1、由大数据到智能医学Translational Medicine Two strategic requirementChange of medical modelHealth care reform The engine and bridge from big data tointelligent medicineTranslational MedicineGenomic medicineDigital medicineBig dataFrom bench to bedsideFrom big data to intelligent medicineIntelligent Medicine5P
2、MedicinePredictive medicine Preventive medicinePersonalized medicine Precision medicineParticipatory medicineIntelligent medicine Right person Right time Right treatment Right healthcareBig DataNature 498:255(2013)THE BIG CHALLENGES OF BIG DATANature 498:255(2013)As they grapple with increasingly la
3、rge data sets,biologists and computer scientists uncork newbottlenecks.Biologists are joining the big-data club.With theadvent of high-throughput genomics,life scientistsare starting to grapple with massive data sets,encountering challenges with handling,processingand moving information that were on
4、ce thedomain of astronomers and high-energyphysicists.Biomedical big data Biological data Medical data Real time physiological and pathologicaldateBiological DataStandardizing experimental protocolsCurrent Opinion in Biotechnology 19:354-359(2008)Systems biology aims at understanding the behavior of
5、biological networks by mathematical modeling based onexperimental data.The procedures of data generation are insufficientlydocumented and data processing is arbitrary.Standardization at multiple levels is essential.One of the key issues is to obtain highly reproduciblequantitative data for mathemati
6、cal modeling.Standardization of hypothesis-driven research in systems biologyCurrent Opinion in Biotechnology 19:354-359(2008)Integration of complexmultidimensional dataNature 452:553(2008)Omics Genomics(metagenomics)Epigenomics(Rnomics)Transcriptomics Proteomics Metabolomics Interactomics Phenomics
7、Microbiome-wide association studies linkdynamic microbial consortia to diseaseN AT U R E 5 3 5：9 4，2016 Rapid advances in DNA sequencing,metabolomics,proteomics andcomputational tools are dramatically increasing access to the microbiomeand identification of its links with disease.In particular,time-
8、series studiesand multiple molecular perspectives are facilitating microbiome-wideassociation studies,which are analogous to genome-wide association studies.Early findings point to actionable outcomes of microbiome-wide associationstudies,although their clinical application has yet to be approved.An
9、 appreciation of the complexity of interactions among the microbiomeand the hosts diet,chemistry and health,as well as determining thefrequency of observations that are needed to capture and integrate thisdynamic interface,is paramount for developing precision diagnostics andtherapies that are based
10、 on the microbiome.Developing a microbialGlobal Positioning System tostratify individuals and toguide their treatmentRnomics snRNA snoRNA microRNA lncRNA Circular RNAOmics Genomics Epigenomics Transcriptomics Proteomics Metabolomics Interactomics PhenomicsMaximizing the potential of the mouse as a m
11、odel organismNature Review/Genetics 10:372(2009)The biological organization of the-omicsGlobal views of the human interactomeMedical Data Clinical dataStructured medical recordMedical image Cohord research data Clinical research dataReal time physiological and pathologicaldate from in situ sensors W
12、earable devices Film Chips Implantable chipsFully integrated wearable sensor arrays（FISA）for multiplexed perspiration analysisN AT U R E 529:5 0 9(2016)Sensing a shift in health careScience Translational Medicine 7(283),283rv3,2015Epidermal ElectronicsScience 333,838(2011)LifeWatch获得远程患者可粘贴监测设备FDA许可
13、 瑞士远程心脏监测公司LifeWatch获得其LifeWatch VSP(生命体征贴片）的FDA许可，是远程患者监测贴片。LifeWatch尺寸小、易粘贴、穿戴舒适，与现在使用的为数众多的有线设备相比，限制更少。VSP可用于医院、救护车、护理和家庭环境。用一个舒适得多且非常便宜的方式替代多个硬件设备。同时设备还可定制参数、设定提醒，可配置数据并兼容EMR系统。LifeWatch是一次性粘贴带，包含检测心电图、心率、呼吸频率、体温、血氧饱和度和运动的传感器。他还包含电池，可通过设备连续收集数据五到七天。针对VSP系统的许可还包括无线连接血压腕带和用于处理及传输数据的安卓app。app还能监测患者
14、，同时在发生异常生命体征时发出警报。Soft,stretchable,fully implantable chipsSoft,stretchable,fully implantable miniaturized chipsmHealth taking center stageScience Translational Medicine 7(283),283rv3,2015Heterogeneous and non-traditional sources of big dataGenomics Proteomics Bioinformatics 14：3141(2016)Time to Inte
15、grate Clinical andResearch InformaticsScience Translational Medicine 2012 Vol 4 Issue 162 162fs41Integration of clinical and research informatics can streamlineclinical research,patient care,and the building of a learninghealth care system.EHRs are dominated by unstructured narrative data that are n
