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HEALTHGRID.ORG
The EuropeanThe EuropeanHealthGrid InitiativeHealthGrid Initiative
Grid-based E-health projects in the European UnionGrid-based E-health projects in the European Union
Tony Solomonides on behalf of Tony Solomonides on behalf of The HealthGrid AssociationThe HealthGrid Association
22 [email protected]@uwe.ac.uk BioGrid 2004, ChicagoBioGrid 2004, Chicago
HEALTHGRID.ORG HistoryHistory
DG Information Society TechnologiesDG Information Society Technologies funds projectsfunds projects brings them together in Sept 02brings them together in Sept 02 supports conference callsupports conference call
HealthGrid 2003 – Lyon, Jan 03HealthGrid 2003 – Lyon, Jan 03
HealthGrid Association incorporatedHealthGrid Association incorporated
HealthGrid 2004 – HealthGrid 2004 – Clermont-Ferrand, Jan 04Clermont-Ferrand, Jan 04
HealthGrid 2005 – Oxford, Apr 05HealthGrid 2005 – Oxford, Apr 05
33 [email protected]@uwe.ac.uk BioGrid 2004, ChicagoBioGrid 2004, Chicago
HEALTHGRID.ORG Issues and ProjectsIssues and Projects
What is a health grid?What is a health grid? combines Grid and e-Science ideascombines Grid and e-Science ideas oriented to biomedical advancesoriented to biomedical advances supports evidence-based practicesupports evidence-based practice
What projectsWhat projects e-Science led to Grid projectse-Science led to Grid projects Grid projects included applicationsGrid projects included applications e-Health applications took offe-Health applications took off
44 [email protected]@uwe.ac.uk BioGrid 2004, ChicagoBioGrid 2004, Chicago
HEALTHGRID.ORG Principal ThemesPrincipal Themes
IntegrationIntegration
Levels of life & knowledgeLevels of life & knowledge
Correspondence & Correspondence & convergenceconvergence
Issues of ethics and trustIssues of ethics and trust
55 [email protected]@uwe.ac.uk BioGrid 2004, ChicagoBioGrid 2004, Chicago
HEALTHGRID.ORG Principal ThemesPrincipal Themes
IntegrationIntegration medical and bioinformaticsmedical and bioinformatics patient information and medical patient information and medical
knowledgeknowledge ‘‘gold standard’ evidence and practice-gold standard’ evidence and practice-
based evidencebased evidence patient data – images, labs, historypatient data – images, labs, history trust and ethical issuestrust and ethical issues
66 [email protected]@uwe.ac.uk BioGrid 2004, ChicagoBioGrid 2004, Chicago
HEALTHGRID.ORG An example An example
Legal Aspects
Simulation &Imaging
GridSoftware
Bio-numeric modelling
Medical Expertise
Secure & lawful Grid provision of medical services
Build 6 Grid-enabled medical prototype applications
Build suitable middleware on top of common standards
Install and evaluate a GEMSS test-bed
Anticipate privacy, security & other legal concerns
Taken from Gerhard Engelbrecht
77 [email protected]@uwe.ac.uk BioGrid 2004, ChicagoBioGrid 2004, Chicago
HEALTHGRID.ORG ApplicationsApplicationsNameName DomainDomain ClassClass
Maxillofacial Maxillofacial surgery surgery simulationsimulation
Medicine – pre-surgical Medicine – pre-surgical planningplanning
On demand / On demand / distributed distributed supercomputingsupercomputing
Neurosurgery Neurosurgery supportsupport
Medicine – intra-Medicine – intra-operative planningoperative planning
On demandOn demand
Radiotherapy Radiotherapy planningplanning
Medicine – Monte Carlo Medicine – Monte Carlo treatment simulationtreatment simulation
On demand / On demand / distributed distributed supercomputingsupercomputing
Inhaled drug Inhaled drug delivery planningdelivery planning
Medicine – air flow Medicine – air flow dynamicsdynamics
On demand / On demand / distributed distributed supercomputingsupercomputing
Cardio-vascular Cardio-vascular system system simulationsimulation
Medicine – blood flow Medicine – blood flow dynamicsdynamics
On demandOn demand
Advanced image Advanced image reconstructionreconstruction
Medicine – nuclear / in Medicine – nuclear / in vivo diagnosticsvivo diagnostics
On demandOn demand
88 [email protected]@uwe.ac.uk BioGrid 2004, ChicagoBioGrid 2004, Chicago
HEALTHGRID.ORG ApplicationsApplications
Compute-intensive numerical methods parallel MPI codes Finite Element Method (FEM) Computational Fluid Dynamics Monte Carlo Simulation ML-EM Iterative Image Reconstruction Method
Data Transfers (few MBs to few GBs) Services composed of multiple application components (workflow)Flexibility – User InteractionsNear-realtime requirements
QoS support required
99 [email protected]@uwe.ac.uk BioGrid 2004, ChicagoBioGrid 2004, Chicago
HEALTHGRID.ORG MammoGridMammoGrid
EU project to prefigure a EU project to prefigure a pan-pan-European distributed databaseEuropean distributed database of of mammographic mammographic imagesimages using using GridGrid Technologies.Technologies.AimAim:: To provide a To provide a demonstratordemonstrator for for use in epidemiological studies, quality use in epidemiological studies, quality control and validation of computer control and validation of computer aided detection algorithms.aided detection algorithms.
