1. IntroOH-1 CSE 300 Topics in BMI: Course Objectives Prof. Steven A. Demurjian, Sr. Computer Science & Engineering Department The University of Connecticut 371 Fairfield Road, Box U-255 Storrs, CT 06269-2155 steve@engr.uconn.edu http://www.engr.uconn.edu/~steve (860) 486 - 4818

2. IntroOH-2 CSE 300 What is Informatics?  Informatics is:  Management and Processing of Data  From Multiple Sources/Contexts  Involves Classification (Ontologies), Collection, Storage, Analysis, Dissemination  Informatics is Multi-Disciplinary  Computing (Model, Store, Process Information)  Social Science (User Interactions, HCI)  Statistics (Analysis)  Informatics Can Apply to Multiple Domains:  Business, Biology, Fine Arts, Humanities  Pharmacology, Nursing, Medicine, etc.

3. IntroOH-3 CSE 300 What is Informatics?  Heterogeneous Field – Interaction between People, Information and Technology  Computer Science and Engineering  Social Science (Human Computer Interface)  Information Science (Data Storage, Retrieval and Mining) People Information Technology Informatics Adapted from Shortcliff textbook

4. IntroOH-4 CSE 300 What is Biomedical Informatics (BMI)?  BMI is Information and its Usage Associated with the Research and Practice of Medicine Including:  Clinical Informatics for Patient Care  Medical Record + Personal Health Record  Bioinformatics for Research/Biology to Bedside  From Genomics To Proteomics  Public Health Informatics (State and Federal)  Tracking Trends in Public Sector  Clinical Research Informatics  Deidentified Repositories and Databases  Facilitate Epidemiological Research and Ongong Clinical Studies (Drug Trails, Data Analysis, etc.)

5. IntroOH-5 CSE 300 What are Key BMI Focal Areas?  T1 Research  Transition Bench Results into  Clinical Research  Clinical Research  Applying Clinical Research Results via Trials with Patients on Medication, Devices, Treatment Plans  T2 Research  Translating “Successful” Clinical Trials into Practice and the Community  Clinical Practice  Tracking all of the Information Associated with a Patient and his/her Care  Integrated and Inter-Disciplinary Information Spectrum

6. IntroOH-6 CSE 300 Where/How is BMI Utilized? T1 Research (Bench  Clinical)  Transfer of Knowledge from Laboratory or Bench to Clinical Trials  Move Genomic Research from Bench (Lab) to Clinical Trial (or Genetic/Test Intervention)  Transfer in Lab/Bench Research to Pre-Clinical and Early Clinical Human Subject Research  Exs:  New Genetic Test for Autism  Tested on Samples from DNA Repository  Transition to Actual Patient Population  Growing new Jaw Bone in Mice for Dental Implants – Transition to Human Tissue

7. IntroOH-7 CSE 300 Where/How is BMI Utilized? Clinical Research (Trials)  Wide Range of Implications from Medical Treatment to Medication Regime  Multi-Phased Process for Clinical Trials:  Phase I: First Stage – 20-80 Healthy Patients  Phase II: Second Stage – 20-300 Patients  IIA – Dosing – How Much of Drug Should be Used  IIB – Efficacy – How Well Does Drug Work  Randomized Clinical Trials (Not all Get Drug)  Phase III: Multi-Center Trials – 300-3000  Longer Term, Data Collected, Multiple Locations  Preparation of Data for Regulatory Approval (FDA)  Phase IV: Ongoing Monitoring of Drug After Approval

8. IntroOH-8 CSE 300 Where/How is BMI Utilized? Clinical Research (Trials)  Differing Perspectives for Carrying out Research:  Patients: Drug, Treatment Regime, or Device  Increased Dose of Existing Drug (Safety/Effective)  Applying Drug to New Disease  Compare Two or more Treatments  Epidemiological  Study Existing Data for Trend  Against Existing Data Repositories  Patients with CHF and Diabetes Taking Statins  Tracking Communicable Disease/Outbreaks  Phases I, II, III, and IV Apply  Bad Results in IV – Pull Drug (Vioxx)

9. IntroOH-9 CSE 300 Where/How is BMI Utilized? T2 Research (Clinical Research  Practice/Community)  Practice-Oriented Translation Research  Results: Clinical Trails  Clinical Practice  Strategies for Establishing/Implementing New Technologies  Improvements in Practice  New Evidence-Based Guidelines  New Care Models  Phase III Success Translated to Health Providers  Examples  Statin Drugs (Lipitor) and Exercise  New Treatment Regime for Chronic Disease

