of organs/systems targeting specific clinical needs.  Go beyond the state of art of available models  Models should be multilevel when appropriate  Better understanding of the functioning of the organs  New insight into the response to physiological changes

36. 3RD KNOW HOW TRANSFER EVENT - SEPVE - Mar 2007 36 Objective 3.5.2.1 – Virtual Physiological Human Technical focus on: b)Data integration and knowledge extraction  Target: creation and formalisation of patient specific knowledge from multi-level integration of biomedical data  Requirement: open distributed health infrastructures and tools  Focus:  Coupling scientific research data with clinical/empirical databases  Linking genotype data (genetic markers, pathways) with phenotype data (clinical data)  Image processing assessing disease evolution/presence  Data mining and image processing across many biological levels

37. 3RD KNOW HOW TRANSFER EVENT - SEPVE - Mar 2007 37 Objective 3.5.2.1 – Virtual Physiological Human Application focus on: a)Patient-specific modelling and simulation & b) Data integration and knowledge extraction to be demonstrated on c) following clinical applications:  Medical simulation environments for surgery  Environment used for simulation, training and planning of surgeries  Prediction of disease or early diagnosis (patient specific)  knowledge and predisposition obtained from lab tests, biomedical imaging (imaging bio-markers and other data)  assessment of efficacy/safety of drugs  Use patient specific computational models to assess the drugs.  Alternative screening for clinical trials

38. 3RD KNOW HOW TRANSFER EVENT - SEPVE - Mar 2007 38 Objective 3.5.2.1 – Virtual Physiological Human d)Networking action (NoE): in multilevel modelling and simulation of human physiology  sharing of knowledge  multidisciplinary training programmes  reusable software tools e)Coordination & Support Actions 1.Enhancing security and privacy in modelling and simulation addressing  patient data processed over distributed networks  use of genetic data  Trustworthy environment 2. International cooperation on health information systems based on Grid capabilities

39. 3RD KNOW HOW TRANSFER EVENT - SEPVE - Mar 2007 39 Funding for Objective 3.5.2.1 When :Call 2 Instruments (Draft not yet agreed):  (a-c) CPs 62M€ (minimum 22M€ for IP and Minimum 22M€ for STREPs)  (d)Integrating action: NoE max 8M€  (e) Coordination & Support Actions: CSAs Max 1M€ per action

40. 3RD KNOW HOW TRANSFER EVENT - SEPVE - Mar 2007 40 The future will tell…

41. 3RD KNOW HOW TRANSFER EVENT - SEPVE - Mar 2007 41 Thank you for your attention and time! Panos Bamidis, Ph.D. Lecturer in Medical Informatics Lab of Medical Informatics, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece bamidis@med.auth.gr http://lomiweb.med.auth.gr