1010 [email protected]@uwe.ac.uk BioGrid 2004, ChicagoBioGrid 2004, Chicago
HEALTHGRID.ORG Why a Mammography Database?Why a Mammography Database?
Improved reliability of screening and early diagnosis Improved reliability of screening and early diagnosis requires:requires: better epidemiological understandingbetter epidemiological understanding improved diagnostic toolsimproved diagnostic tools enhanced quality controlenhanced quality control continuous trainingcontinuous training efficient management of data and recordsefficient management of data and records
Need to establish research and training repositories Need to establish research and training repositories that contain sufficiently large statistical samples:that contain sufficiently large statistical samples: MammoGrid-EUMammoGrid-EU NDMA-USNDMA-US eDIAMonD-UKeDIAMonD-UK GPCalma-ItalyGPCalma-Italy
1111 [email protected]@uwe.ac.uk BioGrid 2004, ChicagoBioGrid 2004, Chicago
HEALTHGRID.ORG TechnologiesTechnologies
MammographyMammography SMF™ (Mirada)SMF™ (Mirada) CADe (CALMA)CADe (CALMA) DICOM (Medical Imaging Standard)DICOM (Medical Imaging Standard)
Distributed computationDistributed computation CRISTAL Database (CERN/UWE)CRISTAL Database (CERN/UWE) AliEn GRID (CERN)AliEn GRID (CERN)
1212 [email protected]@uwe.ac.uk BioGrid 2004, ChicagoBioGrid 2004, Chicago
HEALTHGRID.ORG Standard Mammogram FormStandard Mammogram Form
1313 [email protected]@uwe.ac.uk BioGrid 2004, ChicagoBioGrid 2004, Chicago
HEALTHGRID.ORG The theory of SMF™The theory of SMF™
Mirada’s Mirada’s Standard Mammogram FormStandard Mammogram Form (SMF™) measures (SMF™) measures the column of non-fatty tissue between the compression the column of non-fatty tissue between the compression plate and the imaging surface. plate and the imaging surface.
SMF algorithmSMF algorithm models the physics of image formation, models the physics of image formation, including extrafocal radiation, scatter, grid effects, film-including extrafocal radiation, scatter, grid effects, film-screen characteristics, etc.screen characteristics, etc.
The contribution of the imaging system is factored out.The contribution of the imaging system is factored out.
The image is decomposed into fatty tissue and non-fatty The image is decomposed into fatty tissue and non-fatty tissue.tissue.
The new representation gives a numerical value for the The new representation gives a numerical value for the amount of non-fatty tissue at any point on the image.amount of non-fatty tissue at any point on the image.
1414 [email protected]@uwe.ac.uk BioGrid 2004, ChicagoBioGrid 2004, Chicago
HEALTHGRID.ORG Grid ArchitectureGrid Architecture
GRID
VPN
WorkstationsWorkstations
MammoGrid Data
MammoGrid Data
MammoGrid Data
Udine
Oxford
CERN
MammoGrid Data
Cambridge
GridBox
GridBox
GridBox
High Security Level
MG W/s(‘‘MAS’’)
MG W/s(‘‘MAS’’)
1515 [email protected]@uwe.ac.uk BioGrid 2004, ChicagoBioGrid 2004, Chicago
HEALTHGRID.ORG MammoGrid VOMammoGrid VO
1616 [email protected]@uwe.ac.uk BioGrid 2004, ChicagoBioGrid 2004, Chicago
HEALTHGRID.ORG MammoGrid VOMammoGrid VO
1717 [email protected]@uwe.ac.uk BioGrid 2004, ChicagoBioGrid 2004, Chicago
HEALTHGRID.ORG Multilevel VO of VOsMultilevel VO of VOs
1818 [email protected]@uwe.ac.uk BioGrid 2004, ChicagoBioGrid 2004, Chicago
HEALTHGRID.ORG MammoGrid QueriesMammoGrid Queries
1919 [email protected]@uwe.ac.uk BioGrid 2004, ChicagoBioGrid 2004, Chicago
HEALTHGRID.ORG Scope of projectsScope of projectsMammoGridMammoGrid eDiamondeDiamond GP CALMAGP CALMA
TelediagnosisTelediagnosis √√ √√
Quality Quality ControlControl
√√ √√
EpidemiologyEpidemiology √√ √√
Algorithm Algorithm DevelopmentDevelopment
√√
(dm)(dm)√√
(dm)(dm)√√
(CADe)(CADe)
TeachingTeaching √√
2020 [email protected]@uwe.ac.uk BioGrid 2004, ChicagoBioGrid 2004, Chicago