10. IntroOH-10 CSE 300 Where/How is BMI Utilized? Clinical Practice  Dealing with Patients – Direct Medical Care  Hospital or Clinic  Physician’s Office  Testing Facility  Insurance/Reimbursement  Tracking All Data Associated with Patients  Medical Record  Medical Tests (Lab, Diagnostic, Scans, etc.)  Prescriptions  Stringent Data Protection (HIPAA)  Distributed Repositories, Inability to Access Data in Emergent Situations, Competition, etc.

11. IntroOH-11 CSE 300 What is Medical Informatics?  Clinical Informatics, Pharmacy Informatics  Public Health Informatics  Consumer Health Informatics  Nursing Informatics  Systems and People Issues  Intended to Improve Clinical outcomes, Satisfaction and Efficiency  Workflow Changes, Business Implications, Implementation, etc…  Patient Centered – Personal Health Record and Medical Home  Care Centered – Pay for Performance, Improving Treatment Compliance

12. IntroOH-12 CSE 300 What is Bionformatics?  Focused on Research Tools for T1:  Genomic and Proteomic Tools, Evaluation Methods, Computing And Database Needs  Information Retrieval and Manipulation of Large Distributed (caBIG) Data Sets (cabig.cancer.gov/index.asp)  Often Requires Grid Computing  Includes Cancer and Immunology Research  Increasing Need to Tie These Separate Types of Systems Together = Personalized Medicine  Biology and the Bedside (www.i2b2.org) www.i2b2.org

13. IntroOH-13 CSE 300 Where is Data/How is it Used?  Medical And Administrative Data Found in Clinical Information Systems (CIS) Such As:  Hospital Info. Systems Electronic Medical Records  Personal Health Records such as Google Health and Microsoft Healthvault  Pharmacy, Nursing, Picture Archiving Systems  Complex Data Storage and Retrieval – Many Different Systems  T1 Research Increasingly Reliant on CIS  T2 Research is Reliant on:  End Systems for Embedding EBM (Evidence- Based Medicine) Guidelines  Measuring Outcomes, Looking at Policy

14. IntroOH-14 CSE 300 What are Major Informatics Challenges?  Shortage of Trained People Nationally  Slows adoption of Health Information Technology  Results in Poor Planning and Coordination, Duplication of Efforts and Incomplete Evaluation  What are Critical Needs?  Dually Trained Clinicians or Researchers in Leadership of some Initiatives  Connect all folks with Informatics Roles across Institutions to Improve Efficiency  Multi-Disciplinary: CSE, Statistics, Biology, Medicine, Nursing, Pharmacy, etc.  Emerging Standards for Information Modeling and Exchange (www.hl7.org) based on XML www.hl7.org

15. IntroOH-15 CSE 300 What is UConn Doing in this Area?  NIH’s CTSA Program: Transform the Way Clinical and Translational Science Research is Conducted  From Bench to Clinical Research to Translational Research to the Bedside and Back Again  45+ Academic Medical Centers Awarded to Date see: http://www.ctsaweb.org/  Under President Mike Hogan’s Leadership  UConn Submitted a CTSA Proposal in Oct 2008  Formed CICaTS: Connecticut Institute for Clinical and Translational Science (Sept. 29 th 09)  University Initiative with Partners  John Dempsey, St. Francis, Hartford Hospital, CCMC, Hospital for Central CT, Institute for Living, etc.  http://cicats.uconn.edu/

16. IntroOH-16 CSE 300CICATS  Official Launching:  Tuesday September 29, 10:30am-1:30pm  UConn Global Business Learning Center, Hartford  Speakers Include: Pres. M. Hogan, Provost P. Nichols, and Dean Cato Laurencin (Med School)  Mission:  to educate and nurture new scientists  to increase clinical and translational research being conducted at UCHC, regional hospitals, UConn Storrs, and healthcare organizations throughout greater Hartford  to increase clinical and translational research being conducted at UCHC, regional hospitals, UConn Storrs, and healthcare organizations throughout greater Hartford  to work collaboratively with regional stakeholders to combat the leading causes of morbidity, mortality, disability, and health disparities  CICATS will have Biomedical Informatics Center

