1. Internet2 Health Sciences: CUDI Application discussion on medical discipline Mary Kratz, MT(ASCP) Internet2 Health Sciences Program Manager Mkratz@internet2.edu CUDI meeting in Manzanillo, Colima

2. Referral Doctor Doctor 2 Hospital Admission Doctor 1 Why should we care? X X X Medical records are not shared Medical Record Patient Medical Record Medical Record Medical Record X XXX

3. One Physician’s Story  #1 Problem: TOO MANY MISTAKES NRC Report “To Err is Human”  No ill will, simply a very badly undesigned non-system  Costs are EXPLODING!  Current medical science is not consistently available to caregivers  30,000 medical journals …. no one can keep up!

4. Healthcare is…  An information-dependent profession with crippled access to information  Slow to adopt change Five-year lead time from proven new science to 50 percent usage (Jim Reinertson, MD)  Procedures done in some medical specialties do not have validated data demonstrating effectiveness and value.

5. Evidence-Based Medicine  “...Evidence-based medicine de-emphasizes intuition, unsystematic clinical experience, and patho-physiologic rationale as sufficient grounds for clinical decision making and stresses the examination of evidence from clinical research.” Evidence-Based Medicine Working Group, JAMA (1992)  In the absence of data, decisions are made based on professional judgment…inconsistent and fraught with error.

6. The Doctor (1891), Fildes, Sir Luke Yesterday and Today Medicine used to be simple, ineffective and relatively safe. Now it is complex, effective and potentially dangerous.  Sir Cyril Chantler, Lancet 1999

7. The Solution: Electronic Medical Networks  What is needed in health care are pioneers in using the computer to make a real difference  No other option offers anything with comparable potential for either quality improvement or value

8. Core Functions for Electronic Medical Networks  Exploit data, turn it into information and extract the value  Produce knowledge from a world of partial, confused and unstructured information  Transfer the right information into the hands of the right person at the right moment

9. Objectives  Develop a strong infrastructure and support services which facilitate clinical care, education and research  Target specific areas Imaging TeleHealth Bioinformatics  Promote professional development of faculty and technical personnel

10. CLINICAL: Why Physicians Participate in Internet2  Extend the provision of better healthcare TeleHealth (eHealth) Develop Clinical Skills and Assessment  Distributed data sharing Electronic Health Record Presence and Integrated Communications (VoIP, RFID) Advanced visualization Computer Assisted Surgery Computer Aided Diagnosis  Collaboration independent of boundaries Geography Time Cognition: Knowledge Management

11. Educators: Why Faculty Participate in Internet2  Rich resources from student endpoints to centralized powerful computation and large storage  Students absorb multiple channels of information lecture Second screen Dynamic charts messaging Communal note taking Slide courtesy: Parvati Dev, Stanford University

12. RESEARCHERS: Why Scientists Participate in Internet2 Internet2 doesn't only save time, it allows interactivity in places where that was not possible before. I'd call it a quantum leap, if I didn't know that physics defines that as the smallest change a system is capable of... Timothy Poston, Bangladesh

13. Health Science Grand Challenge (1m)(10 -3 m) (10 -6 m) (10 -9 m)(10 -12 m) (10 -15 m) Systems models Continuum models (PDEs) ODEs Stochastic models Pathway models Gene networks Courtesy: Peter Hunter, University of Auckland

14. The Wizard GAP: Translational Research Discipline Community CS, Math, CSE Discipline Community Network of Research CS, Math, CSE Healthcare Life Sciences Slide courtesy Chris Johnson, SCI

15. NIH Roadmap: http://nihroadmap.nih.gov/  What are today’s most pressing scientific challenges?  What are the roadblocks to progress and what must be done to overcome them?  Which efforts are beyond the mandate of one or a few…but are the responsibility of (NIH as) a whole? E. Zerhouni, M.D. Director, National Institutes of Health