HEALTHGRID.ORG Next stepsNext steps
Ongoing:Ongoing: set-up collaborationsset-up collaborations address “digital divide” where possibleaddress “digital divide” where possible
Short term:Short term: join other “synergetic” projects to develop join other “synergetic” projects to develop
Mammography application inside EGEEMammography application inside EGEE
Long term:Long term: new “Image-Grid” project, extending outside new “Image-Grid” project, extending outside
mammography domainmammography domain address distributed database issues address distributed database issues
2121 [email protected]@uwe.ac.uk BioGrid 2004, ChicagoBioGrid 2004, Chicago
HEALTHGRID.ORG Principal ThemesPrincipal Themes
Levels of lifeLevels of life
Levels of knowledgeLevels of knowledge
Correspondence and Correspondence and convergenceconvergence medicine and genomicsmedicine and genomics ‘‘molecular medicine’molecular medicine’ ‘‘individualized healthcare’individualized healthcare’
2222 [email protected]@uwe.ac.uk BioGrid 2004, ChicagoBioGrid 2004, Chicago
HEALTHGRID.ORG Principal ThemesPrincipal Themes
Molecular andImage-based
diagnosis
Population
Disease
Patient
Tissue, organ
Molecular, genetic
GenomicEpidemiology
Pharmacogenetics
Bioinformatics
MedicalImaging
MedicalInformatics
Public HealthInformaticsI
NBIOMED
PATHOLOGIESTaken from Fernando Martín-Sánchez
2323 [email protected]@uwe.ac.uk BioGrid 2004, ChicagoBioGrid 2004, Chicago
HEALTHGRID.ORG An exampleAn example
Integration of clinical and genetic info Integration of clinical and genetic info from heterogeneous remote databasesfrom heterogeneous remote databases
A vocabulary server that aims to combine A vocabulary server that aims to combine existing terminology systems in Medicine existing terminology systems in Medicine and Geneticsand Genetics
Novel framework for clinicians to locate, Novel framework for clinicians to locate, search, access, retrieve and use genomic search, access, retrieve and use genomic information in patient careinformation in patient care
Taken from Fernando Martín-Sánchez
2828 [email protected]@uwe.ac.uk BioGrid 2004, ChicagoBioGrid 2004, Chicago
HEALTHGRID.ORG Focus: the individualFocus: the individual
INDIVIDUALISED HEALTHCAREMOLECULAR MEDICINE
Association
Modelling
Computation
Computational recommendation
Patient related data
PublicHealth
Patient
Tissue, organCell
Molecule
PublicHealthPatient
Tissue, organCell
Molecule
Sofie NøragerYves PaindaveineDG INFSO
Individualizedhealthcare requires mixing and analysing information at 5 levels:
- molecule- cell- tissue- patient- population
2929 [email protected]@uwe.ac.uk BioGrid 2004, ChicagoBioGrid 2004, Chicago
HEALTHGRID.ORG Issues and ProjectsIssues and Projects
EUROGRID
DATAGRID
DAMIEN
CROSSGRID
GRIDSTART
Only health related Grids Multidisciplinary Grids
GEMSS
HEALTHGRID CLUSTER
BIOGRID
MAMMOGRID
Public Health
Patient
Tissue, organ
Cell
Molecule
Public health
informatics
Medical Informatics
Medical Imaging
Bio-informatics
Figure 1
ETC.
3030 [email protected]@uwe.ac.uk BioGrid 2004, ChicagoBioGrid 2004, Chicago
HEALTHGRID.ORG Principal ThemesPrincipal Themes
Issues of ethics and trustIssues of ethics and trust use of data in care and in researchuse of data in care and in research data provenancedata provenance privacy / confidentialityprivacy / confidentiality securitysecurity national / EU legal frameworknational / EU legal framework … … extending the concept of a ‘virtual extending the concept of a ‘virtual
organization’organization’ & building negotiation into the & building negotiation into the
infrastructureinfrastructure
3131 [email protected]@uwe.ac.uk BioGrid 2004, ChicagoBioGrid 2004, Chicago
HEALTHGRID.ORGGRIDs and Privacy
Good reasons for talking about privacy here and now!
