First AMA-IEEE EMBS Medical Technology Conference on Individualized Health Care

Telehealth has been an active research area for over a decade. It promises healthcare cost reduction, better health delivery environment for patients, better case outcome, and greater patient participation in their health management. As part of the Connected Health,
Electronic Medical Records & Personal Health Records, and Point of Care Technology themes, it would be helpful to have a session or discussion on Telehealth recent success stories, remaining obstacle for wide spread implementation, and emerging new paradigms in patient care delivery.

Over 50 Million U.S. citizens alone suffer from some form of chronic pain, which doesn’t include those suffering from temporary injuries or strains.  According to the American Chronic Pain Association, “Pain is the most common reason Americans access the health care system… providing adequate pain management is a crucial component of improving and maintaining quality of life for patients.”

Pain management is a $19 Billion global industry of which $1.5B is spent on non-pharmaceutical pain therapy. The industry is currently dominated by drugs that often cause unfortunate side effects or aren’t used by patients for a variety of reasons.  In a 2007 survey by the National Pain Society of 1,484 adults, 72% of respondents admitted to having suffered some form of pain within the last twelve months but were reluctant to use drugs for pain relief.  More than 90% agreed that “people take too many pills these days.”   Medicinal therapies are not adequately meeting market needs and the majority of chronic pain sufferers have turned to pharmaceuticals that currently dominate the treatment options due to widespread insurance coverage and convenience.  However, there are a myriad of public health problems associated with analgesic use including addiction, medical side effects, and illegal drug use.

The purpose of this session is to showcase novel technologies and techniques that provide pain relief from the clinic to the home and reduce health disparities between populations that may not have access to traditional pain-management clinics. Approaches include: wearable devices, telemedicine, massage therapy, homeopathic techniques and other non-pharmaceutical based approaches.

Even though the MIT Technology Review has declared 2009 as a turning point for personal genomes, a number of legal and ethical issues surrounding the use of personal genomics remain unanswered.

Last year, when more than 100 of the world’s top geneticists, technologists, and clinicians converged on Cold Spring Harbor Laboratory in New York for the first annual Personal-Genomes conference, the main focus was James Watson’s genome. The codiscoverer of the structure of DNA was the first to have his genome sequenced and published (aside from Craig Venter, who used his own DNA for the private arm of the human genome project.) Watson sat in the front row of the lecture hall as scientists presented their analysis of his genome. They paid special attention to the number of single-letter variations or small insertions and deletions in his DNA–clues as to whether he had a genetic variation that slightly boosted his risk for heart disease or cancer. But there was very little usable information in the genome.

That has all changed. In the last year, the number of sequenced, published genomes has shot up from two or three to approximately nine, with another 40 or so genomes sequenced but not yet published. “While the numbers are still small numbers, we are starting to put this research into the real disease context and get something out of it,” says Jay Shendure, a geneticist at the University of Washington in Seattle, and a TR35 winner in 2006.  …

Unsurprisingly, a number of startups are also looking to cash in on this new trend in medicine: 23andme, DNATraits, Pacific BioSciences, Navigenics.  Some have even garnered millions of support from venture capitalists.

1. 23AndMe Completes $27.8 Million Series B Round
2. Pacific Biosciences takes $68M as genome sequencing becomes more competitive

The main products of these companies are direct to consumer (DTC) genetic testing services.  Wide spread acceptance of genetic testing continue to face multiple challenges besides price.

1. Whether data collected will be used by health insurance companies to discriminate against certain genetic pre-dispositions
2. Privacy of data collected
3. Who owns the data that gets sequenced, and whether the genes sequenced can be patented

With the recent passage of the Genetic Information Nondiscrimination Act in the United States, congress has begun to take on addresing issue #1.

