“Informing individual patient care with Big Data and predictive analytics is the Holy Grail these days”

As an intern in the US Department of Veteran Affairs in the ‘80s, Lou Fiore noticed how unique the organization was in its sophisticated handling of electronic medical records (EMR). Now Executive Director of the VA’s Massachusetts Veterans Epidemiology Research and Information Centre and Professor of Medicine at the Boston University School of Medicine, Fiore talks to HealthTech Wire about what Europe could learn – even today – from the VA’s approach to data – and why he’s decided to jump onto the program board at the HIMSS Impact 17 event, November 20-21!

What is so special about the work the US Department of Veterans Affairs (VA) – is doing in the field of Big Data?

The average insured person in the US is in any given health plan for no longer than three years; it’s not like England’s NHS, for example, where people are continuously covered. And what this does is it fragments not just the care, but as they change systems they typically change physicians and they change medical record systems as well. The VA, however, is unique in the US – being responsible for the care of retired soldiers (‘veterans’) – in that it follows patients longitudinally, digitally, throughout the lifespan – something that’s virtually impossible in the States outside of it!

Another benefit is that, as a result, the VA has a very robust dataset, going back many years, for all patients – having handled electronic medical records (EMR) since I was an intern there, back in the 80s. And that allows for some really cool things in terms of looking back – and then being able to predict forward.

What is the VA working on within the field of Big Data that is particularly relevant to the themes of this conference?

I head up a research team at the VA that uses EMR data to improve the patient care experience. My group has been working on repurposing this data to be able to identify groups of patients with certain features in common – and by studying how they’ve been treated and how they’re doing, to predict best practices going forward… using predictive analytics and Big Data to inform individual patient care. That is, it has to be said, pretty much the overarching goal of many different groups – not just my own, these days… I think that it’s kind of the Holy Grail!

Perhaps the best-use case of this in programs we’ve implemented is in precision oncology. This involves taking a newly diagnosed patient’s tumor sample and analyzing the DNA in the cancer cells to identify mutations that are putatively causative for the cancer development.

By understanding what mutations the patient has, we can then target the downstream effects of those mutations, using emerging targeted therapies. And we can expect to get better outcomes doing this than when using traditional chemotherapy – which is, of course, not patient-specific but rather general for a whole population of patients. This is generally the emerging field of precision oncology. The problem that we have in this field, as precision medicine advances across other disciplines, is that when you start learning enough information about a patient to treat them as an individual it becomes increasingly difficult to know what to do for each individual: a clinician can’t possibly have in their brain an encyclopedia of individual mutation statuses and how to behave. So, therefore, the art of medicine really falls apart at this point. And what you need is computational resources in order to do what used to be done by a clinician!

What’s compelling about precision oncology as a clinician is that it makes a huge difference if you can treat a patient with a therapy that is specific to them based on their DNA; the likelihood of a response is far greater than using general treatment.

So what are the obstacles to achieving the potential of precision medicine in this way?

In order to access these data, to analyse them, to understand them and to use them effectively in healthcare, of course, you need a marriage of two very distinct worlds: clinical care or operations and research. The problems that need to be solved are owned by the clinical care or operations community and in order to access the relevant data and understand them you need skills that are resident in the research community – and those two sides really don’t talk to each other. Clinical care don’t know how to use big data; meanwhile, researchers don’t know how to make it relevant to clinicians when they do use it and discover things.

What are you hoping the session you’re leading on will achieve?

Well I would hope that the session “Big Data – what will be the impact on the medical profession and on healthcare provider organizations?” will provide a forum to discuss some of the themes mentioned above. It will also, I hope, present a coherent discussion of how Big Data could impact patient care from the perspective of both clinicians and healthcare administrators and will examine the benefits and the challenges of accessing and analyzing real-world data and offer ‘lessons learnt’, along with best practices going forward.

We will get an opportunity to talk about the research use and clinical care use of Big Data and to look at what data are available with EMR and why would you want to access it, what can you access with those data and what can you do with it – as a healthcare provider and as a clinician.

And it won’t be just theoretical. We’ll be looking at best practice examples going forward and how delegates can make practical changes within their organizations when they return home.

“Can we empower patients to become their own data guardians?”

Professor Christof von Kalle, head of the Department of Translational Oncology at the German Cancer Research Centre (DKFZ) in Heidelberg, is passionate about how Big Data can benefit the patient – and every member of the healthcare ecosystem. But it will only fulfill its promise, he says, if we listen to patients as doctors do – and learn a bit about what they want from their healthcare system. This is an issue, he tells HealthTech Wire, that his session at the forthcoming HIMSS Impact 17 (November 20-21, Potsdam, Germany) will tackle … and not before time, he says.

What are your views on the potential of Big Data within the healthcare arena?

