Carolyn McGregor , Andrew James, Mike Eklund, Daby Sow, Maria Ebling, Marion Blount

1. Real-time Multidimensional Temporal Analysis of Complex High Volume Physiological Data Streams in the Neonatal Intensive Care Unit Carolyn McGregor, Andrew James, Mike Eklund, DabySow, Maria Ebling, Marion Blount Canada Research Chair in Health Informatics, Professor, Associate Dean of Research Faculty of Business and IT, University of Ontario Institute of Technology c.mcgregor@ieee.org

2. Outline • Neonatal Big Data • Clinical Problem and Motivation • Artemis • LONS • Clinical Application

3. Care of the Preterm Infant

4. Neonatal Care • Multiple devices are attached to the baby or humidicrib • Medical devices output via serial port in a range of formats • Indicative readings are recorded on paper every 30 or 60 minutes • Cost of care per baby is approx $100-150K not including morbidity related care http://preemie.info/cms/modules/news/

5. Neonatal ICUBig Data • Heart beats • Average 130/minute| 7800/hour • Breathing • Average 35/minute | 2100/hour • Blood oxygen levels • 60/minute | 3600/hour

6. Neonatal ICUBig Data • Heart beats • 1 value /hour (7799 lost) • Breathing • Average 35/minute | 2100/hour • Blood oxygen levels • 60/minute | 3600/hour

7. Neonatal ICUBig Data • Heart beats • 1 value /hour (7799 lost) • Breathing • 1 value /hour (2099 lost) • Blood oxygen levels • 60/minute | 3600/hour

8. Neonatal ICUBig Data • Heart beats • 1 value /hour (7799 lost) • Breathing • 1 value /hour (2099 lost) • Blood oxygen levels • 1 value /hour (3599 lost)

9. Condition Onset Predictors • Behaviour of physiological data streams that describe respiratory and cardiac function . . . • Pneumothorax (McIntosh et al, 2000) • Nosocomial infection (Griffin and Moorman, 2001) • Periventricularleucomalacia (Shankaran et al, 2006) • Intraventricularhaemorrhage (Fabres et al, 2006; Tuzcu et al, 2009)

10. LONS

11. LONS

12. LONS

13. Knowledge TranslationChallenge • Retrospective Analysis • Not implemented in clinical practice • Not scalable • Either or combination of: • Patient centric • Condition centric • Stream centric

14. Artemis

15. Health and Medicine Experts Health Informatics Information Technology and Computer Systems Research

16. InfoSphere Streams Runtime Artemis SpO2 BP ECG HR MP50 Babylog8000 Medical Data Hub Online Analysis ResultPresentation Data Aquisition FA AR CapsuleTech Server HR Source Op EP PT QRS RR Alert Sink Op SpO2 Source Op USER INTERFACE Sepsis BPA BP BP Source Op Configuration Server WTA WT CIS Source Op Clinical Information System CIS Adapter Cognos Deployment Server Data Integration Mgr Knowledge Extraction (Re)deployment Stream Persistency Data Mover Ontology Driven Rule Modifier SPADE IDE Data Miner Patient Stream HIR Knowledge Extraction • McGregor, C., Catley, C., James, A., Padbury, J., “Next Generation Neonatal Health Informatics with Artemis”, Medical Informatics Europe, Oslo, Norway, pp115-119 16

17. Current Status of Artemis • Deployed August, 2009 • The Hospital for Sick Children, Toronto • Maximum 8 concurrent Neonatal ICU patients • Enabling new Nosocomial Infection Clinical Research http://www.youtube.com/watch?v=QVbnrlqWG5I YouTube: IBM commercial data baby

18. Artemis • Upscaling to all patients within SickKids NICU • 2 Hospitals Online • Cloud Computing Version • Other conditions and events • Expand to other ICUs beyond Neonatal http://www.youtube.com/watch?v=QVbnrlqWG5I YouTube: IBM commercial data baby

19. Artemis • Heart rate (HR) (1 Hz); • Transcutaneous blood oxygen saturation (SpO2) (1 Hz) • Respiration rate (RR) (1 Hz) • Blood pressure [systolic, diastolic, and mean] (BP) (1Hz)

20. Artemis: Clinical RESEARCH - LONS

21. LONS • Phase 0: no infection present • Phase 1: infection present but no detectable clinical symptoms and signs • Phase 2: subtle clinical symptoms and signs present • Phase 3: definite clinical symptoms and signs present • Phase 4: very obvious clinical symptoms and signs present

22. LONS • Phase 0: no infection present • Phase 1: infection present but no detectable clinical symptoms and signs • Phase 2: subtle clinical symptoms and signs present • Phase 3: definite clinical symptoms and signs present • Phase 4: very obvious clinical symptoms and signs present

23. LONS • Phase 0: no infection present • Phase 1: infection present but no detectable clinical symptoms and signs • Phase 2: subtle clinical symptoms and signs present • Phase 3: definite clinical symptoms and signs present • Phase 4: very obvious clinical symptoms and signs present

24. Level 0: No specified features present. • Level 1: Presence of features reporting reduced heart rate variability (HRV), or bradycardia, or a significant downward drift of heart rate. • Level 2: Presence of level 1 features plus the presence of a respiratory pause as determined by fall in respiratory rate below the defined threshold.

25. Level 3: Presence of level 2 features plus a blood oxygen desaturation threshold breach or a significant downward drift of blood oxygen desaturation • Level 4: Presence of level 3 features plus a blood pressure threshold breach on any of the readings or a significant downward drift of any of the blood pressure readings

27. ArtemisClinical Partners Shenzhen Maternity & Child Health Hospital深圳市妇幼保健院 Nepean Hospital Westmead Hospital

28. Funding Acknowledgements Canada TJ Watson Research Center, NY

29. TeamAcknowledgements Dr Andrew James Assoc Prof Mikael Eklund Assoc Prof Jennifer Percival Dr J. Edward Pugh Dr Christina Catley Dr Nadja Mench-Bressan Shermeen Nizami Rishikesan Kamaleswaran Agam Dhanoa Kathy Smith Anirudh Thommandram Wenlan Huang Sascha Tuuha Nathan Percival

30. Real-time Multidimensional Temporal Analysis of Complex High Volume Physiological Data Streams in the Neonatal Intensive Care Unit Carolyn McGregor, Andrew James, Mike Eklund, DabySow, Maria Ebling, Marion Blount Canada Research Chair in Health Informatics, Professor, Associate Dean of Research Faculty of Business and IT, University of Ontario Institute of Technology c.mcgregor@ieee.org