Smart and Connected Health A small-business perspective from Silicon Valley

1. Smart and Connected HealthA small-business perspective from Silicon Valley Colleen E Crangle, PhD CONVERSPEECH LLC, Palo Alto, California, USA Affiliated Research Scientist, Suppes Brain Lab and QSci, Center for the Study of Language and Information, Stanford University US-UK Fulbright Fellow 2013, School of Computing and Communications, Lancaster University, United Kingdom Talk given at the MBA Association of Ireland (MBAAI), NIBEC, University of Ulster at Jordanstown, Northern Ireland, UK. Wed 27 Mar 2013.

2. First, a joint NSF (National Science Foundation) and NIH (National Institutes of Health) perspective on Smart and Connected Health • WHAT? • HOW? • DOING WHAT?

3. WHAT? transformation of healthcare from reactive and hospital-centered to preventive, evidence-based, person-centered and focused on well-being rather than disease

4. HOW? multidisciplinary teams addressing technical AND behavioral AND clinical issues fundamental science  - - - - - - clinical practice drawing on the social, behavioral, and economic sciences, engineering, medicine, biology, and computer and information sciences

5. DOING WHAT? generating breakthrough ideas in … sensor technology, networking, information and machine learning technology, decision support systems, modeling of behavioral and cognitive processes, system and process modeling

6. Silicon Valley Large Corporations / Small Businesses / Developers / Entrepreneurs / Universities / Not-for Profit Organizations / Angel investors and VCs / Competitions, Challenges …

7. … and visiting Europeans 5th March 2013: Silicon Valley Entrepreneurs Learn From Ulster Health Technology Leader Sensor technology innovator Professor Jim McLaughlin of the University of Ulster this week told a VIP audience at California’s Stanford University how healthcare technologies developed at Ulster have inspired a set of globally successful spin-out companies.  Stanford Engineering's European Innovation & Entrepreneurship Thought Leaders series, associated with the Stanford Entrepreneurship Network (SEN)

8. T he Stanford Entrepreneurship Network (SEN) serves as a forum for collaboration within Stanford's community of uniquely focused entrepreneurship programs and groups. • SEN benefits students, faculty and all members of the entrepreneurship community by: • Serving as a single point of contact for all things “entrepreneurship” at Stanford • Helping students find and access appropriate entrepreneurship resources at Stanford • Advancing Stanford's multi-disciplinary approach to entrepreneurship teaching, research and outreach  • SEN benefits member organizations, and their constituents, by: • Increasing awareness of entrepreneurship activities on campus • Facilitating collaboration between member organizations • Encouraging thoughtful and responsible interaction between Stanford and the Silicon Valley community

9. A challenge on large-scalebiomedical semantic indexingand question answering BIOASQ initiates a series of challenges on biomedical semantic indexing and question answering (QA). The challenge (aka competition or shared task) will assess: • large-scale classification of biomedical documents onto ontology concepts (semantic indexing), • classification of biomedical questions onto relevant concepts, • retrieval of relevant document snippets, concepts and knowledge base triples, • delivery of the retrieved information in a concise and user-understandable form. • March 18: Training data available for task 1a. Dry-run data available for task 1b. • April 15: Start of task 1a. • June 3: Start of task 1b. • July 15: Submission of papers for BioASQ workshop. • August 30: End of the challenge. • September 27: BioASQ workshop, collocated with CLEF 2013.

10. Mobilizing Data for Pressure Ulcer Prevention Challenge Submission Deadline: April 29, 2013 First Place: $60,000 plus conference exhibition opportunity Second Place: $15,000 Third Place: $5,000 Agency for Healthcare Research and Quality (AHRQ) tells us that each year more than 2.5 million people in the United States are affected by skin breakdowns that cause pain, increased risk for serious infection, and increased health care utilization. AHRQ has published an acute care toolkit for prevention of pressure ulcers atwww.ahrq.gov/research/ltc/pressureulcertoolkit/putool7b.htm.

11. QSci at Stanford CSLI http://lingo.stanford.edu/qsci/ QSciis a research and engineering group at the Center for the Study of Language and Information (CSLI) at Stanford University.QSci serves Stanford faculty and students who are engaged in research involving the nature of questions in human language with the help of big data engineering and computational linguistics. People Colleen Crangle Ali Farghaly Dan Flickinger Patrick Hunt PenttiKanerva DikranKaragueuzian Henry Liao Paul Skokowski

12. CONVERSPEECH LCC R&D since 1997 • Beyond information extraction: Identifying Gene Ontology concepts in text, National Library of Medicine (NLM), National Institutes of Health (NIH) R03 LM009752-01, PI Colleen Crangle • Biomedical ontology and tools for database curation, National Human Genome Research Institute (NHGRI), NIH R43CAHG003600-01. Subcontract PI: J. Michael Cherry, Ph.D., Dept. of Genetics, Stanford University. PI Colleen Crangle • Cancer narratives for low-literacy adult learners, National Cancer Institute (NCI), NIH 1R43CA103445-01, PI Colleen Crangle • Improved access to breast cancer information, NAPBC Supplement to NLM, Stanford University School of Medicine, LM-05305. Shortliffe, PI. In collaboration with Palo Alto-based Community Breast Health Project (CBHP) • Voice recognition front­end to cancer knowledge sources, NCI N44­CO­33071, Mark Tuttle, PI • Wireless, pen­based front­end to cancer knowledge sources, NCI N44­CO­40550, David Sherertz, PI • Language and the Brain, Stanford University, Suppes Brain Lab, PI Colleen Crangle Healthcare Delivery and Methodologies Methods and Measurement in Behavioral and Social Sciences Health Services, Informatics, Literacy and Communication Analytical Methods in Neurolinguistics

