Recently Laura Pombo Juárez, Director of Impetu Solutions responsible of PHS Foresight outreach activities, interviewed Prof. Marco Viceconti, Director of the Insigneo Institute and Executive Director of the VPH Institute, on the future of personal health forecasting and in silico medicine.
September 2009, a FP7 support action ‘Personal Health Systems Foresight’
has coordinated strategic stakeholder
engagements in the realm of Personal Health Systems (PHS) within and beyond
European Union. The project expands across different PHS areas of application
such as chronic disease management, life-style management, independent living and
emergency services. As part of this project, stakeholders are invited to share,
comment and assess future visions on PHS in the dedicated website.
Here the interview with our Executive Director, Prof. Marco Viceconti.
I serve as scientific director of the new Insigneo Institute for in silico medicine, based in Sheffield, UK. I also serve as executive director of an international not-for-profit organisation called VPH Institute, which coordinates worldwide the research activity around the Virtual Physiological Human. The VPH is a framework of methods and technologies that once realised will make possible to investigate the human body as a whole. At the core of the VPH vision there is the use of computer models, based on existing knowledge and individualised on the data available for each patient, that describe a specific physiological or pathological process across multiple space-time scales, from the molecular up to the whole organism scale. When such multiscale models are used to support the clinical decision for prevention, diagnosis, prognosis, treatment planning, and monitoring, we call it in silico medicine, where computer simulations are directly involved in the clinical process.
Traditionally VPH models operates starting from the patient-specific information collected within the hospital (imaging, sensing, lab exams, clinical observations, etc.) but for more and more diseases it is even more important to capture reliable quantification of physiological parameters and behaviours during the daily life. This is where the VPH and PHS connect, in our opinion.
I think Information Technology is the future of medicine. But we need to overcome cultural, technological and business barriers that make health IT systems we use today closed, proprietary and largely non-interoperable. Europe in general and UK in particular has a huge opportunity, which comes from its universal healthcare systems, to impose interoperability standards to all providers. But before this we must produce a culture shift, where the provision of care becomes patient-centric instead of hospital-centric.
As researchers in healthcare technologies, I think our responsibility is to develop fully functional demonstrators that provide operational evidences around which drive this cultural transformation. VPH and PHS must work together to build an information bridge between the patient, his/her carers, and all the providers of care (hospitals, GPs, gyms, pharmacies, protected houses, etc.)
What the VPH Institute proposes is something we call “Personal Health Forecasting” (PHF). It can be described like this: continuously all your health-related information is collected digitally, through the healthcare information systems, the PHS solutions, wearable sensors, intelligent implants and pharma packaging, ambient sensors in our house and workplace, etc. All these data, combined with all information we log directly during our daily life, are stored in a private secure cloud that initially can be accessed only by the patient him/herself. However, we can grant access to some of this information to our relatives, carers, GPs, or hospital specialists, by setting policies that define if the access is continuous, intermittent, sporadic, and whether it needs to be constantly re-authorised or not. A huge works has to be done to make the user interfaces so simple and intuitive that they do not constitute an additional barrier for the weaker members of our societies.
Another thing we can do is to expose some of our personal health data to remote processing services, typically provided by the healthcare institutions but also by for-profit entities, which continuously process such data with VPH-based predictive models, which return forecasts on how our health status will evolve in the near and distant future. Such personal health forecasting services can be designed around generic wellness programmes (such as the ten thousands steps initiative), or around very specific conditions (management of type 2 diabetes, management of post-operative stage in breast cancer, stroke recovery, etc.).
Personal health forecasting services can be designed to simply provide life style coaching, raise alarms and warnings to carers and healthcare services, support participative programmes where the patient is expected to undertake specific activities that are monitored by PHS solutions and tuned by PHF services, or trigger healthcare provisions when specific combinations of health states appear.
All personal health data will be aggressively anonymised (and where the law requires accompanied by an informed consent) before they are replicated in national warehouse for secondary use. Two important uses will be continuous validation of Personal Health Forecasting models (by comparing the predicted states to those actually observed in the same subject), and what we call Public eHealth, decisions support systems for policy makers capable of forecasting the healthcare needs of the population in the near and far future.
First we need to develop reliable VPH models for important families of conditions. Thanks to the VPH Priority in the European FP7 programme, a significant amount of research is being conducted right now, and the first VPH models are starting to become available for large-scale validation.
Secondly we need to ensure a significant budget for technological research under the in silico medicine priority of the new Horizon 2020 programme, and to engage national funding agencies around the same strategic priorities, so as to ensure critical mass but also the necessary flexibility across funding opportunities, between local and union-wide projects.
Then we need to pierce the hospital barrier, creating demonstrators where patient-specific information is collected both inside and outside the hospital; we also need to show how VPH models can help to cope with the inherent complexity that would emerge with the interpretation of such large information streams.
Last, but least, we need to engage the industry in a pre-competitive alliance that drives the development of truly open interoperability standards, and the associated security standards. The Avicenna support action that will kick-off in the fall, will roadmap this territory for what we call “in silico clinical trials” where PHS and VPH technologies can be used to generated data and models to improve the pre-clinical assessment of biomedical products before they are tested on real patients. I think Avicenna, PHS Foresight, and other similar initiatives should join forces in the creation of such pre-competitive alliance.
Collaborative technological research through the H2020 programme. But also a pre-competitive alliance between industrial players, research institutions, and healthcare providers, which sets standards and policies for the health information technology of the future.
We need to watch closely the current debate on data protection, and provide expert advise to the policy makers in order to ensure that the new legislation does not produce as non intended side effect a drastic reduction of the opportunities for innovation in this critical sector.
For more information:
- Visit the PHS Foresight, www.phsforesight.eu
- Contact Laura Pombo Juárez, firstname.lastname@example.org