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Top Ten Digitalist Magazine Posts Of The Week [May 29, 2017] – Business Intelligence Info

LastAugust,awomanarrivedataReno,Nevada,hospitalandtoldtheattendingdoctorsthatshehadrecentlyreturnedfromanextendedtriptoIndia,whereshehadbrokenherrightthighbonetwoyearsago。

Thewoman,whowasinher70s,hadsubsequentlydevelopedaninfectioninherthighandhipforwhichshewashospitalizedinIndiaseveraltimes。

TheRenodoctorsrecognizedthattheinfectionwasserious—andthevisittoIndia,whereantibiotic-resistantbacteriarunsrampant,raisedredflags。

Whennoneofthe14antibioticsthephysiciansusedtotreatthewomanworked,theysentasampleofthebacteriumtotheU。

S。

CentersforDiseaseControl(CDC)fortesting。

TheCDCconfirmedthedoctors’worstfears:thewomanhadaclassofmicrobecalledcarbapenem-resistantEnterobacteriaceae(CRE)。

Carbapenemsareapowerful?

classofantibioticsusedaslast-resorttreatmentformultidrug-resistantinfections。

TheCDCfurtherfoundthat,inthispatient’scase,thepathogenwasimpervioustoall26antibioticsapprovedbytheU。

S。

FoodandDrugAdministration(FDA)。

Inotherwords,therewasnocure。

Thisisjustthelatestalarmingdevelopmentsignalingtheendoftheroadforantibioticsasweknowthem。

InSeptember,thewomandiedfromsepticshock,inwhichaninfectiontakesoverandshutsdownthebody’ssystems,accordingtotheCDC’sMorbidityandMortalityWeeklyReport。

Otherantibioticoptions,hadtheybeenavailable,mighthavesavedtheNevadawoman。

Butthesolutiontothelargerproblemwon’tbeanewdrug。

Itwillhavetobeanentirelynewapproachtothediagnosisofinfectiousdisease,totheuseofantibiotics,andtothemonitoringofantimicrobialresistance(AMR)—allenabledbynewtechnology。

ButthatnewtechnologyisnotbeingimplementedfastenoughtopreventwhatformerCDCdirectorTomFriedenhasnicknamednightmarebacteria。

Andthenightmareisbecomingscarierbytheyear。

A2014Britishstudycalculatedthat700,000peoplediegloballyeachyearbecauseofAMR。

By2050,theglobalcostofantibioticresistancecouldgrowto10milliondeathsandUS$100trillionayear,accordingtoa2014estimate。

AndtherateofAMRisgrowingexponentially,thankstothespeedwithwhichhumansservingashostsforthesenastybugscanmoveamonghealthcarefacilities—orcountries。

IntheUnitedStates,forexample,CREhadbeenseenonlyinNorthCarolinain2000;todayit’snationwide。

Abuseandoveruseofantibioticsinhealthcareandlivestockproductionhaveenabledbacteriatobothmutateandacquireresistantgenesfromotherorganisms,resultingintrulypan-drugresistantorganisms。

Asever-morepowerfulsuperbugscontinuetoproliferate,wearepotentiallyfacingthedeadliestandmostcostlyhuman-madecatastropheinmoderntimes。

“Withouturgent,coordinatedactionbymanystakeholders,theworldisheadedforapost-antibioticera,inwhichcommoninfectionsandminorinjurieswhichhavebeentreatablefordecadescanonceagainkill,”saidDr。

KeijiFukuda,assistantdirector-generalforhealthsecurityfortheWorldHealthOrganization(WHO)。

Evenifnewantibioticscouldsolvetheproblem,thereareobstaclestotheirdevelopment。

Foronething,antibioticshavecomplexmolecularstructures,whichslowsthediscoveryprocess。

Further,theyaren’tterriblylucrativeforpharmaceuticalmanufacturers:publichealthconcernscallfornewantimicrobialstobefinanciallyaccessibletopatientsandusedconservativelypreciselybecauseoftheAMRissue,whichreducesthefinancialincentivestocreatenewcompounds。

