BCNET 2013 Keynote

UBC's CIO Oliver Grüter Andrews MC'ed the event this year, and started by introducing the chair of BCNET, Michael Hrybyk. Michael noted this year is the 13th annual event, and there are over 500 registrants.  Additionally we were informed of some key growth metrics this year:

1. All public post secondary institutions in BC are now members of BCNET

2. BC Libraries cooperative just joined BCNET

As an interesting note for those who might wish to speak at BCNET, there is no CFP (Call For Papaers) for the conference; the BCNET sub-committees each get a slot and determine the topics and speakers from within their groups.

Lastly, Michael announced that the Data Safe service hosted at TRU is now available to all BCNET members.

With that, the keynote speaker, Jer Thorp was introduced. His topic was "Making Data More Human."

Jer starts by asking us to consider"What is the human experience of technology; what is the subjective experience we are increasingly facing?"

We told that at any given time, there are more than 1M people in the air.  Jer then shared a digital moving image illustrating the global air traffic system, that impresively illustrated context for that number, helping us grasp a ridiculously large number in context of things we can easily express.

Jer recommends reading the book "Infinite Justice" by David Foster Wallace.

We're provided with a definition of data - measurements of something.

Contains an act of measurement, and that data is continually tethered to the something that was measured.

Example - Keppler Sattelite viewing the Cygnus-Lyra returning digital photographs continually; Watching these images for transit is akin to watching a lightbulb 20 kms away to see if a mosquito flies in front of the bulb.  Paladies is the supercomputer crunching this data

~4,000 potential orbiting planets identified. The condiseration of how to represent this data in a meaningful way is the key.

Data has character, every data set has unique character

How we can visualise that data is related to its character

Jer shifts gears, and talks about manipulating the visuals of the data in three and four dimensions. Consider the "Minority Report" style interface. Oblong is the company that built the minority report interface, and it is actively in use today. But it's not yet as accepted as it could be, although it has new collaborative features where people can grab the data relevent to them, pull it out and work with it without affecting the whole.

"Collaborative systems usually don't work because one person is driving, and the other people are jerks."

Measurement

Use the Ooh/Aah methodolgy - draw them in with the Ooh factor, and keep them interested with the Aah.

Peoples patterns of their lives is highly predictable given the data avilable for tracking their movements via cell phone tracking, or social media postings.

How can we model how people are sharing data on the web?

Examples given that are dramatic and effective:

Peoples data can be used without them being aware - opportunistic sensing

OpenPaths is an open project for your phone that sends your location data somewhere you and others can see it, which gives people the experience of data ownership, and first party access to their data.

People who generate data should have access to that data.

It is a reality that cellular phones have become the virtual biographer of our lives.

If we remind ourselves of our personal relationship with our data, we will take conversation more seriously with those who want it.

We should always ask ourselves "What experiences have we had that resulted in this data being produced?"

Bringing data into public spaces removes the "choice" to not view it

Distant reading is the new paradigm for data analysis: New systems bring us to the idea of distant reading where viewing our data at a higher level, from a further distance, new patterns emerge.

Examples cited are:

Monk

Rhyme-brain

3 things we need to be considering

1. Data ethics - we need this conversation outside of just privacy

2. Data ownership - the coming central issue over data

3. Data possibilities - rapid change gives us the opportunity to consider where data usage might be in 5 years

Jer's primary tool for data visualisation is "Processing" - MIT open source data visualisation software

O-c-r.org

IBM and Evidence Based Medicine Decision Support Systems

Jeffrey Betts from IBM makes a repeat appearance at the conference to discuss how the IBM Watson project can be leveraged for evidence based medicine and clinical decision support systems.

The Watson systems understands natural language, generates and evaluates hypothesis, and learns by homing its own decision algorithms. The solution has been developed hardware agnostic, but is generally run on parallel HPC systems for optimal response times.

The key point of this lecture is that computers are by default and historically poor at responding to unstructured data. Human minds have natural abilities to view unstructured data and identify patterns, and this is the goal of a true expert system such as Watson aspires to be.

Jeffrey takes us through screen shots of a case of an oncologist using Watson to assist with a consult. It was an interesting update for which no one in the audience had any questions.



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Location:Hwy 97 S,Kelowna,Canada

itManageCast Review of 12th Annual Western Cdn Health Summit

This week I've been in Kelowna attending my third Western Canadian Healthcare Summit, and while I have been blogging summaries of some of the more interesting sessions, this entry is intended to be an over-all review of the conference, venue, and most importantly, the value of the time spent in Kelowna.

