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CSE4939

What is BMI?What is BMI?

Prof. Steven A. Demurjian, Sr. Computer Science & Engineering Department

The University of Connecticut191 Auditorium Road, Box U-155

Storrs, CT 06269-2155steve@engr.uconn.edu

http://www.engr.uconn.edu/~steve(860) 486 - 4818

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CSE4939

Expand Knowledge on Emerging DisciplinesExpand Knowledge on Emerging Disciplines Biomedical Informatics/Health Information Biomedical Informatics/Health Information

Technology Rapidly Emerging DisciplineTechnology Rapidly Emerging Discipline Cutting Edge, Incredible Career and Research Cutting Edge, Incredible Career and Research

OpportunitiesOpportunities Improve Practice of Medicine Through InformaticsImprove Practice of Medicine Through Informatics

Patient Managed Patient Care Hospital Based Research (Genomics/Trials)

What is Biomedical Informatics?What is Biomedical Informatics? Where is the Future?Where is the Future?

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CSE4939

What is Informatics?What is Informatics? Informatics is:Informatics is:

Management/Processing of Data From Multiple Sources/Contexts Classification (Ontologies),

Collection, Storage, Analysis, Dissemination

Informatics is Multi-DisciplinaryInformatics is Multi-Disciplinary Computing (Model, Store,

Mine, Process Information) Social Science (HCI) Statistics (Analysis)

Informatics Can Apply to Multiple Informatics Can Apply to Multiple Domains:Domains: Pharmacology, Nursing,

Medicine, Biology, etc. Business, Fine Arts, Humanities

People

Information Technology

Informatics

Adapted from Shortcliff textbook

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CSE4939

What is Biomedical Informatics (BMI)?What is Biomedical Informatics (BMI)? BMI is Information and its Usage Associated with the BMI is Information and its Usage Associated with the

Research and Practice of Medicine Including: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.) Clinical Informatics, Pharmacy Informatics,

Consumer Health Informatics, Nursing Informatics

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CSE4939

BMI & Clinical PracticeBMI & Clinical Practice Tracking all Information for Patient and his/her CareTracking all Information for Patient and his/her Care

Medical Record, Medical Tests (Lab, Diagnostic, Scans, etc.), Prescriptions

Dealing with Patients – Direct Medical CareDealing with Patients – Direct Medical Care Hospital or Clinic, Physician’s Office Testing Facility, Insurance/Reimbursement

Informatics Support via:Informatics Support via: Electronic Medical Record Linking/Accessing Data Repositories Collaborative and Secure (HIPPA) Web Portals

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CSE4939

Learn about New/Emerging TechnologyLearn about New/Emerging Technology Explore Smartphone Technologies and ApplicationsExplore Smartphone Technologies and Applications Four Smartphone PlatformsFour Smartphone Platforms

Android Blackberry iPhone Microsoft

All with Differing APIsAll with Differing APIs Java Java Objective C .NET

How do we Develop Applications? How do we Develop Applications? How can we Link to Web and Existing BMI Apps?How can we Link to Web and Existing BMI Apps?

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Learn about New/Emerging TechnologyLearn about New/Emerging Technology Personal Health Records (PHR) are Patient Controlled Personal Health Records (PHR) are Patient Controlled

RepositoriesRepositories Google Health (www.google.com/health)

Accessible via Java API XML-Based Interface

Microsoft HealthVault (www.healthvault.com/) Accessible via .Net Infrastructure

Electronic Medical Records (EMRs) are Health Electronic Medical Records (EMRs) are Health Provided Controlled RepositoriesProvided Controlled Repositories General Electric Centricity EMR Version 9.2 – Secure Web Services

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Project Focus this SemesterProject Focus this Semester Smartphone Applications that Interact with Google Smartphone Applications that Interact with Google

Health (or MS Health Vault) and GE CentricityHealth (or MS Health Vault) and GE Centricity Focus on Observations for Daily Living (ODLs)Focus on Observations for Daily Living (ODLs) What are ODLs?What are ODLs?