Thelastentirelynewclassofantibioticwasintroduced30yearago。

Finally,bacteriawilldevelopresistancetonewantibioticsaswellifwedon’tadoptnewapproachestousingthem。

Technologycanplaytheleadroleinheadingoffthisdisaster。

Vastamountsofdatafrommultiplesourcesarerequiredforbetterdecisionmakingatallpointsintheprocess,fromtrackingorpredictingantibiotic-resistantdiseaseoutbreakstospeedingthepotentialdiscoveryofnewantibioticcompounds。

However,microbeswillquicklyadaptandresistnewmedications,too,ifwedon’talsoemploysystemsthathelpdoctorsdiagnoseandtreatinfectioninamoretargetedandjudiciousway。

Indeed,digitaltoolscanhelpinallfouractionsthattheCDCrecommendsforcombatingAMR:preventinginfectionsandtheirspread,trackingresistancepatterns,improvingantibioticuse,anddevelopingnewdiagnosticsandtreatment。

Meanwhile,individualswhounderstandboththecomplexitiesofAMRandthevalueoftechnologieslikemachinelearning,human-computerinteraction(HCI),andmobileapplicationsareworkingtodevelopandadvocateforsolutionsthatcouldsavemillionsoflives。

KeepinganEyeOutforOutbreaks

LikeotherswhoareleadingthefightagainstAMR,Dr。

StevenSolomonhasnoillusionsaboutthedifficultyofthechallenge。

“Itisthesinglemostcomplexprobleminallofmedicineandpublichealth—faroutpacingthecomplexityandthedifficultyofanyotherproblemthatweface,”saysSolomon,whoisaglobalhealthconsultantandformerdirectoroftheCDC’sOfficeofAntimicrobialResistance。

SolomonwantstotakethebattleagainstAMRbeyondthelaboratory。

Inhisview,surveillance—trackingandanalyzingvariousdataonAMR—iscritical,particularlygivenhowquicklyandwidelyitspreads。

Butsurveillanceeffortsarecurrentlyfraughtwithshortcomings。

Theavailabledataisfragmentedandoftennotcomparable。

Hospitalsfailtocollecttherepresentativesamplesnecessaryforsurveillanceanalytics,collectingdataonlyonthosepatientswhoexperienceresistanceandnotonthosewhogetbetter。

Laboratoriesuseawidevarietyoftestingmethods,andreportingisnotalwaysconsistentorcomplete。

Surveillancecanserveasanearlywarningsystem。

ButweaknessesinthesesystemshavecausedpublichealthofficialstoconsistentlyunderestimatetheimpactofAMRinlossoflivesandfinancialcosts。

That’swhyimprovingsurveillancemustbeatoppriority,saysSolomon,whopreviouslyservedaschairoftheU。

S。

FederalInteragencyTaskForceonAMRandhasbeentrackingtheadvanceofAMRsincehejoinedtheU。

S。

PublicHealthServicein1981。

ACollaborativeDiagnosis

Ineffectivesurveillancehasalsocontributedtohugegrowthintheuseofantibioticswhentheyaren’twarranted。

StrongpatientdemandandfinancialincentivesforprescribingphysiciansareblamedforantibioticsabuseinChina。

Indiahasbecomethelargestconsumerofantibioticsontheplanet,inpartbecausetheyareprescribedorsoldfordiarrhealdiseasesandupperrespiratoryinfectionsforwhichtheyhavelimitedvalue。

Andmanycountriesallowindividualstopurchaseantibioticsoverthecounter,exacerbatingmisuseandoveruse。

IntheUnitedStates,antibioticsareimproperlyprescribed50%ofthetime,accordingtoCDCestimates。