Let me start by saying that I rarely if ever am disappointed to have to be in Kelowna. So Reboot Communications Ltd. couldn't pick a better city for this in my opinion. While the weather was crappy (like everywhere in BC) so far this week, and I still can't swing a golf club, my colleagues at UBCO, the UBC Southern Medical Program, and Interior Health make it worthwhile for me to be here, outside of the conference itself.

So what unholy deal exists between Carla Tadla and Keith Baldry? While I certainly don't have anything against Keith personally, it would be a nice change to have a fresh face for the event emcee/moderator. Not that he takes much speaking time, but it's just getting a little long in the tooth. Something that isn't long (enough) is the hashtag for the event - #HCYLW. I get what it means, because I'm here and I've thought about it a bit, but is it really a tag people would search on? I would suggest something a bit more descriptive like #WstrnHCSummit or some shorter variant that is slightly more self-explanatory.

And on the topic of technology, at the start of day two we have no conference wifi, and ergo, my blogging & tweeting will be restricted. Perhaps by design? :-) Those are some extreme measures to keep rogue bloggers like me under control. I'm thinking it's by design (or GE Healthcare only paid for one day?) as the passcode changed on the second day, but this wasn't announced until enough people complained around 10:00. I'd encourage the organisers to address that more quickly in the future, or at least let attendees know that it was a technical issue if that was the case. Otherwise, it just appears to be disorganisation, which my experience with Reboot would make me think that unlikely.

The theme for Tuesday seems to be big data, so I'm enjoying this, although I must admit I was surprised to see Jeffrey Betts from IBM presenting for the second year on IBM Watson. That said, it was interesting in so much that he was able to provide us with a case study of use in an oncological patient discussion to provide deep and wide evidence based patient care.

The big data panel discussion was excellent and was a highlight for me of the second day. Excellent panel, and great job by the conference planners.

However, since it's only 1.5 days of session content, I think the organisers should be more consistent with the level of speakers and topics. The audience seems to mostly be clinical administration, so I get that there needs to be logistics/supply chain discussions and I can tolerate that, but I get the feeling that some of the panels were really stuck for speakers as not all were of an equal calibre, or regarded by the audience as being the appropriate subject matter experts for their topic area.

If the organisers could get more content like we had on Monday morning and all day Tuesday, I'd encourage adding a half day to the conference. All in all, my biggest take away each year is the networking, and I have to thanks HP Canada in large part for their facilitation of that!


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Big Ideas About Big Data in Health Care

Lindsay Kislock, ADM in the BC Ministry of Health, introduced the panel and started the discussion on the premise that health has to be proactive with the data at our disposal, and be responsible and forward thinking about how we can turn health data into positive health outcomes.

Dr. Tom Karson spoke first, informing us that globally, we are in the zettabyte era, and we cannot do anything with this volume of data in healthcare without big data analytics. Genomic sequencing & epigenomic analysis are given as examples of big data that medical research and practice need to have and manage daily.

Dr. Karson clarified the reality in our healthcare systems where there is no governance or standardisation of the data sets that individual groups within the provincial health system, and that this is the lowest step of the DELTA five stage maturity model for data analytics. dr. Karson's point was that we need to evolve through this maturity model to better use the data, but that we cannot do that without in parallel establishing and maturing governance over this data.

Additionally, Dr. Karson insisted that we must develop, recruit, and educate the appropriate talent pool to manage big data, and be able to turn data to information, and then to insight.

Julie Lockner from Informatica followed to discuss how we prepare our data centres for big data. The questions came up around pure capacity, security and governance, and obtaining the skills needed to manage these systems.

When asked what is stopping people from dealing with big data better they say: "Time constraints on business analysts and lack of skills for staff in how to manage big data."

We are next introduced to the concept of hadoop, which allows for real-time massive data processing on standard hardware platforms, as an Open Source solution.

Our last speaker on this topic is Rachel Debes, a biostatistics researcher from Cerner. Rachel states that the two biggest drivers towards big data solutions is electronic medical/health records, and the emergence of an accountability framework for the Canadian healthcare system. I would suspect that she is overlooking medical research requirements and data generation/analysis, but I'll assume she's targeting the clinical administrative audience here.