16、otavailable for research or quality improvement efforts.Clinical research databases which contain well-defined andstructured dataare created independently,and clinicallyrelevant data within these research databases are not availablefor purposes of clinical care.A meaningfully integrated approach to
17、clinical and research datainformatics is needed to promote improved health outcomesand more rational allocation of health care resources.The Electronic Medical Records andGenomics(eMERGE)NetworkGenetics in medicine 15:761(2013)The Electronic Medical Records and Genomics Network is aNational Human Ge
18、nome Research Institutefundedconsortium engaged in the development of methods and bestpractices for using the electronic medical record as a tool forgenomic research.The network has played a major role in validating the conceptthat clinical data derived from electronic medical records can beused suc
19、cessfully for genomic research.Current work is advancing knowledge in multiple disciplines atthe intersection of genomics and healthcare informatics,particularly for electronic phenotyping,genomewide associationstudies,genomic medicine implementation,and the ethical andregulatory issues associated w
20、ith genomics research andreturning results to study participants.A vision and a prescription forbig dataenabled medicineNATURE IMMUNOLOGY 16:435(2015)Genetic,environmental and socioeconomicfactors render humanity remarkably diverse.-Omic and sensor technologies permit thecapture of this diversity wi
21、th unprecedentedprecision.Leveraging these technologies in clinical decisionmaking will help to bring about the long-heraldedpersonalization of medicine.Big dataenabled medicineNATURE IMMUNOLOGY 16:435(2015)From Big Data to Intelligent Medicine Data qualification and digitization Data annotation and
22、 knowledge formation Simulation and mathematic modeling Precise and smart actionFrom Big Data to Intelligent Medicine Data qualification and digitization Data annotation and knowledge formation Simulation and mathematic modeling Precise and smart actionKnowledge management system A knowledge managem
23、ent system is defined as atool that selectively provides information relevantto a specific to the characteristics or circumstancesof a clinical situation but which requires humaninterpretation for direct application patient.Electronic KMSs include information retrievaltools and knowledge resources t
24、hat consist ofdistilled primary literature on evidence-basedpracticesClinical decision support system A clinical decision support system is defined asany electronic system designed to aid directly inclinical decisionmaking,in which characteristics ofindividual patients are used to generate patient-s
25、pecific assessments or recommendations that arethen presented to clinicians for consideration.Electronic CDSSs include alerts,reminders,ordersets,drug-dosage calculations,and care-summarydashboards that provide performance feedback onquality indicators or benchmarks.From Big Data to Intelligent Medi
26、cine Data qualification and digitization Data annotation and knowledge formation Simulation and mathematic modeling Precise and smart actionDigital liver anddigital manFederal regulators hopecomputer modeling can identifydrugs that damage the liverbefore they do harmDRUG-INDUCED LIVER INJURY is thel
27、eading cause of acute liver failureand thesingle greatest reason the U.S.Food and DrugAdministration refuses to approve a drug orpulls a drug from market.The FDA seems toagree on the potential to build predictivecomputer models which could identify livertoxicity problems early in the drugdevelopment
28、 process.Clinical decision support system A clinical decision support system is defined asany electronic system designed to aid directly inclinical decisionmaking,in which characteristics ofindividual patients are used to generate patient-specific assessments or recommendations that arethen presente
29、d to clinicians for consideration.Electronic CDSSs include alerts,reminders,ordersets,drug-dosage calculations,and care-summarydashboards that provide performance feedback onquality indicators or benchmarks.Metabolomics in drug discoveryand precision medicineNATURE REVIEWS DRUG DISCOVERY 15：473，2016