OnestudyofadultpatientsvisitingU。

S。

doctorstotreatrespiratoryproblemsfoundthatmorethantwo-thirdsofantibioticswereprescribedforconditionsthatwerenotinfectionsatallorforinfectionscausedbyviruses—forwhichanantibioticwoulddonothing。

That’s27millioncoursesofantibioticswastedayear—justforrespiratoryproblems—intheUnitedStatesalone。

Andevenincountrieswheretherearenationalguidelinesforprescribingantibiotics,thoseguidelinesaren’talwaysfollowed。

AstudypublishedinmedicaljournalFamilyPracticeshowedthatSwedishdoctors,boththosetrainedinSwedenandthosetrainedabroad,inconsistentlyfollowedrulesforprescribingantibiotics。

Solomonstronglybelievesthat,worldwide,doctorsneedtoexpandtheiruseoftechnologyintheirofficesoratthebedsidetoguidethemthroughamorerationalapproachtoantibioticuse。

Doctorshavetraditionallybeenreluctanttoadoptdigitaltechnologies,butSolomonthinksthattheAMRcrisiscouldchangethat。

Newdigitaltoolscouldhelpdoctorsandhospitalsintegrateguidelinesforoptimalantibioticprescribingintotheireverydaytreatmentroutines。

“Human-computerinteractionsarecritical,astheamountofinformationavailableonantibioticresistancefarexceedstheabilityofhumanstoprocessit,”saysSolomon。

“Itoffersthepossibilityofgreatlyenhancingtheutilityofcomputer-assistedphysicianorderentry(CPOE),combinedwithclinicaldecisionsupport。

”Healthcarefacilitiescouldembedrelevantinformationandprotocolsatthepointofcare,guidingthephysicianthroughdiagnosisandprescriptionand,asabyproduct,facilitatingthecollectionandreportingofantibioticuse。

CincinnatiChildren’sHospital’santibioticstewardshipdivisionhasdeployedasoftwareprogramthatgathersinformationfromelectronicmedicalrecords,orderentries,computerizedlaboratoryandpathologyreports,andmore。

Thesystemmeasuresbaselineantimicrobialuse,dosing,duration,costs,andusepatterns。

Italsoanalyzesbacteriaandtrendsintheirsusceptibilitiesandhelpswithclinicaldecisionmakingandprescriptionchoices。

Thegoal,saysDr。

DavidHaslam,whoheadstheprogram,istodecreasetheuseof“biggun”superantibioticsinfavorofmoretargetedtreatment。

Whilethisapproachisnotyetwidespread,thereisconsensusthatincorporatingsuchclinical-decisionsupportintoelectronichealthrecordswillhelpimprovequalityofcare,containcosts,andreduceovertreatmentinhealthcareoverall—notjustinAMR。

A2013randomizedclinicaltrialfindsthatdoctorswhouseddecision-supporttoolsweresignificantlylesslikelytoorderantibioticsthanthoseinthecontrolgroupandprescribed50%fewerbroad-spectrumantibiotics。

Puttingmobiledevicesintodoctors’handscouldalsohelpthemacceptdecisionsupport,believesSolomon。

Lastsummer,Scotland’sNationalHealthServicedevelopedanantimicrobialcompanionapptogivepractitionersnationwidemobileaccesstoclinicalguidance,aswellasanaudittooltosupportboardsingatheringdataforlocalandnationaluse。

“Theimmediacyandtheconsistencyoftheinputtophysiciansatthetimeoforderingantibioticsmaysignificantlyhelpaddresstheproblemofoverprescribinginwaysthatless-immediateinterventionshavefailedtodo,”Solomonsays。

Inaddition,handhelddeviceswithso-calledlab-on-a-chip?

technologycouldbeusedtotestclinicalspecimensatthebedsideandtransmitthedataacrosscellularorsatellitenetworksinareaswhereinfrastructureismorelimited。

Artificialintelligence(AI)andmachinelearningcanalsobecomeinvaluabletechnologycollaboratorstohelpdoctorsmorepreciselydiagnoseandtreatinfection。