ADM Kislock asked the panel "is big data bad?" and the response was that it is not, but it's all about the governance and skills to handle that big data responsible and effectively.

A question came up from the audience as to whether the protections we put in place around big data in the possession of healthcare are nullified by patients and the general populations freely placing health and health-care information in the public domain via social media, which can be mined by anyone who wishes to invest in that.
My thoughts are that people will place this information in the public domain along with all kinds of other things that if that data were placed into government care we would be held accountable, and the fact that people are irresponsible with their information, or that people on an individual level doesn't feel that certain information is actually "private" doesn't absolve us of our responsibility to protect the data given into our care. If the public voice eventually changes the definition of what is "private" or "personal information"
then we will adapt our levels of governance accordingly.

Dr. Karson provided an answer to this question that mostly aligned with me thoughts, and cited the regulations we work under in the healthcare industry.

Dan Gonos from HP asked the panel their thoughts on the challenges with mining unstructured data. Dr. Karson answered that unstructured data is best mined if you have discrete unstructured data and you understand the data sources, so that the algorithms can be modified to assume contexts. Julie added that certain vernacular can complicate free-form data, further to Dr. Karson's point.



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Location:Hwy 97 S,Kelowna,Canada

Innovating in Health Care While Managing Fiscal Constraints

Ida Goodreau, Board of Directors, Genome BC & Adjunct Professor, Sauder School, UBC

Premise is that public sector always views innovation as something that drives up costs. Private sector doesn't see it that way, because of what innovations they allow into the business.

Ironically, while health care costs across the Western developed world are increasing rapidly, hospital spending specifically has trended down in the last 12 years. The well known and discussed paradox is the demand for high quality care within a fiscally sustainable system. Patients (who are taxpayers) want improvements in life expectancy and functionality, while taxpayers (who are also patients) want greater system efficiencies at lower costs.

The definition targeted is a diminished gap between GDP and health care spending within 20 years.

Innovation in health care over the past twenty years an be measured as successful if we use extended life expectancy as a metric, but not if we measure it against the cost. It seems cold to put a price against the length of a life, but this is the reality that the population wants, per the paradox we discussed earlier.

So the crux is how to adapt innovations that improve health outcomes at reduced costs. The innovations in question are technology devices, drugs, and information, process redesign, and over-all system redesign. We know what all these innovations can and should look like. We need a model for cost-effective integration of these innovations, and an agreed upon set of metrics for measuring progress and assessing risks.

Ida suggest we need to look at systems around the globe where healthcare is privatized, as those are driven by business economics to be the most innovative. The key factors to be considered are:
Lower cost and consumer direct payment
Simplification
Closer to the patient
Re-invention of delivery by use of existing technologies
Right-skilling the workforce
Standardised operating procedures
Copying and then building

Ida proposes also that innovations should be frugal to deliver superior value at a fraction of the costs typically seen, and new technologies should be designed to work within an integrated continuum of care.

Ida re-iterates that the core issue with Canada's healthcare system and why we cannot make the urgent changes needed to innovate cost effectively is that "no one is really in charge."

The innovations and the cost reductions are both necessary, and have been put off for years, but time is running out, as we are approaching a tipping point. Ida proposes that Canadian health care leaders must align, and agree on how to make the public system leverage the optimizations that privatized health care solutions use.


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Location:Water St,Kelowna,Canada

Complexity Exceeds Cognition - How Analytics Will Transform Healthcare

Dr. Graham Hughes, Chief Medical Officer, SAS

We are challenged to provide meaningful and useful health care information available online to every Canadian. Big data is about how much data we are getting from where, how quickly, and how to turn it into meaningful information.

This was an interesting exploration of one of the Game Changing technology disruptors, and how it can, should, and is being leveraged to improve health outcomes.

Health information is still in silos, and needs to be integrated or federated in meaningful ways to enable clinical decision support systems (CDSS). Carolina's Health Systems in North Carolina has been innovative in this area.

Structured and unstructured data continues to expand rapidly, and not all of it is electronic, and most of it continues to grow in the silos. Data-intensive mega trends such as population based patterns, personal signatures, genomics, home monitoring, mobility, & social media.

Home Depot in the US expects to have an aisle dedicated to home medical monitoring systems in two years.