This really depends on your definition of Big Data. Some see it as very large data that have no algorithm to resolve them. If you consider it from a broader perspective, however – which is how I like to see it – as something that tries to work with all the available information that we have of patients – i.e. as ‘smart data’ – then things become very interesting!

There is, for example, great potential for machine learning to find patterns in data where we have no hypotheses at all. We simply let the machine discover new patterns for us! This is obviously very exciting.

What are you particularly looking forward to about the HIMSS Impact event?

The idea of bringing together the state-of-the-art thinking around Big Data and trying to push the boundaries a little is very exciting. I am also looking forward to looking at Big Data from the patient’s perspective, which is something that we have never really done before.

The session you’re leading on at the event is going to do just that, isn’t it? Can you tell us a bit more about it?

Yes, that’s right. With the session “The Patient’s Perspective: What benefits are in it for them?” we are doing what we can to present Big Data from the patient’s perspective.

I wanted to get away from the usual format – having a computer specialist, a few physicians and a data geek, say – who talk through the issue among themselves – and instead invite the perspective of those people who are either directly affected or represent those who are directly affected by Big Data in healthcare – the patients, patient advocates and so on.

Of course, we have a much more developed and liberal use of data and smart devices in other industries than we have in the healthcare system. If we let the patients talk to us they will tell us what they want – and expect – to have, and of course, what they don’t want to have. And I think that’s going to be a very interesting and healthy discussion.

There could also be a substantial degree of innovation coming from the patient population if we begin to harness it. If we start to understand what the patient as a customer of the healthcare system wants, then things will start to dramatically improve. And not just from the perspective of the patient, but also from the position of other healthcare stakeholders.

Can you tell us a little bit about the work you are doing with Big Data as head of the Department of Translational Oncology at the DKFZ/NCT – and what relevance it has to the HIMSS Impact event?

We are active in three layers of data. One is the really high throughput diagnostic level – which generates really large sets of data. An example of this is the sequencing of tumor patients that generates terabyte amounts of data for every individual patient.

And the next one, which we’re doing in collaboration with enterprise application software firm SAP – and I’m very interested in this – is looking at all the data that we already have – much of which is sitting in so many different patient files and separate IT systems – and finding ways to start to connect all those silos.

And then the third dimension is around patient-related data. Can we make the patients their own ‘data guardians’, if you wish? Can we provide the patients with the data space that will allow them to connect to their health data on their own and do all the things that they can do – and expect to be able to do – in so many other areas of their lives? I find this third area particularly exciting.

How will you know that this HIMSS IMPACT event has been a success, from a personal perspective, at least?

Success for me would be if I came back with at least one new angle or perspective on what we are currently trying to do at DKFZ. And I am pretty sure that that is going to happen – the field is so interesting and vivacious!

The other thing, as I’ve hinted at already, is that it’s all very well us getting really excited about how we can gather large amounts of data from patients – through wearable devices and other new tech developments. But from my point of view, we’re not really making a success of this until we find ways to understand and make use of the data that we already have. So that’s a subject that I’m going to do my best to ensure we take up at HIMSS Impact 17!

So what’s all the fuss about? – Interview, part 4

Q. Why should people make an effort to be at the event? And what do you think people will take home from the event if they do?

FLORIAN SCHLEHOFER, HEALTHCAPITAL: As already mentioned, with our program we tried to paint the big picture of Big Data in Medicine. So I would love to see representatives from right across the healthcare world: patient organizations and representatives, physicians and hospital executives as well as executives from the healthcare industry -from biotech to medical devices.  Also, start-ups and, last but not least, academia. And I hope that the delegates will get an insight look in what happens in Big Data in Medicine right now and that it is a topic which will fundamentally change healthcare.

RAINER HERZOG, HIMSS EUROPE: C-level managers with responsibilities for healthcare organizations should attend – and all those who are in a position to shape healthcare. Also, opinion leaders from academia, industry members, pharma, life sciences, health IT…. in fact, all those who need to rethink their roles in healthcare in response to the paradigm shift that Big Data is bringing in.

When it comes to take-aways, we hope that everyone will gain a new insight into the potential of Big Data, its relevance to their own roles, responsibilities and professional life – and a network of connections that will help them make the potential of Big Data a reality within their organizations.

So what’s all the fuss about? – Interview, part 3

Q. I should imagine that the question, ‘Are we at the beginning of a golden age of healthcare?’ which is one of the questions that is expected to kick off the conference program, will generate a lot of interest at the conference. What does it take, to bring such a ‘golden age’ into being?