Insuchasystem,“thephysicianandtheAIprogramarereally‘co-prescribing,’”saysSolomon。

“TheAIcanhandlesomuchmoreinformationthanthephysicianandmakerecommendationsthatcanincorporatemoreinputonthetypeofinfection,thepatient’sphysiologicstatusandhistory,andresistancepatternsofrecentisolatesinthatward,inthathospital,andinthecommunity。



SpeedIsEverything

GrowingbacteriainadishhasneverappealedtoDr。

JamesDavis,acomputationalbiologistwithjointappointmentsatArgonneNationalLaboratoryandtheUniversityofChicagoComputationInstitute。

Thefirstofagrowingbreedofcomputationalbiologists,DavischoseaPhDadvisorin2004whowassteepedinbioinformaticstechnology“becauseyoucouldseethatthingswerestartingtochange,”hesays。

Hewasoneofthefirstinhismicrobiologydepartmenttosubmitacompletely“dry”dissertation—thatis,onethatwasalldigitalwithnothinggrowninalab。

Upongraduation,Daviswantedtoseeifitwaspossibletopredictwhetheranorganismwouldbesusceptibleorresistanttoagivenantibiotic,leadinghimtoexplorethepotentialofmachinelearningtopredictAMR。

Astheavailabilityofcheapcomputingpowerhasgoneupandthecostofgenomesequencinghasgonedown,ithasbecomepossibletosequenceapathogensampleinordertodetectitsAMRresistancemechanisms。

Thiscouldallowdoctorstoidentifythenatureofaninfectioninminutesinsteadofhoursordays,saysDavis。

DavisispartofateamcreatingagiantdatabaseofbacterialgenomeswithAMRmetadataforthePathosystemsResourceIntegrationCenter(PATRIC),fundedbytheU。

S。

NationalInstituteofAllergyandInfectiousDiseasestocollectdataonprioritypathogens,suchastuberculosisandgonorrhea。

Becausethecurrentinabilitytoidentifymicrobesquicklyisoneofthebiggestroadblockstomakinganaccuratediagnosis,theteam’sworkiscriticallyimportant。

Thestandardmethodforidentifyingdrugresistanceistotakeasamplefromawound,blood,orurineandexposetheresidentbacteriatovariousantibiotics。

Ifthebacterialcolonycontinuestodivideandthrivedespitethepresenceofanormallyeffectivedrug,itindicatesresistance。

Theprocesstypicallytakesbetween16and20hours,itselfaninordinateamountoftimeinmattersoflifeanddeath。

Forcertainstrainsofantibiotic-resistanttuberculosis,though,suchtestingcantakeaweek。

Whilephysiciansarewaitingfortestresults,theyoftenprescribebroad-spectrumantibioticsormakeabestguessaboutwhatdrugwillworkbasedontheirknowledgeofwhat’shappeningintheirhospital,“andinthemeantime,youeithergetbetter,”saysDavis,“oryoudon’t。



AtPATRIC,researchersareusingmachine-learningclassifierstoidentifyregionsofthegenomeinvolvedinantibioticresistancethatcouldformthefoundationfora“laboratoryfree”processforpredictingresistance。

BeingabletoidentifythegeneticmechanismsofAMRandpredictthebehaviorofbacterialpathogenswithoutpetridishescouldinformclinicaldecisionmakingandimprovereactiontime。

Thusfar,theresearchershavedevelopedmachine-learningclassifiersforidentifyingantibioticresistanceinAcinetobacterbaumannii(abigplayerinhospital-acquiredinfection),methicillin-resistantStaphylococcusaureus(a。

k。

a。

MRSA,aworldwideproblem),andStreptococcuspneumoniae(aleadingcauseofbacterialmeningitis),withaccuraciesrangingfrom88%to99%。

HoustonMethodistHospital,whichusesthePATRICdatabase,isresearchingmultidrug-resistantbacteria,specificallyMRSA。

