healthgrid.org the european healthgrid initiative grid-based e-health projects in the european union...

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


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


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



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


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


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


Inhaled drug Inhaled drug delivery planningdelivery planning

Medicine – air flow Medicine – air flow dynamicsdynamics


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


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


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.


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


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)


HEALTHGRID.ORG Standard Mammogram FormStandard Mammogram Form


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.


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’’)


HEALTHGRID.ORG MammoGrid VOMammoGrid VO


HEALTHGRID.ORG Multilevel VO of VOsMultilevel VO of VOs


HEALTHGRID.ORG MammoGrid QueriesMammoGrid Queries


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 √√


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



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’



Molecular andImage-based

diagnosis

Population

Disease

Patient

Tissue, organ

Molecular, genetic

GenomicEpidemiology

Pharmacogenetics

Bioinformatics

MedicalImaging

MedicalInformatics

Public HealthInformaticsI

NBIOMED

PATHOLOGIESTaken from Fernando Martín-Sánchez


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


HEALTHGRID.ORG


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


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.



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


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


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


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


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


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


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


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


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!


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

healthgrid.org the european healthgrid initiative grid-based e-health projects in the european union...

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