ICU of the future and Information Technology
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This document discusses the future of intensive care units and information technology. It outlines how precision medicine, big data, medical devices, virtual reality, and the internet of things can transform ICU care. Specifically: - Precision medicine and identifying patient subphenotypes can lead to personalized treatment protocols. Big data from medical devices, images, and sensors can help with this approach. - Medical devices are becoming informatics platforms that can integrate with hospital systems to share vital sign data, detect adverse events, and measure asynchrony during ventilation. - Virtual reality and early neurocognitive rehabilitation are emerging technologies being studied to benefit ICU patients. - The internet of things, smart alerts, and continuous remote monitoring via mobile
ICU of the future and Information Technology
- 1. Dr. Lluís Blanch Torra Senior Critical Care Former President of SEMICYUC WFSICCM Council member Director of Institut d’Investigació i Innovació Parc Taulí I3PT Cairo, 12 January 2017 ICU of the future & Information technology
- 3. Intensive Care Med 2016 DOI 10.1007/s00134-016-4525-y Computer Driven Intensive Care GeneticAnalysis “Triage” Structural & Physiological Organ Analysis Organ Reconstruction and the brain?
- 4. ICU of the Future by Sonia Touriño
- 5. THE PRECISION MEDICINEINITIATIVE Mission statement: To enable a new era of medicine through research, technology, and policies that empower patients, researchers, and providers to work together toward development of individualized care. - President Obama, January 30, 2015 https://www.whitehouse.gov/precision-medicine
- 6. Syndromic Medicine: Guidelines Precision Medicine Personalized Medicine Protocols for Specific Subgroups
- 7. Phenotype Identification: Personalized Medicine for ARDS Patients? Subphenotypes of ARDS: Severity: oxygenation impairment & PEEP response Biology: epitelial vs endothelial injury & inflammation Aetiology: pneumonia, sepsis, disease-like ARDS Timing: early, late Imatge appearence: diffuse, local Combinations of above Beitler JR et al. Intensive Care Med 2016;42:756-67
- 8. Differencesin categoricalvariables based on phenotype assignment Differencesin the standardized values of each variable by phenotype on the y-axis,with the individualcontinuous variables alongthe x-axis
- 9. JAMA Published onlineSeptember 26, 2016 Invest in and apply the promise of cognitive computing. With rapidly expanding computing capability to integrate, process, and assess very large databases, opportunities develop for accelerated learning, understanding individual variation, and developing predictive modeling.
- 10. Sources of Big Data of course in the ICU Iwashyna TJ & Liu V AnnalsATS 2014;11:1130-5 5Vs: value, volume, variety, velocity, veracity
- 11. Turner MC et al AJRCCM Articles in Press. Published on 17-December-2015 Ware LB et al AJRCCM Articles in Press. Published on 17-December-2015 Long-Term Ozone Exposure & Respiratory Diseases
- 12. Drivers of “Big Data” in Medicine Biological Processes Are Better Understood human genome, genetics & response to therapies, individualised treatment decisions Growth of Digitised Information images, reports, lab. results, monitoring sensors monitors, ventilators smartphones, Fitbit Cloud-Based IT Solutions data unified & available in space and time, novel algorithms & machine learning Individual Patients = Decision Support Whole Populations = Population Health Mathias Goyen 2016
- 13. Information overload ICU ITs Lack of Information !
- 14. CCM 2013; 41:1502–1510 Physicians use a limited number of clinical information concepts at the time of patient admission to the ICU. The electronic medical record contains an abundance of unused data. Information Overload in ICU Reported frequency of utilization of data elements in EMR HR SpO2 RR MAP
- 15. The Connectivity Envelope Includes Hardware for Source Tracking and Data Acquisition Halpern NA. Chest 2014;145:903
- 17. Potentially injurious ventilator settings for 1 h during the first 3 days of MV
- 18. Asynchrony Index & Sedation Scale Representative Patient 0 100 200 300 400 500 600 700 800 900 1000 1100 0 10 20 30 40 50 AI SAS Hour Hours AI SAS
- 19. Summary: ICU Informatics & Big Data: Association Patients ID or patient location Interoperability Data generated by one device can be accessed and used by another Time Synchronization Vital for maintaining an electronic flow sheet and tracking alarms and responses Medical Devices are Informatics Platforms Integration with ICU middleware
- 20. Virtual reality (VR) typically refers to computer technologies that se software to generate realistic images, sounds and other sensations that replicate a real or imaginary environment, and simulate a user's physical presence in this environment, by enabling the user to interact with this space and any objects depicted therein using specialized display screens or projectors and other devices. From Wikipedia
- 21. Journal of Critical Care (2011)
- 22. Virtual Reality
- 23. Early Neurocognitive Rehabilitation in Intensive Care Project funded by La Marató TV3 2010 Multidisciplinary Team ENRIC at ClinicalTrials.Gov
- 25. Internet of Things Smart Alerts Linked to Domotics Clinic BCN
- 26. Vital signs display A middleware (Better Care®) provides connectivity to HIS (SAP)
- 27. Opportunities for the Future of Health (of course in the ICU) Joint enterprise of patients & health professionals & others (cross fertilization) using digital technologies: big data, connectivity and artificial intelligence New forms of technology: sensors and mobile apps for continuous monitoring, early interventions and immediate corrections New players: Small start ups (drive innovation) & Google and Apple (services providers) instead of big manufacturers (marketing and distribution): collaboration versus competition Finding successful business models: adding services to the portfolio, system efficiencies and long term value In the ICU we must go from Volume to Value !!
- 28. ASYNICU group is supported by: AVANZA, FIS, MaratoTV3, CIBERes, I3Parc Tauli and Better Care S.L. Thanks to Members of ASYNICU Group!!