A major focus of research in the Neurocritical Care Center is on integrated data acquisition, complex processing, and innovative visualization in the intensive care unit. To achieve these goals we have created the Case Critical Care Bioinformatics Consortium, a tight collaboration between physicians, engineers, computer scientists, experts in informatics and complex biostatistics, and industry.
Established in 2007, the mission of CCCBC is to provide a forum for multidisciplinary collaboration between the computational science and critical care medicine. The potential payoffs are huge: better insight into complex physiology, early detection of secondary insults, reduction in medical errors, improved efficiency, and most importantly, better patient outcomes. We believe that this approach could fundamentally change the way medicine is practiced.
The ICU is a complex, data-intense environment. Physiologic data is acquired, continuously or intermittently, using devices from a variety of different manufacturers. Dozens of systemic parameters are monitored including hemodynamics, blood pressure, heart rate, respiratory rate, and pulse oximetry. Neuromonitoring is superimposed on this systemic monitoring. And while the number of monitors has grown exponentially since the origins of critical care almost forty years ago, the reality is that we look at the data essentially the same way. Standard practice at most institutions simply includes recording and logging the data by hand onto paper medical records.
We believe that the future of intensive care monitoring lies in:
- integration and time-synchronization of multiple channels of physiological data continuously and simultaneously;
- processing of this data in real- time, using new tools such as multivariate analysis and nonlinear time series analysis to facilitate rapid diagnoses; and
- presenting the processed information visually in a user-friendly and customizable way to maximize the information available to clinical staff.
The combination of all three elements—data integration, processing, and visualization—is far beyond the scope of what is commercially available today.
This is a job beyond clinicians. It is ambitious and the challenges immense. It is like the Apollo Space Mission and requires a coordinated effort involving clinicians, engineers, computer scientists, experts in informatics and complex biostatistics, and industry to truly move this field of “critical care bioinformatics” forward. In 1961, President Kennedy said, “It is time for this nation to take a clearly leading role in space achievement…I believe we possess all the resources and talents necessary. But… we have never made the national decisions or marshaled the national resources required for such leadership. I believe that this nation should commit itself to achieving the goal, before this decade is out, of landing a man on the moon and returning him safely to the earth.” This is our mission at Case Western Reserve University, to bring people together, marshal the resources and talents, and lead in this area.
the Integrated Medical Environment™ (tIME™)
There is a broad consensus that health care in the 21st century will require the intensive use of information technology to acquire and manage patient data, transform the data into actionable information, and then disseminate this information so that it can be effectively used to improve patient care. Nowhere is this more evident and more important than in the intensive care unit (ICU) where there are staggering amounts of data, beyond the capability of any person to absorb. The result is too much data and not enough information. At University Hospitals Cleveland Medical Center and Case Western Reserve University, we have focused on solving this problem by developing the Integrated Medical Environment™ (tIME™), a new open source architecture that we believe can provide the backbone for the ICU of the future. Specifically tIME™ provides
- real-time data acquisition, integration, time-synchronization, and dataannotation of all physiological waveform data;
- complex systems analysis and data mining for hypothesis generation and testing; and
- a clinician-centric visual display and interface, to present an integrated overview of the patient state so that providers can make sensible decisions at the bedside.
Only when all of these components work in concert will we be able to fully harness the power of information technology to improve patient outcomes in the ICU.