13. Questions in the Biomedical Sciences • Clinical Questions • Genomics Questions • Patient Reported Outcome Questions

14. Clinical Questions -- Questions asked, often at the point of care, about etiology, prognosis, diagnosis, prevention, or treatment of disordersWhat protective effects do vitamins E, C, and beta carotene have on the cardiovascular system? What is the interval for monitoring warfarin therapy once therapeutic levels are achieved? Clinicians have up to 18 questions for every 10 patients they care for. Answers to two-thirds of these questions are either not sought or sought but not found. These unanswered questions could be answered if the questions were asked the right way and the answers sought more effectively. In the age of the internet, that comes down to better query formulation and better search strategies for a given category of question. Questions about prognosis using PubMed should include the following: (incidence[MeSH] OR mortality[MeSH] OR follow up studies[MeSH] OR prognos*[Text Word] OR predict*[Text Word] OR course*[Text Word]). Clinical questions have been widely collected and studied. Helping physicians articulate their clinical information needs through carefully-constructed, focused questions has become a crucial part of evidence-based medicine. PubMed is the online database of the National Library of Medicine -- more than 21 million citations for biomedical literature from MEDLINE, life science journals, and online books, with access to the full text of many articles.

15. Genomics Questions – concerned with the information needs of working biologists, specifically those trying to collect and collate the information flowing from the human genome project and appearing in the scientific literature. Identifying genes is just a first step. What comes next is the question: What do the genes do, or more specifically, what molecular functions do genes have? We have a set G of genes, a set F of molecular functions of genes, and a set A of articles in the scientific literature. F is given by the entities in the Molecular Function sub-ontology of the Gene Ontology (GO). The following five questions capture different ways the biologist seeks to gather information from the literature about genes and their functions. Distinct information seeking activities of the biologist correspond to distinct formulations of the one overarching question: What do genes do?

16. Given gene g ϵ G and article a ϵ A, what molecular functions fi (i=1,…,n) can be ascribed to g based on experimental evidence in a?(This question is the one we sought to automate in NIH-funded projects R43CAHG003600-01 and R03LM009752-01.) • β1: G x A F • Questions typically asked by curators of model organism databases as they do their work: • Given article a ϵ A, what molecular functions fi (i=1,…,n) can be ascribed to which genes gj (j=1,…,m) based on experimental evidence in a? • β2: A  F x G • Given article a ϵ A and molecular function f ϵ F, what genes gj (j=1,…,m) are shown in article a to have function f based on experimental evidence? • β3: A x F  G • Questions asked when a given gene’s function is not known to the research scientist and there is no entry in the relevant organism database, but there is reason to believe that • the scientific literature may contain experimental evidence for a specific candidate molecular function (suggested by related genes in another organism, for example) or some as yet unknown function – the article just has to be found. • Given gene g ϵ G and molecular function f ϵ F, what if any articles ak (k=1,…,p) provide experimental evidence for the claim that g has function f? • β4: G x F A • Given gene g ϵ G, what if any articles ak (k=1,…,p) provide experimental evidence for the claim that g has some function from F? • β5: G  A x F

17. Local (Palo Alto) not-for profit medical clinic and foundation, associated with larger not-for-profit healthcare organization Sutter Health. Wished to bring the ingenuity of Silicon Valley developers to bear on its vision for connected health. Palo Alto Medical Foundation Innovation Center Developer Challenge to Create "Signal Detection Solution" for Successful Aging …asked developers to explore "Signal Detection," the creative detection and use of signals of physical and social health of our seniors to improve health outcomes and quality of life Began in March 2012 Winning developer solution to be completed around March 2013 In 1990, 1 in 8 residents of Santa Clara County was over age 60. (Includes Palo Alto, Pop. > 1,809,378 ) By 2030 it will be over 1 in 4. Today, the vast majority ... express the desire to age independently in place in their homes and communities.  But … increasingly complex health issues ... fragmented services, high cost, and suboptimal outcomes Fromhttp://innovation.pamf.org/linkages/linkages-ecosystem/our-focus-on-aging/

18. The Technology Strategy Board is inviting applications for participation in a revolutionary sandpit workshop in the autumn looking for novel thinking to blow apart conventional thinking about institutional long-term care. … transform the future of long-term care to create better quality of life and economic growth in the Uk ... applications from people representing organisations (large or small) that will contribute new expertise and new thinking to revolutionary new designs for long-term care – we are more interested in new ideas, underpinned by radical and innovative thinking … create a vibrant and empowered consumer group, along with their families and carers, requires radical thinking, risk taking and multidisciplinary approaches. The aim of this sandpit is to bring together a varied group of up to 25 individuals, … work together to develop radical, risky and novel ideas that can then be developed into full proposals for industry led Small Business Research Initiative (SBRI) projects. Following on from the sandpit … up to £2.4m in such projects. Academics can be fully involved as sub-contractors in the proposals. … any industry sector, for example: built environment, engineering, media, tourism, aerospace, robotics, even the military. Or from an academic field, for example engineering, design, ICT, maths, management and business studies, sociology, economics, geography, legal studies, anthropology, social policy or creative arts. The five-day sandpit will be held16-20 september 2013. You can apply from 8 april 2013. The deadline for applications is noon 12 June 2013. We will be holding briefings for potential applicants in Edinburgh, Leeds and London and strongly recommend applicants attend one. For further information and to apply go to www.innovateuk.org. SBRI The SBRI programme uses the power of government procurement to drive innovation. It provides opportunities for innovative companies to engage with the public sector to solve specific problems. Competitions for new technologies and ideas are run on specific topics and aim to engage a broad range of organisations.