1. HEALTHGRID.ORG The European HealthGrid Initiative e-Health and the Grid: Projects and Prospects in the European Union NEC 2005 40 years Tony Solomonides on behalf of The HealthGrid Association

2. HEALTHGRID.ORG 2 Tony.Solomonides@uwe.ac.uk NEC 2005 Issues and Projects What is a ‘healthgrid’?  combines Grid and e-Science ideas  oriented to biomedical advances  supports evidence-based practice What projects?  imaging for diagnosis and treatment  simulation for treatment guidance  bioinformatics for biomedicine  legal, ethical, security and trust issues

3. HEALTHGRID.ORG 3 Tony.Solomonides@uwe.ac.uk NEC 2005 History HealthGrid 2003 – Lyon, Jan 03 HealthGrid Association incorporated HealthGrid 2004 – Clermont-Ferrand, Jan 04 HealthGrid ‘White Paper’, June 04 HealthGrid 2005 – Oxford, Apr 05 FP6 Project ‘SHARE’ – December 05 HealthGrid 2006 – Valencia, June 06

4. HEALTHGRID.ORG 4 Tony.Solomonides@uwe.ac.uk NEC 2005 Principal Themes Integration Levels of life & knowledge: correspondence & convergence Issues of ethics and trust Services on grid infrastructure

5. HEALTHGRID.ORG 5 Tony.Solomonides@uwe.ac.uk NEC 2005 Principal Theme 1 Integration  medical and bioinformatics  patient information and medical knowledge  ‘gold standard’ evidence and practice-based evidence  patient data – images, labs, history  models of the human body  legal, ethical, social, trust issues

6. HEALTHGRID.ORG 6 Tony.Solomonides@uwe.ac.uk NEC 2005 EU project to prototype a pan-European distributed database of mammographic images using Grid Technologies. Aim: To provide a demonstrator for use in epidemiological studies, quality control and validation of computer aided detection algorithms. Example 1 Knowledge Grid

7. HEALTHGRID.ORG 7 Tony.Solomonides@uwe.ac.uk NEC 2005 Grid Architecture GRID VPN Workstations MammoGrid Data Udine Oxford CERN MammoGrid Data Cambridge GridBox High Security Level MG W/s (‘‘MAS’’) MG W/s (‘‘MAS’’)

8. HEALTHGRID.ORG 8 Tony.Solomonides@uwe.ac.uk NEC 2005 Grids and Imaging 1 Diagnosis  comparison, ‘find-one-like-it’ Epidemiology  virtual databases  significant statistics Therapy planning  targetting, implantation, surgery Problems of heterogeneity Security Issues

9. HEALTHGRID.ORG 9 Tony.Solomonides@uwe.ac.uk NEC 2005 Grids and Imaging 2 Service Oriented Architecture  grid services can deal with heterogeneity  grid services can be used to plan workflow  examples include annotation, detection, analysis, registration, aggregation and visualization services Optimistically …  legal, ethical, social and trust negotiations may be implemented through services

10. HEALTHGRID.ORG 10 Tony.Solomonides@uwe.ac.uk NEC 2005 Example 2 Computational Grid Legal Aspects Simulation & Imaging Grid Software Bio-numeric modelling Medical Expertise Secure & lawful Grid provision of medical services Build 6 Grid-enabled medical prototype applications Build suitable middleware on top of common standards Install and evaluate a GEMSS test-bed Anticipate privacy, security & other legal concerns Taken from Gerhard Engelbrecht

11. HEALTHGRID.ORG 11 Tony.Solomonides@uwe.ac.uk NEC 2005 Applications NameDomainClass Maxillofacial surgery simulation Medicine – pre-surgical planning On demand / distributed supercomputing Neurosurgery support Medicine – intra-operative planning On demand Radiotherapy planning Medicine – Monte Carlo treatment simulation On demand / distributed supercomputing Inhaled drug delivery planning Medicine – air flow dynamics On demand / distributed supercomputing Cardio-vascular system simulation Medicine – blood flow dynamics On demand Advanced image reconstruction Medicine – nuclear / in vivo diagnostics On demand Taken from Gerhard Engelbrecht

12. HEALTHGRID.ORG 12 Tony.Solomonides@uwe.ac.uk NEC 2005 Principal Theme 2 Levels of life Levels of knowledge Correspondence and convergence  medicine and genomics  ‘molecular medicine’  ‘individualized healthcare’

13. HEALTHGRID.ORG 13 Tony.Solomonides@uwe.ac.uk NEC 2005 Bio-social being & pathology Molecular and Image-based diagnosis Population Disease Patient Tissue, organ Molecular, genetic Genomic Epidemiology Pharmacogenetics Bioinformatics Medical Imaging Medical Informatics Public Health Informatics INBIOMEDINBIOMED PATHOLOGIESPATHOLOGIES Taken from Fernando Martín-Sánchez

14. HEALTHGRID.ORG 14 Tony.Solomonides@uwe.ac.uk NEC 2005 An example: Integration of clinical and genetic info from heterogeneous remote databases A vocabulary server that aims to combine existing terminology systems in Medicine and Genetics Novel framework for clinicians to locate, search, access, retrieve and use genomic information in patient care Taken from Fernando Martín-Sánchez

15. HEALTHGRID.ORG 15 Tony.Solomonides@uwe.ac.uk NEC 2005

16. HEALTHGRID.ORG 16 Tony.Solomonides@uwe.ac.uk NEC 2005

17. HEALTHGRID.ORG 17 Tony.Solomonides@uwe.ac.uk NEC 2005

18. HEALTHGRID.ORG 18 Tony.Solomonides@uwe.ac.uk NEC 2005 Principal Theme 3 ‘LEST’ Issues  use of data in care and in research  data provenance  privacy / confidentiality  security  national / EU legal framework  … extending the concept of a ‘virtual organization’  & building negotiation into the infrastructure