IT consumerisation and mobility have provided us a platform for ubiquitous bidirectional access to health care resources. We are introduced to fitbit which provides 24x7 wearable health monitoring. This is worthy of further investigation. Health oriented apps are growing rapidly, allowing EMR access by patients. Telemedicine continues to evolve and reduce the demand for face-to-face health care provisioning. Gaming theory continues to improve the engagement of people in preventative healthcare and wellness. The immediate impact and benefit that might be missing in personal engagement of wellness is provided by gamification of peoples health monitoring. Influence networks leveraging social media provides a platform for quicker responsiveness to health care interactions.

The price for sequencing the human genome is below $1k, this is an example of how meaningful use of health care information is being made affordable, but the challenge is to use these innovations to improve specific patient outcomes through primary care and wellness. Again, we create mounds of data, but need to turn this into useful information accessible to patients and health care providers in a proactive manner.

Predictive analysis feeding into CDSS allows us to better understand risks in individual and population level health actions. We can identify potential patient cohorts who need intervention based on health habits and target them with the appropriate wellness services. At an individual level, we can better understand how our individual health situation may be impacted by various health care or wellness decisions. Treatment sequences by populations demographics can ensure better medical outcomes in clinical situations.

The problem is we are going to be over-whelmed by a tidal wave of data, the opportunity is that we will have the information we need to improve health outcomes.




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Location:Water St,Kelowna,Canada

Healthcare Success Stories from Western Canada

Western Cdn Healthcare Summit 2012

Healthcare leaders from the Yukon, Alberta and British Columbia shared their stories of challenges and visions in the search for effective and efficient healthcare delivery throughout Western Canada.

Introduced by: Donna Lommer, VP Residential Services & CFO, Interior Health Authority of B.C.
Speakers:
Graham Whitmarsh, Deputy Minister of Health, Province of British Columbia
Chris Mazurkewich, EVP & COO, Alberta Health Services
Stuart Whitley, QC, Deputy Minister of Health & Social Services, Government of Yukon

Chris spoke first, shared some statistics about the scope and depth of AHS (Alberta Health Services). AHS is down the road that HSSBC is taking, and has insight to share for BC folks. A key comment is that the merger was done, and the details are being worked out post-change.

A primary metric that AHS uses to measure success is hip and knee elective primary replacements per annum. The integration of EMS is a current large initiative, and response times are publicly available to ensure transparency and availability. EMS has been a stand-alone entity, but this is changing. This allows the EMS responders to have greater support and options and provision deeper care quicker.

AHS believes that having a deeper and wider integration of clinical services across the province allows for quicker innovation and response to discovered administrative or clinical challenges.

AHS has asked clinicians and staff to identify game changers in health care, and some identified are standardized discharge methodologies and metrics, allowing communities and families to be better prepared for when patients are discharged back into the communities.

Wellness is a major push, with high profits and demand from private sector to license a successful regionalized program. AHS feels they are ready to move their primary care networks to the next level, but have identified that good governance is vital to that success. What that next level really looks like was not described.


Stuart shared an anecdote that illustrated that it is important to focus on need by examining where risk is.

Stuart asked us rhetorically how we innovate and transform health care in Canada. We are referenced to the innovations happening in EU Nordic countries. Extraordinary technological innovations are occurring daily, but the cost to accommodate and implement these are barriers to adoption. Transformation therefore must occur in the management and funding, as well as the current culture of health care. Negotiations with practitioners is the beginning place.

Acute disorders are stealing attention from the chronic issues which Canadians are increasing with high-risk health behaviours increasingly dramatically in school aged children. Interventions must start here, and we must look further upstream to be more preventative and intervene before conditions become acute, and warrant more expensive treatment.

Top 30 users of the Yukon health care system, on average, incur more than $150k each year. A key issue in their acute issues is prolonged alcoholism.

Many small, simple innovations focussed on the upstream aspects of the health care system will (and have been proven in the Yukon) reduce the costs and improve delivery of health care.


Graham Whitmarsh presented the innovation and change agenda diagram. The three pillars of the program are:
1. Effective health promotion & prevention
2. Integrated & targeted primary & community health care
3. High quality hospital services

A series of metrics were shared for each of these three pillars to identify what is working in the past year, and what isn't, and where to focus efforts this year. Over $250M in savings is expected from HSSBC next year.

Royal Columbian & St. Paul's improvements are planned and committed to.

ThinkHealthBC is where this strategy is shared with the public. We are provided a teaser, but if you are interested in learning more about the strategy, current results, and next steps, you should check out the site.



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