17. IntroOH-17 CSE 300 Biomedical Informatics in CICATS

18. IntroOH-18 CSE 300 Summary of Web Sites of Note:  AMIA (www.amia.org)  IHE (http://www.ihe.net/)  Smartplatform (http://www.smartplatforms.org/)  Mysis MOSS (http://www.misys.com/OpenSource) http://www.misys.com/OpenSource  NSF Clinical and Translational Science Program  http://www.ctsaweb.org/ http://www.ctsaweb.org/  Emerging Patient Data Standard  http://www.hl7.org/  Informatics for Integrating Biology & the Bedside.  https://www.i2b2.org/  Cancer Biomedical Informatics Grid  http://cabig.cancer.gov/index.asp

19. IntroOH-19 CSE 300 Semester Topics (weeks)  Four Core Topics:  Semester and Course Overview (0.5)  Informatics/Information Engineering (1.5)  Software Architectures (2)  Security and Dynamic Coalition Problem (2)  Service Based Computing (2)  CORBA, JINI,.NET, Interoperability, Web  Security  Discussion of Semester Project (0.5)  Presentations by Outside Speakers (2.5)  Student Presentations on Biomedical Informatics Materials (3)

20. IntroOH-20 CSE 300 Planned Speakers  Dr. L. Fagan, Co-Director, Stanford Biomedical Informatics Training Program, March 31  Dr. M. Smith, Pharmacy Practice, UConn, April 5  Dr. T. Shortliffe, President, AMIA, April 28  Others to be Scheduled:  Dr. Thomas Agresta  Dr. Michael Blechner  Dr. Xiaoyan Wang

21. IntroOH-21 CSE 300 Class Materials, Textbook, Projects, etc.  Course Web Site: http://www.engr.uconn.edu/~steve/Cse300/cse300.html http://www.engr.uconn.edu/~steve/Cse300/cse300.html  Reading List  Constant Updates and Changes  Textbook  Biomedical Informatics: Computer Applications in Health Care and Biomedicine (Health Informatics), Edward H. Shortliffe (Editor), James J. Cimino (Editor), ISBN-10: 0387289860  Project 1 – Due in 2 weeks  Project 2 – Out in 2 weeks  Team Project – Out in 2 weeks as well  Questions? Comments? Suggestions?

22. IntroOH-22 CSE 300 Course Projects and Exam (???) …  Individual/Team Course Project(s) Throughout the Semester  Individual Projects have two Goals  Increase Student Knowledge on BMI  Assist in Creating Courseware  Project will be the Entire Class  Explore and Learn about BMI Technologies  Span Subset of: T1 Research - Clinical Research - T2 Research - Clinical Practice  Explore Open Source and Other Solutions  Develop Extensible Plug and Play Framework  Exam – At MOST Final Exam (Still open to debate!)

23. IntroOH-23 CSE 300 Individual Semester Projects  Readings, Readings, and More Readings  Project 1: Annotated Bibliography  Accumulate Web/Hard Links on T1 Research - Clinical Research - T2 Research - Clinical Practice  Read 7 Papers on Clinical & Translational Science  Project 2: Courseware Materials  Choose two Different Areas for Indepth Examination  Topics include (but not Limited to):  HIE I2b2  Standards (HL7, Common Data Architecture CDA)  caBIG  BIRN (Biomedical Informatics Research Network)  Another NIH Computing Initiative

24. IntroOH-24 CSE 300 Semester Project  Still Evolving – Possible Projects Include:  Usage of SmartPlatform  Utilization of Personal Health Records (PHR) Such as Google Health and/or MS Healthvault in New or Extended Context  Interoperability with EMR  Google Health Hibernate API Available  XML (HL7/CDA) to i2b2 DB Translation  Supervised by M. Blechner (UCHC BMI Faculty)  Extending Cell Phone Applications (iphone, blackberry, and android) for  Maintaining Prescriptions  Observations of Daily Living  Prior Work by Undergraduate Teams (with Source)

25. IntroOH-25 CSE 300 Semester Project Objectives  Objective – Wide Scale Open Source Framework  Envision Plug and Play Architecture  High Reliance on Open Source Solutions for PHR and EMR  Support Interoperability to Components via XML and Standards  Develop Complete, Integrated, and Extensible Framework