19. HEALTHGRID.ORG 19 Tony.Solomonides@uwe.ac.uk NEC 2005 GRIDs and Privacy Good reasons for talking about privacy here and now! –The HealthGrid promises access to large amounts of heterogeneous distributed data –Health related information is very sensitive and prone to abuse –Privacy impacts society as a whole (e.g. loan applications, insurance, scholarship,...) –Privacy violation is irreversible –Confidential information can never be considered confidential again, once it was out in the open –Grid and Privacy Enhancing Technology exist and are used They could both benefit from early integration Adapted from Georges de Moor and Brecht Claerhout

20. HEALTHGRID.ORG 20 Tony.Solomonides@uwe.ac.uk NEC 2005 Sharing of Healthcare Data Local Databases: –Nominative records (e.g. patient treatment) –Privacy protected DBs Data Access through the Grid Privacy Protecting Interface Privacy Protecting Interface (PETs): –Locally controlled –Pseudonymisation –Content filtering and transformation –Query evaluation (restriction) Local Database Adapted from Georges de Moor and Brecht Claerhout

21. HEALTHGRID.ORG 21 Tony.Solomonides@uwe.ac.uk NEC 2005 Principal theme 4 A Grid Infrastructure for Health Applications Technology attitude To build on what already exists To build on what already exists To build only what is necessary To build only what is necessary Healthgrid Components Healthgrid Applications Clinical Data Grid Infrastructure

22. HEALTHGRID.ORG 22 Tony.Solomonides@uwe.ac.uk NEC 2005 Layered Grid Technologies Knowledge Grid Data Control Data Abstraction Data Grid Information Grid  Distributed databases, streaming, near-line storage, large objects, access mechanisms, data staging …  Metadata, middleware, intelligent retrieval, information modelling, warehousing, workflow …  Data mining, visualisation, simulation, problem solving methods/environments …

23. HEALTHGRID.ORG 23 Tony.Solomonides@uwe.ac.uk NEC 2005 A Grid Infrastructure for Health Applications To address the problems of integration of multi-level medical data, and the exploitation of its intrinsic knowledge through a health-specific grid Infrastructure and a set of grid applications for health. through a health-specific grid Infrastructure and a set of grid applications for health. To integrate grid infrastructures, health-related grid components, and pilot applications to provide a workbench for medical and clinical support. to provide a workbench for medical and clinical support. To develop components to link the available expertise, data, and resources. to demonstrate the benefits through pilots in epidemiology and personalised healthcare. to demonstrate the benefits through pilots in epidemiology and personalised healthcare.

24. HEALTHGRID.ORG 24 Tony.Solomonides@uwe.ac.uk NEC 2005 Benefits Expected At the patient level Personalised healthcare, e.g. through simulation in therapy. Improvement in the effectiveness of health policies through epidemiological studies. At the medical professional level Development of federated databases and collaborative communities. Development of services to support diagnosis and therapy in day-to-day work. At the IT Level A workbench for the development of tools and services towards specific features of healthcare IT.

25. HEALTHGRID.ORG 25 Tony.Solomonides@uwe.ac.uk NEC 2005 NEXT NEXT 10 years (2003-2014) PAST PAST 10 years (1991-2002) Computer Applications for Doctors Telemedicine systems and services Budget 20M € Budget 100M € Budget 140M € Budget 200M € Projects 30 Projects 63 Projects 158 Projects 125 Results Feasibility Study Results AIM Community Results 1 st batch of Products Results EU Health Telematics Industry @ 20 Years of eHealth R&D Context Regional Health Info Networks Home-care systems Personal Health Systems -HealthGrid Biomedical Informatics - informatics for Genomic Medicine - Virtual Physiological Human Personal health systems (Wearable & Implantable) based on new biosensors Decision Support Syst./Patient Safety www.cordis.lu/ist/directorate_c/ehealth/index.html ’02-’06 Research activities (200 Mil. €) ’89-’91’91-’94’94-’98’98-’02 Currently preparing activities for ’06-’10

26. HEALTHGRID.ORG 26 Tony.Solomonides@uwe.ac.uk NEC 2005 EC - ICT for Health Current Activities and Plans EHR & interoperability Biomedical informatics HealthGrid Time to results Deployment Applied/ Industrial R&D Basic research 5 years10 years 15 years Decision Support Systems Support to eHealth “Action Plan” Health info networks & services Personal Health Systems (wearables) General issues EHR, Security, Interoperability I II III

27. HEALTHGRID.ORG 27 Tony.Solomonides@uwe.ac.uk NEC 2005 CISTRANA - IST ERA Implementation I eHealth ERA I2HEALTH Identification doctors/patient Messages/requests I2HEALTH Identification doctors/patient Messages/requests Certification EHR SSA Certification EHR SSA TMA Bridge Interop. approach TMA Bridge Interop. approach RIDE Interoperability RIDE Interoperability SHARE Healthgrid SYMBIOMATICS BMI ERA Pilot STEP VH CA INFOBIOMED BIOPATTERN SEMANTIC MINING Semantic Health Interoperability Semantic Health Interoperability II III Short time research Long time research

28. HEALTHGRID.ORG 28 Tony.Solomonides@uwe.ac.uk NEC 2005 More information References  http://lyon2003.healthgrid.org/program.php  http://clermont2004.healthgrid.org/program.php  http://oxford2005. healthgrid.org/program.php HG2004, HG2005 Proceedings ‘White paper’  http://www.healthgrid.org/download.php (June 2004) SHARE Project – Road Maps