Patient Provided Information Related to their Chronic Diseases or Health Goals Augment Typical Information Provided at MD

Visit Continuous Input Clinical Decision Support to Spot Problem Trends Intervene Before Event Occurs Monitor Progress Towards Goal (e.g., weigh loss)

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CSE4939

Two Types of ODLsTwo Types of ODLs Passive – Once Initiated, Collects DataPassive – Once Initiated, Collects Data

Accelerometer Pedometer Pill Bottle that Sends a Time Stamp Message (over

Bluetooth?) to SmartPhone Active – Patient InitiatedActive – 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.

From Basic to Sophisticated!From Basic to Sophisticated! All ODLs will have Help (Usability) and Education All ODLs will have Help (Usability) and Education

(Disease) Capability Built in.(Disease) Capability Built in.

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Overall ArchitectureOverall Architecture

GoogleHealth

Patient Demographicsand ODLs

Figure 1: Architecture Diagram of the Proposed System.

Patients

Providers

DatabaseRepository

Web/ApplicationServer

SQL ServerDatabase

Client Side Technologieshttps, html, Ajax, XML

Server Side TechnologiesJava, JSP, Hibernate, Relational Database, XML

Centricity EMR

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CSE4939

Possible ODLsPossible ODLs Multi-Media Support Repository:Multi-Media Support Repository: It has been found in a It has been found in a

number of settings, that people with chronic diseases may be number of settings, that people with chronic diseases may be able to cope with their pain, fatigue, etc., through the use of able to cope with their pain, fatigue, etc., through the use of audio clips, video clips, or pictures that mean something too audio clips, video clips, or pictures that mean something too them. For example, for one person it may be pictures and clips them. For example, for one person it may be pictures and clips of family and loved ones, for another person it may be popular of family and loved ones, for another person it may be popular music, for yet another inspirational speeches, and so on. The music, for yet another inspirational speeches, and so on. The intent is to develop a Smartphone application that is capable of intent is to develop a Smartphone application that is capable of tracking a repository of audio, video, and pictures, categorized tracking a repository of audio, video, and pictures, categorized by Topic, Title, and/or Keywords. The system will track a by Topic, Title, and/or Keywords. The system will track a complete historical record for each participant, noting the complete historical record for each participant, noting the selections that are being utilized along with their date-time selections that are being utilized along with their date-time stamp and frequency. There will be the ability to have a stamp and frequency. There will be the ability to have a favorites list of most frequently used selections, as well as for favorites list of most frequently used selections, as well as for each participant to upload their own audio/videos for her own each participant to upload their own audio/videos for her own use. The intent is to also have a version of this application that use. The intent is to also have a version of this application that could cache selections with the memory of the Smartphone to could cache selections with the memory of the Smartphone to reduce download times, particularly for those selections chosen reduce download times, particularly for those selections chosen most frequently. most frequently.

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Possible ODLsPossible ODLs Pedometer or AccelerometerPedometer or Accelerometer: For either of these : For either of these

applications, you will need to have an actual applications, you will need to have an actual Smartphone that has motion sensors. The idea would Smartphone that has motion sensors. The idea would be that these applications would be initiated by a be that these applications would be initiated by a patient to collect information associated with walking patient to collect information associated with walking (pedometer) or movement (accelerometer) for a fixed (pedometer) or movement (accelerometer) for a fixed period of time. period of time.

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CSE4939

Possible ODLsPossible ODLs Discrete Measurement of Symptom/Condition: Discrete Measurement of Symptom/Condition:

Historically, pain scales have been used extensively in Historically, pain scales have been used extensively in medical settings (just to a Google Search on “pain medical settings (just to a Google Search on “pain scale” images). This type of scale can be generalized scale” images). This type of scale can be generalized to collect information related to pain, fatigue, to collect information related to pain, fatigue, mobility, adherence to medication, and so on. Note mobility, adherence to medication, and so on. Note that some of these ODLs may be regularly schedule that some of these ODLs may be regularly schedule (e.g., the smartphone beeps a reminder), triggered as (e.g., the smartphone beeps a reminder), triggered as the result of a contact to the patient (e.g., an automated the result of a contact to the patient (e.g., an automated call or email to the smartphone), or initiated by the call or email to the smartphone), or initiated by the user. The numerical values are tracked for each user. The numerical values are tracked for each individual to capture all of the values entered. This individual to capture all of the values entered. This would be a simplistic ODL based on a scale (1 to 10, would be a simplistic ODL based on a scale (1 to 10, Good to Bad, etc.) rather than any actual collection of Good to Bad, etc.) rather than any actual collection of medical/personal data.medical/personal data.