26. IntroOH-26 CSE 300SmartPlatform  Substitutable Medical Apps, reusable technology  (http://www.smartplatforms.org/)http://www.smartplatforms.org/  NSF/NIH Funded SHARP Proposal at Harvard  Intended to: “A platform with substitutable apps constructed around core services is a promising approach to driving down healthcare costs, supporting standards evolution, accommodating differences in care workflow, fostering competition in the market, and accelerating innovation”  Likely Led by Timo Ziminski

27. IntroOH-27 CSE 300 Personal Health Records  Google Health  Detailed Hibernate API to Allow Programmatic Transfer of Information to/From Google Health  Utilized in Web-Based Application  Utilized by Cell Phone Projects (see later slides)  Existing Platform Available for Future Design, Development, and Usage  Explore EMR/PHR Interoperability

28. IntroOH-28 CSE 300 TMR Architecture

29. IntroOH-29 CSE 300

30. IntroOH-30 CSE 300 XML (HL7/CDA) to i2b2 DB Translation  Work with Dr. Michael Blechner (UCHC BMI Faculty Member)  Explore a Prototype that can take:  HL7/CDA Data (Simulated from an EMR)  Store in a i2b2 Compatible Database  Utilization of Standards, New Technologies, etc.

31. IntroOH-31 CSE 300 Cell Phone Applications  RWJ Project Health Design  Observations of Daily Living and PHRs  Passive – Once Initiated, Collects Data  Accelerometer  Pedometer  Pill Bottle that Sends a Time Stamp Message (over Bluetooth?) to SmartPhone  Active – Patient Initiated  Providing Information via Smartphone on: –Diabetes (Glucose, Weight, Insulin) –Asthma (Peak Flow, use of Inhaler) –Heart Disease (Pulse, BP, Diet) –Pain, Functional status, Fatigue, etc.  http://www.engr.uconn.edu/~steve/Cse4904/cse4904.html

32. IntroOH-32 CSE 300 Focus of Grant  Management of Two Diseases in Women of Color  Obesity and Osteoarthritis  Team  TRIPP (Crowell, Fifield) and AHFP (Agresta)  SisterTalk (Headley) and CHCAT (Granger)  UConn Storrs (Demurjian) and Netsoft (Collins)

33. IntroOH-33 CSE 300 CSE4904 – Spring 2010  Smartphone Projects on ODLs and Other Medical Data Tracking and Alerts  Three Platforms:  Google’s Android (Java)  Blackberry (Java)  iPhone (Objective C)  Three Teams of Three Students Each

34. IntroOH-34 CSE 300 Blackberry Team  Ability to Track Information on ODLs and Prescriptions  Login Screen  Connection to Google Health  Health Screen to Track ODLs  Charting of ODLs over Time  Loading Scripts from Google Health  Prescription Alarms  Adam Siena, Kristopher Collins, William Fidrych

35. IntroOH-35 CSE 300 Screen Shots

36. IntroOH-36 CSE 300 Screen Shots

37. IntroOH-37 CSE 300 Screen Shots

38. IntroOH-38 CSE 300 Screen Shots

39. IntroOH-39 CSE 300 Screen Shots

40. IntroOH-40 CSE 300 Android Team  Similar Capabilities to Blackberry Project  Wellness Diary and Medication Alarm  Integration with Google Health  Much Improved ODL Screens  Male and Female Faces  Change “Face” Based on Value  Tracking Prescriptions and Alarms  Reports via. Google Charts  Ishmael Smyrnow, Kevin Morillo, James Redway

41. IntroOH-41 CSE 300 Screen Shots

42. IntroOH-42 CSE 300 Screen Shots

43. IntroOH-43 CSE 300 Screen Shots

44. IntroOH-44 CSE 300 Screen Shots

45. IntroOH-45 CSE 300 iPhone Team  Similar Capabilities to Blackberry Project  Tracking of Conditions, Medications, and Allergies  ODLs for:  Blood-Glucose, Peak-Flow, and Hypertension  Generation of Reports  Synchronization with Google Health  Brendan Heckman, Ryan McGivern, Matthew Fusaro

46. IntroOH-46 CSE 300 Screen Shots

47. IntroOH-47 CSE 300 Screen Shots

48. IntroOH-48 CSE 300 Screen Shots

49. IntroOH-49 CSE 300 Screen Shots

50. IntroOH-50 CSE 300Questions?