RAINER HERZOG, HIMSS EUROPE: Everyone is talking about this new golden era in medicine. But what I’m interested in – and I think this conference will help answer this – is what this means for the patient! Is it the ‘second shoot to the moon’, as an ex-president once referred to it? If it is, then of course, that’s a very exciting thing! But we also need to explore what it takes to implement Big Data – not just from a change point of view, but from a delivery-of-care point of view – and then, of course you’re into genomics, personalized medicine, population health management, risk stratification…

We need to ask ourselves, is this really the big breakthrough for the patient that everyone’s expecting? And, if so, how can we make sure that it materializes?

MATTHIEU-P. SCHAPRANOW, HPI: Yes. Big Data is not just a theory anymore! It’s about the practical application. And so it’s important to have these real-world examples so that people can say, ‘Ahah, so Big Data’s not just about buzzwords any more – it’s about data analysis at our fingertips… we can really begin to use this stuff now!’

And this is one of the reasons we picked the HPI as the venue for this event. So you’re here at the university campus – you can brainstorm about innovative ideas but you will also have hands-on experiences with latest advantages in life sciences and digital health.

FLORIAN SCHLEHOFER, HEALTHCAPITAL: It was absolutely amazing to see how engaged everyone – from HIMSS, HPI or the program board – was in the development of this program. I really want to thank all of them. These partners tried to create a program which shows the wide range of data-based applications in healthcare and to address the different stakeholders.

I am especially happy that we could also organize the regional-focused HealthCapital Sessions to showcase Berlin-Brandenburg´s research activities, start-ups, companies and initiatives in the field of Big Data in Medicine. With our selection we demonstrate that Big Data is not only a buzz word in the German capital region. No, it has reached entrepreneurs, companies and hospitals and is starting to engage the patient as well. In Berlin-Brandenburg, everyone is preparing for this new age of healthcare.

So what’s all the fuss about? – Interview, part 2

Q. What will the conference program look like? What did you have in mind when you put it together?

MATTHIEU-P. SCHAPRANOW, HPI: We invested a lot of time in planning the structure of these two days. We have, for example, created dedicated IMPACT sessions on each of the key topics, with a range of different, wide-ranging speakers presenting on each one, creating really high impact sessions – hence the name! We kick off with pretty important topics like how patients can benefit and how doctors and healthcare providers might contribute – and then, on the second day, the focus moves to the industry, such as pharma, and the payers, such as health insurance companies.

Extending the sessions, we are introducing very interesting program formats, like regional sessions, bringing together different partners not only from all over the globe but also from the Berlin-Brandenburg region, which provides a great opportunity for networking and match-making.

RAINER HERZOG, HIMSS EUROPE: Yes and what is very important is that we are not just talking about Big Data from a theoretical standpoint, but we also feature the concrete cases, explore the implementations, examine and discuss the best practice projects and examine what we can learn from each other on an international scale. And then we open up an opportunity to really engage in deep networks and share practical information. So it’s this concrete implementation and hands-on approach that we want to feature strongly in the program.

So what’s all the fuss about? – Interview, part 1

There’s a big buzz around Big Data in our industry, right? One reason why the new HIMSS Impact International Symposium on Big Data in Medicine – which takes place in Potsdam, 20-21 November 2017 – is already kicking up quite a storm! HIMSS Insights talks to the organizers of this exciting new event –and finds out why you should make every effort to be there!

POTSDAM, GERMANY – Tonya Stewart talked to Rainer Herzog, General Manager DACH at HIMSS Europe, Matthieu-P. Schapranow, Program Manager E-Health & Life Sciences at HPI and Florian Schlehofer, Deputy Head of Cluster Management Healthcare Industries (HealthCapital).

Q. What is expected of HIMSS Impact? What is so special about the event for you?

RAINER HERZOG, HIMSS EUROPE: Big Data is such a broad and far-reaching topic with huge implications for the whole of healthcare and we think we have significant things to bring to the table with this exciting new event, run in collaboration with the Hasso Plattner Institute (HPI) and the Berlin-Brandenburg Cluster for healthcare industries (HealthCapital).

MATTHIEU-P. SCHAPRANOW, HPI: – Exactly. Although HIMSS Impact is a new event, we are not starting from scratch here. HIMSS Impact continues a very successful series of event on big data in medicine that we established at HPI a couple of years ago. It’s a real pleasure to have this unique collaboration between HPI, the local government, and HIMSS, as one of the leading organizations worldwide in this area – and packaging all this expertise into one unique event at the former borderline between Berlin and Brandenburg at the very heart of Europe.

FLORIAN SCHLEHOFER, HEALTHCAPITAL: At the very start of the planning process, we noticed that there was no such dedicated conference in Europe on “Big Data in Medicine”. We wanted to take a wider look at the subject and to explore what is in there for the different stakeholders – the patient, the doctor and the payer as well as academia and industry. With the HIMSS and the Potsdam-based HPI we have great partners to make such an event happen in our region.