1. Big Data Analytics - Opportunities, Enablers, Challenges and Risks to Consider in Health Care Presented by: Alex J Mair Emerging Technology Group June 20, 2013 Big Data Innovation Summit, Toronto, Ontario

2. Agenda Infoway Background and Context BDA health care characteristics Economics, opportunities and examples Challenges and Assertions Call to action specific to healthcare Summary Questions 2 2013 Canada Health Infoway Inc. 3. Canada Health Infoway Created in 2001 $2.1 billion in federal funding Independent, not-for-profit corporation Accountable to 14 federal/provincial/territorial governments Mission: Fostering and accelerating the development and adoption of electronic health information systems with compatible standards and communications technologies on a pan-Canadian basis with tangible benefits to Canadians. Infoway will build on existing initiatives and pursue collaborative relationships in pursuit of its mission. 3 2013 Canada Health Infoway Inc. 4. Mission The mission of the ETG is to identify, assess and promote viable emerging and disruptive information and communication technologies that can be used to support the health care system in Canada. Demonstrations of promising solutions are facilitated and evaluated for value and benefit to the health system. Analyses of investigations and recommendations are communicated to our public and private stakeholders Vision Emerging technologies are appropriately and effectively used in promoting the health of Canadians and the sustainability of the health care system 4 2013 Canada Health Infoway Inc. Emerging Technology Group Mission and Vision 5. 5 The Blueprint - Key Enabler - Used to define and scope over 387 EHR-related projects across Canada - Representation of a conceptual Blueprint for interoperable EHR Solutions in Canada - Jurisdictions use this Blueprint and underlying concepts to adapt to their specific implementation of EHR solutions - Concept of Service Oriented Architecture - Registries, Domain Repositories, Health Information Access Layer (HIAL) - Privacy & security designed into solutions, change management implications considered for its use 2013 Canada Health Infoway Inc. 5 6. Health information is the context for delivering enhanced collaborative and coordinated care experiences. Point of service systems and mobile devices are the platforms for effective social networking and new ways of work. The health IT eco-system links people to their work and each other in new and unexpected ways. Digital health infostructure as Software-as-a-Service in the cloud enables delivery of information and functionality to users and systems. Nexus of forces in digital health The forces of the Nexus are intertwined to create a user-driven ecosystem for digital health. 6 2013 Canada Health Infoway Inc. 7. Five Technology Enablers Impacting Health 7 2013 Canada Health Infoway Inc. 8. Big Data Analytics in Health White Paper The second white paper in the Emerging Technology Profile series Designed to address Big Data Analytics (BDA) from a Canadian health care perspective Intended to provide: Insight on the potential applicability for this new technology Context for business opportunities and challenges Encouragement to advance activities in this space 2013 Canada Health Infoway Inc. 8 9. BDA Defined Big data characteristics include: high volume, high velocity and variety of types of information that demand cost-effective and innovative forms of information processing Analytics is the process of examining large amounts of big data to deliver new insights that can enable decisions in real or near real time 9 2013 Canada Health Infoway Inc. 10. Big vs Small Data Analytics 2013 Canada Health Infoway Inc. Mine Predict & Model Generate Insights Information management processes are different than traditional processes Does not replace traditional analytics capabilities, as it is complementary and feeds results to traditional tools Experimental, discovery, systemic & predictive Big Data Analytics 10 11. 2013 Canada Health Infoway Inc. Specific to health care, new types of data becoming available for use by BDA Genomic data - new gene sequencing data being made available Streamed data - home monitoring, telehealth, handheld and sensor-based wireless and smart devices Web and social networking-based data - search engines, internet consumer use and data from social networking sites Health publication and clinical reference data - text-based publications (clinical research and medical reference material) and clinical text based reference practice guidelines and health product (e.g., drug information) data Clinical data 80% unstructured documents, images, clinical or transcribed notes Business, organizational and external data - data which previously has not been linked such as financial, billing, scheduling, administrative and non-health data such as environmental data Big Data - New Sources of Health Data 11 12. Economics of BDA in Health Care 2013 Canada Health Infoway Inc. Note: Figure used with permission of McKinsey Global Institute 12 13. Current state of BDA in Canadian healthcare Industry research indicates progress has been slow Activity is largely on the periphery of health care (i.e., research studies); not yet in mainstream practice Benefits are still to be proven and documented Privacy and security are important considerations affecting the pace of adoption Canada tends to lag behind other countries Infoway believes Industry focus, for the last decade, has been on digitizing points of service & the interoperable EHR Majority of Canadian health care organizations are small; few have the financial scale to fund a BDA program 1. IDC White Paper: Survey of Big Data in Canada: Challenging Complacency for Competitive Advantage, December 2012 2013 Canada Health Infoway Inc. 1 13 14. Big Data - weekly, millions of users search Internet for health information online Functionality or Scope how can search data be leveraged for predicting disease outbreaks Analytics - gathers data from Google search, estimates how much flu is circulating in different countries and regions across the world, determines flu activity levels Outcomes - detects regional outbreaks of influenza weekly - gets smarter, producing higher-quality predictions, and faster, as it ingests more data Google.org Flu 14 2013 Canada Health Infoway Inc. 15. Big Data - 1,000+ recordings per second of measures such as body temperature, heart & respiratory rate and blood pressure Functionality or Scope - hospital-acquired infections a serious issue, premature babies (both immature and inexperienced immune systems), late onset neonatal sepsis (LONS) can be deadly unless acted on fast Analytics - real-time analytics and algorithms predict when baby is at risk of infection by detecting subtle changes in measures Outcomes - physicians alerted of life-threatening infection before signs of illness, intervening an hour earlier, improving outcomes dramatically, such as shorter hospital stays and reduced costs Toronto Sick Kids Artemis 15 2013 Canada Health Infoway Inc. 16. Big Data million+ inpatients and outpatients over 20 years - 80% of data unstructured, along with significant # medical journals and research Functionality or Scope too much data for clinician to read, 2,000+ order sets to choose from for cancer treatment - determining the best fit for each patient no easy task Analytics - Watson, cloud based service uses probabilistic algorithms to analyze millions of pages of unstructured text in patient records and the medical literature - locates most relevant answers, while understanding expressions in the English language Outcomes - helps oncologists by following the protocol and providing a list of diagnostic and treatment options for physicians to choose from, with confidence ratings for each option Memorial Sloan-Kettering Cancer Center Question and Answer 2013 Canada Health Infoway Inc. 16 17. Big Data - 80% of data unstructured - physician notes, registration forms, discharge summaries and other medical documents Functionality or Scope - 500,000 new cases of congestive health failure (CHF) diagnosed every year and more than half of patients are readmitted within six months after treatment Analytics - mines unstructured data using natural language processing and search technologies to predict patients at most risk for readmission, based on risk factors Outcomes - combined with structured data, provides a more accurate picture of trends, patterns and deviations, supporting clinician treatment decisions and predicting probability of a person's readmission to the hospital Seton Healthcare Family Natural Language Processing 2013 Canada Health Infoway Inc. 17 18. Big Data - largest dataset of human genetic variation available on Amazon Web Services (AWS) cloud, researchers pay for computing services Functionality and Scope BioMe program - 25,000 people participating in DNA sequencing and longitudinal studies related to data embedded in their EHRs Analytics identification and development of biomarkers which can predict individual disease risk, early detection of disease, and improved diagnostic classification to better inform individualized care Outcomes decision support engine delivers knowledge based on genetic variants informed by the patients geotype data and longitudinal clinical data sourced from their EHR Mount Sinai Medical Center of NYC - Personalized Care (Genomics) 2013 Canada Health Infoway Inc. 18 19. BDA Requires Enablers to Ensure Success It is more than a technology project. Business model sustainability, business case & ROI, in-house vs. hosted service Governance appropriate use of patient information, custodianship frameworks Leadership vision, strategy roadmap, culture, investment Skilled resources mathematical sciences, applied statistics, machine learning, operations research, natural language processing Operational new experimental & data driven knowledge management approaches Information management practices processes, data collection, data quality, knowledge generation, context and visualization Privacy and security policy PHI protection, legal, policy, legislation interpretation Ethics use, research, legal Technical and infrastructure - availability, flexibility, performance, scalability and usability 2013 Canada Health Infoway Inc. 19 20. Infoway Predictions: BDA Gaining Traction The healthcare transition will start incrementally and develop slowly in sophistication Cautious, business case driven Early adopters will focus on use case development, experimentation and collaboration Key areas of application include: Cancer treatment & genomics Clinical Decision Support (Chronic Disease Management, 1% or 5% at risk populations) Streaming data & remote patient monitoring Predictive analytics 2013 Canada Health Infoway Inc. 20 21. Infoway predictions: BDA Readiness Larger health delivery organizations particularly those with a: Research base Advanced level of maturity with their EHRS, DW/BI Established information governance capabilities HDOs that have demonstrated some practical success with knowledge management initiatives and are ready to take the leap to BDA 2013 Canada Health Infoway Inc. 21 22. Communications Opportunities to Collaborate Leadership Identify champions Conduct due diligence to understand BDA Share research, lessons learned Address policy, legal, ethics, business model, sharing, legacy issues Enable a supportive culture, processes, staffing for BDA Create opportunities to bring together several emerging technologies Limited scope pilots, solving specific clinical or business problems Iterative, step- wise investments that limit capital requirements Evaluate the feasibility and utility of BDA Cautious Execution Dont go it alone Look to leverage others work Collaborate on use case, business cases Call to Action 2013 Canada Health Infoway Inc. 22 23. Synopsis of Key Messages Big Data Small data Visualization and contextualization Skills Shortage Governance and privacy Applying science to medicine Its not just about the data or IT Standards Canada is behind the curve 23 2013 Canada Health Infoway Inc. 24. Questions? 24 2013 Canada Health Infoway Inc. 25. Website: www.infoway-inforoute.ca ETG Resources: https://www.infoway-inforoute.ca/index.php/resources/technical- documents/emerging-technology E-mail: etg@infoway-inforoute.ca Blog: http://infowayconnects.infoway-inforoute.ca/ Twitter: @Infoway Thank you 25