30、 Metabolomics is an emerging omics science involving thecomprehensive characterization of metabolites and metabolism inbiological systems.Recent advances in metabolomics technologies areleading to a growing number of mainstream biomedical applications.In particular,metabolomics is increasingly being
31、 used to diagnosedisease,understand disease mechanisms,identify novel drug targets,customize drug treatments and monitor therapeutic outcomes.ThisReview discusses some of the latest technological advances inmetabolomics,focusing on the application of metabolomics towardsuncovering the underlying cau
32、ses of complex diseases(such asatherosclerosis,cancer and diabetes),the growing role of metabolomicsin drug discovery and its potential effect on precision medicine.Metabolites play a central part in disease developmentA decision tree for metabolite-based drug discoveryand developmentiKnife Mass spe
33、ctrometry-linked intelligent surgicaldevices iKnife can distinguish cancer and normal tissue in2 seconds by analyzing the smell.NATURE REVIEWS GASTROENTEROLOGY&HEPATOLOGY 12:459,2015iKnifeiPad帮助外科医生更好的完成肝脏手术 德国Bremen的一位外科医生在一台iPad和虚拟现实软件的帮助下，完成了一次肝脏手术。iPad的摄像头将实时的肝脏拍下来，并且会层叠在虚拟的3D模型上。通过iPad查看肝脏中各种构造
34、，这样可以更好的完成手术並计算肝脏部分是否能提供充足的供血，评估剩下的器官能否维持患者的生命。智能医疗系统 电脑医生 智能医院 智能医联网IBM Watson IBM Watsons cognitive computing capabilities has beengrowing throughout 2014,following the publicly disclosedlaunch of its Watson Genomics project and a relationshipwith the New York Genome Center.More recently,it haspub
35、licized collaborations with the Cleveland Clinic and theMayo Clinic.The Watson Genomics project aims to significantly shortenthe week or more it currently takes bioinformaticians toexamine a patients unique molecular profile and identifydrugs for his or her individual treatment.IBM Watson answers qu
36、estions posed in natural language,processesBig Data to uncover new patterns and learns from each interaction.IBM Wants to Load Doctor Watson toYour Smartphone IBM has invested into a genetic testing serviceslaboratory in a bid to give Watson,its self-learningcomputing system that can be controlled b
37、yhuman voice,the ability to answer questions a usermay have about their personal health.The investment makes Pathway Genomics Corp.one of the best capitalized healthcare startups,with$80 million raised total,according to IBM.智能医疗系统 电脑医生 智能医院 智能医联网More data-driven digital hospitalsEden Estopace|2015-
38、01-02 Against the backdrop of a global economy that is stillstruggling,healthcare cost is rising anywhere in the world,while demand for better health outcomes is also increasing.Research firm IDC predicts that operational efficiency inthe healthcare system will become so critical that by 2016,25 per
39、cent of hospitals will be budgeting for a data-drivendigital hospital strategy.“As we know,hospitals are in the middle of a profoundtransformation and across the globe we can see a lot ofmodernization initiatives that are aimed at accommodatingthe evolving role of hospitals in the health system,”sai
40、dSilvia Piai,Research Manager at IDC,at a recent IDCHealth Insights webinar.Transcutaneous monitoringNATURE COMMUNICATIONS|5:4779|DOI:10.1038/ncomms5779Airstrip TechnologiesRemote continuous vital signmonitoring via the iPhone.This software delivers real-timedata about the vital signs(includingblood
41、 pressure,heart rhythm andrate,blood oxygen level,and bodytemperature)of any patient who isin a hospital intensive care unit to adoctors or nurses smart phoneScience translational medicine 2:16cm4(2010)智能医疗系统 电脑医生 智能医院 智能医联网Large-scalehospitalRemote clinics andeducation centerCommunityhealth service
42、scenterHouseholdsNew mod health care servicesScience 330:759(2010)河南智能医联网河南智能医联网网络医院国家中心国家中心国家远程医疗国家远程医疗监管与服务中心监管与服务中心二期：二期：14Q2数据中心数据中心省中心省中心服务点服务点省省大数据融合平台省远程医疗省远程医疗协同平台协同平台卫生信息平台卫生信息平台急救平台急救平台规划：规划：双活数据中心网络医院、远程门诊网络医院、远程门诊三期：三期：15H118地市分中心地市分中心四期：四期：15H2大数据、大数据、IMS、双活、双活省医院省医院远程远程医疗医疗网络网络二级分二级分中心
43、中心五期：五期：16大数据二期、双活完善大数据二期、双活完善市市18市医院市医院市医院市医院远程急救远程急救县县118一期：一期：2011年年118个远程点个远程点县医院县医院乡乡/50000+乡乡/镇镇/村村规划：规划：覆盖基层、健康管理覆盖基层、健康管理家家/个个+家庭家庭/个人个人视讯设备业务上跨省覆盖、技术上业务上跨省覆盖、技术上4K/VR应用、体征监测应用、体征监测/移动终端移动终端研究机构研究机构与产业与产业国家远程医疗国家远程医疗监管与服务中心监管与服务中心省市远程省市远程医疗医疗网络网络社区社区家庭家庭大医院大医院中国智能医联网Five Circles of Intellige
44、nt MedicineMolecular ProfilingMobile Sensor and AppClinical PhenotypePersonal Big DataPopulation Big DataData MiningEnvironmentGenotypePhenotypeSimulation(CDSS)Intelligent MedicineData SafetyRegulationEthicComputer DoctorIntelligent HospitalIntelligent medicalNetworkSocioeconomic健康中国 2030 促进人的全面发展的必然要求 经济社会发展的基础条件 民族昌盛和国家富强的重要标志 人民群众的共同追求Thank you！