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CSE4939

Possible ODLsPossible ODLs Discrete Measurement of Symptom/Condition: Discrete Measurement of Symptom/Condition:

Historically, pain scales have been used extensively in Historically, pain scales have been used extensively in medical settings (just to a Google Search on “pain medical settings (just to a Google Search on “pain scale” images). This type of scale can be generalized scale” images). This type of scale can be generalized to collect information related to pain, fatigue, to collect information related to pain, fatigue, mobility, adherence to medication, and so on. Note mobility, adherence to medication, and so on. Note that some of these ODLs may be regularly schedule that some of these ODLs may be regularly schedule (e.g., the smartphone beeps a reminder), triggered as (e.g., the smartphone beeps a reminder), triggered as the result of a contact to the patient (e.g., an automated the result of a contact to the patient (e.g., an automated call or email to the smartphone), or initiated by the call or email to the smartphone), or initiated by the user. The numerical values are tracked for each user. The numerical values are tracked for each individual to capture all of the values entered. This individual to capture all of the values entered. This would be a simplistic ODL based on a scale (1 to 10, would be a simplistic ODL based on a scale (1 to 10, Good to Bad, etc.) rather than any actual collection of Good to Bad, etc.) rather than any actual collection of medical/personal data.medical/personal data.

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CSE4939

Possible ODLsPossible ODLs Synching Information with PHR/EMR:Synching Information with PHR/EMR: For this For this

application, you need to consider the information that application, you need to consider the information that is stored in a PHR and/or EMR, and develop is stored in a PHR and/or EMR, and develop Smartphone applications that provide a means for Smartphone applications that provide a means for patients to enter the information which can then be patients to enter the information which can then be synchronized with the PHR/EMR. For example, synchronized with the PHR/EMR. For example, Google Health lets a user maintain his/her Google Health lets a user maintain his/her prescriptions, but it is not set up to handle nutritional prescriptions, but it is not set up to handle nutritional supplements and other home remedies. A application supplements and other home remedies. A application could support the data entry of this information, which could support the data entry of this information, which would then be synchronized into Google Health, and if would then be synchronized into Google Health, and if the user is also a patient with data in the EMR the user is also a patient with data in the EMR Centricity, a second step would synchronize to this Centricity, a second step would synchronize to this repository using its secure web services. A different repository using its secure web services. A different application could also be considered to handle side application could also be considered to handle side effects and reactions to medications, food, allergens.effects and reactions to medications, food, allergens.

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Possible ODLsPossible ODLs Scanning/Recognition: Scanning/Recognition: For this application, it may For this application, it may

be possible to leverage the digital camera in a cell be possible to leverage the digital camera in a cell phone to take a “picture” of a medication and/or phone to take a “picture” of a medication and/or nutritional supplement label that can be then uploaded nutritional supplement label that can be then uploaded to the web into the PHR or EMR. The idea would be to the web into the PHR or EMR. The idea would be for the patient to be able to create a pictorial for the patient to be able to create a pictorial representation of medications/supplements, that would representation of medications/supplements, that would also be supplemented with their complete dosing also be supplemented with their complete dosing information (size, frequency, etc.). This would information (size, frequency, etc.). This would involve being able to capture perhaps multiple images involve being able to capture perhaps multiple images from the same medication/supplement and meld them from the same medication/supplement and meld them together.together.

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Possible ODLsPossible ODLs Futuristic: Are you really Ambitious?Futuristic: Are you really Ambitious?

Link Commercial Glucose Meter to SmartPhone Digital Camera on Smartphone to Scan Bar Codes

on Supplements and/or Medications May Involve OCR

Hooking up Sensors through Smartphones Pulse, BP, etc. Treadmill or Exercise Equipment

GPS and Smartphones? For Movement? Many of these will need to store data in PHR/EMRMany of these will need to store data in PHR/EMR