1. From Biomedical Literature to Electronic Health Record Health Grid for Research and Clinical Decisions
Graduate Institute of
Medical Informatics
Taipei Medical University, Taipei, Taiwan
Yu-Chuan (Jack) Li, M.D., Ph.D.
Arbiter Lin, M.D., M.S.

2. Biomedical Data for Research and Clinical use
Scale, complexity and timeliness
Massive data and heavy computation
Data ownership problem
Privacy problem
Competition and collaboration among hospitals and research institutes
Grid may be ideal here!
Taipei Medical University
Graduate Institute of Medical Informatics

3. Graduate Institute of Medical Informatics
Range of Applications
Genome
Literature text mining
+ Microarray data mining
Transcriptome
Proteome
Metablome
Disease
Literature text mining
+ NHI data mining
+ EHR data mining
Treatment
Taipei Medical University
Graduate Institute of Medical Informatics

4. Graduate Institute of Medical Informatics
Scale and Complexity
Human Genome: 18,000 defined in Gene Ontology, total 25,000?
Human Proteome: not well defined, total 50,000~75,000?
Disease: 11,000 defined in ICD-9-CM
Treatment: 20,000 defined in NHI’s (National Health Insurance) medication + procedures
Taipei Medical University
Graduate Institute of Medical Informatics

5. National Health Insurance
Bureau of Nation Health Insurance
National Health Insurance for all people in Taiwan since 1995
NHI Smart Card issued to all 23 million people in Taiwan since
Taipei Medical University
Graduate Institute of Medical Informatics

6. Graduate Institute of Medical Informatics
NHI Smart Card
Taipei Medical University
Graduate Institute of Medical Informatics

7. Scale and Complexity (cont.)
National Health Insurance DB:
600 hospitals and 17,000 clinics connected in real-time to the NHI for the health smart card authentication
But the bandwidth is mostly 512KB/64KB in ADSL
Taipei Medical University
Graduate Institute of Medical Informatics

8. Size of Medical Data in Taiwan
Outpatient : 300 million visits / yr
Inpatient : 2.8 million-days / yr
1.5 billion prescription / yr
~ 900TB image data per year
~ 30TB text/coded data per year
Growing exponentially in the next 5 years while Electronic Health Record (EHR) matures
Taipei Medical University
Graduate Institute of Medical Informatics

9. Standardized EHR Project
Taipei Medical University
Graduate Institute of Medical Informatics

10. Graduate Institute of Medical Informatics
MIEC Project
National Medical Information Exchange Center
prototype in 1997
Hospitals treat health and medical data as their own property
Not willing to share with other hospitals
Concern about privacy, legal and business issues
Taipei Medical University
Graduate Institute of Medical Informatics

11. Graduate Institute of Medical Informatics
To Share, or Not to Share
Medical data are sensitive and “proprietary”
De-identification is not enough
Practice patterns, medication consumption patterns, outcome variations, case-mix index…etc. are still sensitive information
Share only the results of aggregated computation, not individual hospital
Privacy enhancing technologies
Multiparty private computation
Taipei Medical University
Graduate Institute of Medical Informatics

12. Scenario: Carpal Tunnel Syndrome
A physician of rehabilitation may want to know:
Percentage of different treatment on CTS in whole Taiwan:
Surgical Operation
Rehabilitation
Acupuncture
Outcome of each treatment options for a patient with specific age/sex
CTS Carpal Tunnel Syndrome
Repetitive motion injury
CTS graphic
Taipei Medical University
Graduate Institute of Medical Informatics

13. Scenario: A 58 year-old female
Lab Data: cholesterol 480mg/dl
A doctor may want to know:
Treatment options at these age/sex/lab
Medication usage… etc.
Outcome of each treatment options in Taiwan
The percentage of people who eventually get Coronary Artery Disease
Taipei Medical University
Graduate Institute of Medical Informatics

14. Graduate Institute of Medical Informatics
A Health Grid Can Work
For physicians
Weighing treatment options for individual patient
For patients
Know our options and risks
For health policy maker
Public health policy making
Taipei Medical University
Graduate Institute of Medical Informatics

15. Networking Environment
Taipei Medical University
Graduate Institute of Medical Informatics

16. Biomedical Literature Mining for Gene and Disease Relationship

17. Graduate Institute of Medical Informatics
Range of Applications
Genome
Literature text mining
+ Microarray data mining
Transcriptome
Proteome
Metablome
Disease
Literature text mining
+ NHI data mining
+ EHR data mining
Treatment
Taipei Medical University
Graduate Institute of Medical Informatics

18. Probabilistic Relationship Among Genes and MeSH terms
Medical Literature: 13 million citations collected in Medline
Medical Terms: 341,000 defined in MeSH (Medical Subject Headings)
18,000 gene names
Taipei Medical University
Graduate Institute of Medical Informatics

19. MeSH term: Breast Neoplasms

21. Complex Joint Probability Computation
Taipei Medical University
Graduate Institute of Medical Informatics

22. Graduate Institute of Medical Informatics
Future Applications
Text mining on literature and free-text data from EHR
Data mining on coded/numerical data from EHR or NHI DB or Gene/Protein chips
Support medical decision making and public health policy making
Taipei Medical University
Graduate Institute of Medical Informatics

23. Graduate Institute of Medical Informatics
Conclusion
Use Grid technology to collaborate hospitals and academic institutes
Build a testbed and demo site of a Health Grid in Taiwan
Increase international collaboration – working with EGEE
EU project - Supporting and structuring HealthGrid Activities & Research in Europe (SHARE)
Taipei Medical University
Graduate Institute of Medical Informatics

24. Welcome to ISGC 2004 in Taiwan!
Q & A
Welcome to ISGC 2004 in Taiwan!
Thanks you! ]
Taipei Medical University
Graduate Institute of Medical Informatics