– The HealthGrid promises access to large amounts of heterogeneous distributed data
– Health related information is very sensitive and prone to abuse
– Privacy impacts society as a whole(e.g. loan applications, insurance, scholarship, ...)
– Privacy violation is irreversible– Confidential information can never be considered
confidential again, once it was out in the open– Grid and Privacy Enhancing Technology exist and are
usedThey could both benefit from early integration
Taken from Georges de Moor and Brecht Claerhout
3232 [email protected]@uwe.ac.uk BioGrid 2004, ChicagoBioGrid 2004, Chicago
HEALTHGRID.ORGAvailable PET Technology
Example Technology (PETs for Database Protection):– “Hard” de-identification by the data owner– Anonymisation and Pseudonymisation Techniques– Privacy Risk Assessment– Data Flow Segmentation– Generalisation– Privacy Enhancing Database Agents– Controlled Database Alteration
Beyond Technology:– CEN/TC251 standardization effort on AURTAF
(Anonymity User Requirements for Trusted Anonymisation Facilities)
– CEN/ISSS Focus Group
3333 [email protected]@uwe.ac.uk BioGrid 2004, ChicagoBioGrid 2004, Chicago
HEALTHGRID.ORGExample Application
Sharing research data (e.g. disease traceability studies):
– Different sites maintain databases:– Nominative records, through direct patient
contacts in healthcare delivery– Privacy protected databases
(research centers doing data collection)
These data could be shared amongst researchers on the Grid, enabling:
– Larger geographical coverage(Resource locating)
– Standardized data exchange
3434 [email protected]@uwe.ac.uk BioGrid 2004, ChicagoBioGrid 2004, Chicago
HEALTHGRID.ORGSharing of Healthcare Data
Local Databases:– Nominative records
(e.g. patient treatment)
– Privacy protected DBs
Data Access through the Grid
PrivacyProtectingInterface
Privacy Protecting Interface (PETs):
– Locally controlled– Pseudonymisation– Content filtering and
transformation– Query evaluation
(restriction)
Local Database
3535 [email protected]@uwe.ac.uk BioGrid 2004, ChicagoBioGrid 2004, Chicago
HEALTHGRID.ORGPrivacy Protection Technology
Security and Privacy:
– PETs and Access Control are complementary
– “Security through Privacy” instead of “Privacy through Security”
– Within possibilities of today’s PET technology
– Knowledge on local data is needed for efficient Privacy Risk Assessment and configuration of PET measures
– Data provider is keeping the control:Technically Enforced (= PETs) Dynamic Privacy Policy
3636 [email protected]@uwe.ac.uk BioGrid 2004, ChicagoBioGrid 2004, Chicago
HEALTHGRID.ORGIntegrating Grid and PETs
Should these privacy protecting services be integrated into the HealthGrid itself?
– In the example application, Privacy Protection could easily be separated from the Grid middleware layer(actually such services are already in use)
– But there could be considerable advantages if integrated:
– Privacy (for databases) policy management and advertising
– Synergy of PET and Access Control technology
– Could lead to harmonized and standardized PET implementations
3737 [email protected]@uwe.ac.uk BioGrid 2004, ChicagoBioGrid 2004, Chicago
HEALTHGRID.ORGIntegrating Grid and PETs
Furthermore…– Small “cells” (e.g. geographical area, hospital, …) of
anonymous data can lead to increased re-identification risk (i.e. privacy risk)
– A “virtual database service” combining several databases through distributed query techniques, solves this
– Giving the illusion to the user that a single database is accessed
– Provided through Trusted Third Parties (Privacy Policy Enforcing)
Virtual databases, policy advertising, … are Grid topics
3838 [email protected]@uwe.ac.uk BioGrid 2004, ChicagoBioGrid 2004, Chicago
HEALTHGRID.ORGConclusions
Summarized:– There is a need for Privacy Protection in a HealthGrid– PET Technology is ready for application and/or
integration– The Grid could benefit from integration of a selected
number of Privacy Protection Services (in synergy with Security standards?)
– Basically, it comes down to selecting an appropriate Grid application, and merging two existing knowledge domains
When it comes down to privacy and medical information:Informed consent or other legal measures should not be
considered a valid substitute to technical privacy protection techniques!
3939 [email protected]@uwe.ac.uk BioGrid 2004, ChicagoBioGrid 2004, Chicago
HEALTHGRID.ORG More informationMore information
Web refsWeb refshttp://lyon2003.healthgrid.org/program.phphttp://lyon2003.healthgrid.org/program.phphttp://clermont2004.healthgrid.org/program.phphttp://clermont2004.healthgrid.org/program.phphttp://www.healthgrid.org/http://www.healthgrid.org/
HG2004 ProceedingsHG2004 Proceedings
‘‘White paper’White paper’to appear June 2004to appear June 2004