The Genetic Information Nondiscrimination Act of 2008 (Pub.L. 110-233, 122 Stat. 881, enacted May 21, 2008, GINA), is an Act of Congress in the United States designed to prohibit the improper use of genetic information in health insurance and employment. The Act prohibits group health plans and health insurers from denying coverage to a healthy individual or charging that person higher premiums based solely on a genetic predisposition to developing a disease in the future. The legislation also bars employers from using individuals’ genetic information when making hiring, firing, job placement, or promotion decisions. [1] Senator Ted Kennedy called it the “first major new civil rights bill of the new century” [2] The Act contains amendments to the Employee Retirement Income Security Act of 1974[3] and the Internal Revenue Code of 1986.[4] …

Issue #2 has recently begun to take center stage as deCODE Genetics filed for bankruptcy (another DTC genetics testing company, owned by venture-capital investors Polaris Venture Partners and ARCH Venture Partners).  As a symptom of potential problems to come, an investment company (SAGA investment company) will serve as the custodian for deCODE Genetics.

Privacy fears as DNA testing firm deCODE Genetics goes bust

A leading genetics company that has pioneered personal DNA testing in health assessments went bust yesterday, raising privacy concerns about the sensitive data it holds.

DNA profiles belonging to thousands of people who have paid up to £600 for internet genetic tests are to be transferred to a new organization, after deCODE Genetics filed for chapter 11 bankruptcy in a US court.

The fate of the Icelandic company, which has never turned a profit despite making a string of discoveries about the genetic origins of common diseases, has fueled fresh debate about access to DNA data  …

The third issue is perhaps the trickiest issue, and most relevant to whether any of this technology can be commercially successful in the long term. 3,000 to 5,000 U.S. patents on human genes and 47,000 U.S. patents on inventions involving genetic material have been issued so far, with many arguing that the large number of patents have completely stifled innovation. At stake in a court case filed by the ACLU in federal courts is whether any human gene or test based on it can be covered by a patent. The case in question will a precedent setting case involving the extremely important breast cancer genes BRCA1 and BRCA2.

Medical science’s expanding knowledge of the human genome has opened a promising new field of “personalized” therapeutics tailored to patients’ genetic makeup. But researchers don’t have complete freedom to explore human genes. According to the Hastings Center, a bioethics think tank, 3,000 to 5,000 patents have been issued on various gene sequences. Proponents claim that those patents are advancing the cause of personalized medicine, but the American Civil Liberties Union says they have the opposite effect. This month, U.S. District Judge Robert W. Sweet is scheduled to hear arguments in a case pitting the ACLU — joined by scientists and cancer patients — against the U.S. Patent and Trademark Office and Myriad Genetics, a company that holds patents to two human genes linked to breast and ovarian cancer. At stake is whether any human gene or test based on it can be covered by a patent. …

The landmark 1990 California Supreme Court Decision Moore v Regents of the University of California first set the tone that subjects have no property rights in their tissue or the commercial products developed thererfrom. It is still unclear the repercussions of this case on any findings that are likely to be derived from the massive databases of genetic information currently being compiled by both academic institutions and for-profit companies. For a more detailed review of the argument used on both sides of the Moore case, see Washington and Lee Law Review 61. One of the more frightening arguments used by the Regents of the University of CA (though later not presented to the lower courts) is the use of eminent domain to seize the tissue from John Moore in pursuant to Education Code section 92040, “[t]he Regents . . . may acquire by eminent domain any property necessary to carry out any of the powers or functions of the University of California.” One of the university’s functions is to be “the primary state-supported academic agency for research.” (Ed. Code, § 66500.)

Session Areas ( Speakers as per area of expertise)

1. Physiological Signals: Mining the Value of Continuous Data Acquisition in Acute Care ( Trauma, Critical Care, Neurosciences, Acute Cardiology, Nephrology, Extreme environments)

2. Sensor Technology: Nano, Molecular, Genomic ? The Utopian Trail

3.  Noise or Signal?: Can we know it better? Standardize methods for artifacts?

4.  Information Processing : Analyzing Trend data- Bayesian statistics, Time-series, Non-linear dynamics, Neural networking?

