Innovation, data science & risk in healthcare Bern Shen MD HISA Health Data Analytics Brisbane 11 Oct 2017
Policies & interventions Biology Physical Social Individual environment environment Behavior Technology Access to quality healthcare Health status Adapted from Healthy People 2010 Source: : Mokdad, et al. 2004. Actual causes of death in the United States, 2000. JAMA. 2004;291:1238-45. 2
See Understand Predict Control “Illness is about learning to live with lost control.” Arthur Frank. The Wounded Storyteller: Body, Illness & Ethics. - “It may not be dying we fear so much, but the diminished self.” Anatole Broyard. Intoxicated by My Illness. - 3
Analytics & algorithms are beautiful … (DCF startup valuation) (SVM classifier for machine learning) … but only useful if they effect benefit in the real world. 4
Population Health Framework 5 Source: Care Continuum Alliance. Outcomes Guidelines Report, Vol. 5. Washington, DC: Care Continuum Alliance. 2010.
Translation, implementation, dissemination • NIH National Center for Advancing Translational Sciences (2011) • Centres in Australia including Queensland Translational Research Institute 6
Data science Risk Innovation 7
Top risks “Second on the list is the one we haven’t thought of, and at the very top is the one we can’t imagine.” – David Morens, US NIAID Source: : Mokdad, et al. 2004. Actual causes of death in the United States, 2000. JAMA. 2004;291:1238-45. 8
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Adapt (anticipate?) or die Identify the tree shrew Or better, be the next apex predator 10
Context & Pasteur’s prepared mind “ Dans les sciences d'observation le hasard ne favorise que des esprits préparés .” -Louis Pasteur, 1854 11
Data points (analytical) → data clouds (ecological) 12
Data points (analytical) → data clouds (ecological) Disease anticipated Disease detected Disease signal Disease driver signal Poverty, social inequality Weather, climate change Signal Malnutrition, famine strength Crowding, human/wildlife contact Land use/ecosystem change Disaster … (Noise) Time 13
“Complexity rheostat” Doctor Decision support, practice guidelines, care pathways, etc. Patient Adherence, health beliefs & behaviors, social determinants, etc. Med Similarly for diagnostics, devices, services … 14
Map of science derived from clickstream data Bollen J, Van de Sompel H, Hagberg A, Bettencourt L, Chute R, et al. (2009) Clickstream Data Yields High-Resolution Maps of Science. PLoS ONE 4(3): e4803. doi:10.1371/journal.pone.0004803 15 http://127.0.0.1:8081/plosone/article?id=info:doi/10.1371/journal.pone.0004803
Geographic → genomic a Source: http://rocs.hu-berlin.de/complex_sys_2015/resources/Presentations/C_Mueller.pdf 16
Human disease network graph • 67% of disorders linked to at least one other • Giant cluster contains 516 of 1284 (40%) 17 Kwang-Il Goh, and In-Geol Choi Briefings in Functional Genomics 2012;11:533-542
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Health risks … 19 Source: Univ. of Washington IHME. http://vizhub.healthdata.org/gbd-compare/
…change over time... 1990 2010 Source: R Lozano, et al. 2012. Global & regional mortality from 235 causes of death for 20 age groups in 1990 & 2010. Lancet 380:2095-128. 20
…with age... 21 Source: R Lozano, et al. 2012. Global & regional mortality from 235 causes of death for 20 age groups in 1990 & 2010. Lancet 380:2095-128.
…b y gender & place … 22
Global …b y wealth & place Wealthier Poorer Interpersonal violence in Diarrhea Central & South America HIV/AIDS Liver cancer in China Malaria TB Neonatal sepsis Self-harm Malnutrition Meningitis Lung cancer Interpersonal violence Diabetes Neck pain Alcohol use Lung cancer Stomach cancer Anxiety Drug use Colon cancer Alcohol use Colon cancer Breast cancer Forces of nature in Dementias Caribbean Pancreatic cancer Prostate cancer 23
Technobiome “ A House is a machine for living in. ” -Le Corbusier. Vers Une Architecture. 1923. “ … joining and separation of human and nonhuman are everyday affairs. ” -Suchman. Human-Machine Reconfigurations. 2007. 24
Unintended consequences, ethics “We are building a civilization that is deeply connected yet technologically insecure… in other words, we are constructing a world that is wired for crime.” 25
Dealing with bad data • Unintended • Deliberate Toward Precision Medicine: Building a knowledge network for biomedical research & a new taxonomy of disease. National Academies Press, 2011. 26
New data, new connections 27
• New data types Beyond usual text, tracings, & images • New data sources Outside of the hospital, clinic & lab • …create new information management challenges 28
Data (test) Insight (diagnose) Action (treat) 29
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