16. NIH Roadmap: Implementation Themes  New Pathways to Discovery National Technology Centers Bioinformatics Nanotechnology  Research Teams of the Future  Reengineering the Clinical Research Enterprise Integration/Interoperability Clinical Trials Translational Research

17. Cyberinfrastructure Definition  Medical content focus/driver  High bandwidth  Inter-institutional connectivity via Internet2  Uniformly consistent security model  Grid computing  Distributed (federated) file management and computational services  Performance and resiliency for databases  Integrated visualization and analysis tools

18. What is Internet2?

19. Pathway to Progress: The Patient  CUDI and Internet2 Translational research collaborations Scientific discovery Product development Clinical trials  What should be done for patients Access to services Efficiencies of production Improve quality of care

20. Core Functions for Electronic Medical Networks  Support ongoing and future management decisions  Broadband electronic communication and connectivity  Population health monitoring and reporting NIAID U01-AI46747 P.I. Carmen Zorrilla, M.D.

21. Its not about Technology! * From 6 Competencies ( ACGME) Knowledge Acquisition (technology scouting) Integrated Systems Approach Active Learning (didactic and procedural) Interpersonal Communication (knowledge transfer) Professionalism Project Based Learning & Improvement (Demonstrations) Community (systems based practice- Production Services)

22. Translational Research  Electronic Health Records Quality Heathcare for PATIENTS Access to use and interpret data Computational functionality Engineering infrastructure to support system distribution Deployment of scalable technology choices  Electronic Medical Networks Quality Heathcare for PATIENTS Access to use and interpret data Computational functionality Engineering infrastructure to support system distribution Deployment of scalable technology choices

23. More Information  On the Web www.internet2.edu Health.internet2.edu  Email info@internet2.edu Ana Preston Apreston@internet2.edu Mary Kratz Mkratz@internet2.edu

25. Research Team of the Future: Cancer Biomedical Informatics Grid  Global Cancer Research Community  Grid deployment to Cancer Centers  Bioinformatics infrastructure  Public data sources Funded by: NCI/NIH http://cabig.nci.nih.gov/ David States, MD, PhD

26. ONCOMINE http://141.214.6.14:8080/Array1/ Funded by: Univ of Michigan Pathology, Pew Scholars Program, American Cancer Society, and V Foundation Arul M. Chinnaiyan, MD, PhD  Cancer Microarray Database containing close to 50 million datapoints  Data mining tools to efficiently query genes and datasets of interest  Meta-analyze groups of studies

27. Remote, Real-time Simulation for Teaching Human Anatomy and Surgery  Demonstrate remote, real-time teaching of human anatomy and surgery  Deliver real-time simulation and visualization technologies  Network-based architecture allows for multiple high- resolution stereo-graphic displays and haptic devices Stanford University School of Medicine Stanford, CA

28. Surgical Planning  Pipelines for Morphometric Analysis  Surgical Planning  Interoperative segmentation  Brain atlas  fMRI Funded by NCRR/NIH Ron Kikinis, M.D., Steve Pieper, Ph.D., Simon Warfield, Ph.D. Brigham and Women’s Hospital, Harvard Medical School

29. Telemammography: National Digital Mammography Archive  Storage and retrieval of complete clinical record Mammographic images Radiology images (DICOM) Pathology reports and related patient information  Standard formats using standard protocols  Multi-layered security  Input and retrieval from multiple locations  Measurement Criteria: Saving lives! University of Pennsylvania, Philadelphia, PA Y12 National Security Complex in Oak Ridge, Oak Ridge, TN University of Chicago, Chicago, IL University of North Carolina at Chapel Hill, Chapel Hill, NC University of Toronto, Toronto, Canada

30. Center for Biologic Nanotechnology  Bring together the multiple disciplines to develop nanotechnology from conception to human trials.  Nanotechnology will impact communications, information storage, materials sciences and other non-biologic applications offering limitless opportunities for miniaturization. http://nano.med.umich.edu/ Funded by: NIH, DOE, NSF, DARPA James Baker, MD