5.  Information Visualization of Biosignals: Making it easy for the busy clinician and safe for patients

6.  Complexity analysis: Can Biosignal Complexity predict acute,critical illness or prognosis?

7. Augmented Cognition: Science Fiction or Human factors meets Medical technology meets Biosignals?

Ayan Sen MD, MS

Ashwani Gupta MD, MPH

Departments of Emergency Medicine, Nephrology, Henry Ford Hospital, Detroit, MI

Many good solutions with state of the art technology as well as very simple but very effective designs have been proposed across the globe. Yet, a lot of projects fail or get abandoned even before reaching the completion. One of the major reasons for this is lack of change management practices used in such efforts. So a track to review the processes, in identifying blunders that people have performed in implementing such solutions would be an ideal choice at a time where the global economy is in topsy-turvy.
The objective of using change management in Electronic Medical Solutions is to assist people to adapt to and adopt the desired changes and hopefully, provide greater benefit to their clients. The sooner the change is adopted and fully utilized the better the return on investment will be. In addition the realization of program-benefits for its clients would happen at a quick pace.

Hence, I propose a track on “Change Management for Electronic Medical Solutions” for this conference.

Hi All,

Due to churning global economic conditions in the world, the health domain has been greatly effected in delivering health services to patients at a manageable cost. It is vital to have sound economic models that would concentrate on sustainable electronic health solutions (eHealth) that would cater patients irrespective of their demographics.

Legislations, is another perspective that is crucial in making available patients’ medical data on the internet. These should be managed via protocols at different levels such as privacy policy, data protection and information security, disclaimers, etc.

Therefore, I propose a track by the name “Economic and Legislative sustainability in Patient Centric Solutions”  to be included in the AMA-IEEE EMBS Medical Technology Conference on Individualized Health Care.

Best Regards,

Yvonne D. Wickramasinghe

Colombo, Sri Lanka

I propose a session focusing on what is needed to make wireless healthcare safe, effective, secure and reliable. Presentations could include a survey of different wireless technology used in healthcare now, including traditional wireless medical telemetry, wifi, RFID and emergency radio systems.  Another presentation could speak to the risks and mitigations for wireless healthcare and the underlining issues, and include examples of how things really work in the clinic.  A presentation on the information, processes and tools needed to make wireless medical systems function properly and security.  In addition, a discussion panel covering specific examples of working and planned wireless deployments and future technology. Some of these idea be encompassed by other proposals.  However, the key difference from my proposal is to emphasize a risk based approach in a shared risk environment, which is paramount for healthcare systems.

Don Witters, Center for Devices and Radiological Health, FDA

Dear all:

Thank you for your active participation in shaping the program of the conference.  I will reply individually and see if we can build some sessions based on your suggestions.  Please try to be as specific as possible.  I very much appreciate the suggestion of broad topic, but in order to build a session I am going to need that you guys be specific in defining the program of the session that you want to organize.  The postings by Thomas Jepsen and Paul H. Frisch are very good examples of what I need from you.  Once again, thank you all for your input!!!

Best regards,

Paolo Bonato, PhD

Conference Program Chair

Dear all,

I agree with Arjang’s suggestion. I too think it would be very valuable to have a session dedicated to Point-of-Care diagnostic technologies.

Antonello Caruso
Post-doc
ETH Zurich

I would like to suggest tele-healthcare systems. Recently, healthcare costs in Japan have continued to rise because of growing elderly population, and regional gaps of healthcare service have been increasing. To make matters worse, shortage of physicians causes many regional hub hospitals to have difficulties in management. Information and communications technology (ICT) in medicine has gathered attention to solve these problems which exist not only in Japan but also in other countries. So, we should develop some tele-healthcare systems using ICT and mobile communication environment for home-visit medical services, mass health examination, emergency environment such as ambulance cars and disaster.

Makoto Yoshizawa

Research Division on Advanced Information Technology,
Cyberscience Center,
Tohoku University

Japan