Notonlydoesresistanceincreasethecostofcare,butpeoplewithMRSAare64%morelikelytodiethanpeoplewithanonresistantformoftheinfection,accordingtoWHO。

HoustonMethodistisinvestigatingthemoleculargeneticcausesofdrugresistanceinMRSAinordertoidentifynewtreatmentapproachesandhelpdevelopnovelantimicrobialagents。

TheHuntforaNewClassofAntibiotics

Thereareantibiotic-resistantbacteria,andthenthere’sClostridiumdifficile—a。

k。

a。

C。

difficile—abacteriumthatattackstheintestineseveninyoungandhealthypatientsinhospitalsaftertheuseofantibiotics。

ItisbecauseofC。

difficilethatDr。

L。

CliffordMcDonaldjumpedintotheAMRfight。

TheepidemiologistwasfinishinghisworkanalyzingthespreadofSARSinTorontohospitalsin2004whenheturnedhisattentiontoC。

difficile,convincedthatthebacteriawouldbecomemorecommonandmoredeadly。

Hewasright,andtodayhe’sattheforefrontoftreatingtheinfectionandpreventingthespreadofAMRassenioradvisorforscienceandintegrityintheCDC’sDivisionofHealthcareQualityPromotion。

“[AMR]isanareathatwe’refundingheavily…insofarastheCDCbudgetcanfundanythingheavily,”saysMcDonald,whosegrouphasawarded$14millionincontractsforinnovativeanti-AMRapproaches。

DevelopingnewantibioticsisamajorpartoftheAMRbattle。

Themajorityofnewantibioticsdevelopedinrecentyearshavebeenvariationsofexistingdrugclasses。

It’sbeenthreedecadessincethelastnewclassofantibioticswasintroduced。

Lessthan5%ofventurecapitalinpharmaceuticalRDisfocusedonantimicrobialdevelopment。

A2008studyfoundthatlessthan10%ofthe167antibioticsindevelopmentatthetimehadanew“mechanismofaction”todealwithmultidrugresistance。

“Thelow-hangingfruit[ofantibioticdevelopment]hasbeenpicked,”notedaWHOreport。

Researcherswillhavetodigmuchdeepertodevelopnovelmedicines。

Machinelearningcouldhelpdrugdeveloperssortthroughmuchlargerdatasetsandgoaboutthecapital-intensivedrugdevelopmentprocessinamoreprescriptivefashion,synthesizingthosemoleculesmostlikelytohaveanimpact。

McDonaldbelievesthatitwillbecomeeasiertofindnewantibioticsifwegainabetterunderstandingofthecommunitiesofbacterialivingineachofus—asmanyas1,000differenttypesofmicrobesliveinourintestines,forexample。

Disruptiontothosemicrobialcommunities—our“microbiome”—canheraldAMR。

McDonaldsaysthatBigDataandmachinelearningwillbeneededtounlockourmicrobiomes,andthat’swheremuchofthemedicalcommunity’sinvestmentisgoing。

Hepredictsthatwithinfiveyears,hospitalswilltakefecalsamplesorskinswabsandsequencethemicroorganismsinthemasakindofpulsecheckonantibioticresistance。

“Justdoingthebioinformaticstosortoutwhat’sthereandthetypesofantibioticresistancethatmightbeinthatmicrobiomeisaBigDatachallenge,”McDonaldsays。

“Theonlywaytomakesenseofit,goingforward,willbeadvancedanalytictechniques,whichwillnodoubtinclude?

machinelearning。



ReducingResistanceontheFarm

Bringinginformationclosertowhereit’sneededcouldalsohelpreduceagriculture’scontributiontotheantibioticresistanceproblem。

Antibioticsarewidelygiventolivestocktopromotegrowthorpreventdisease。

IntheUnitedStates,morekilogramsofantibioticsareadministeredtoanimalsthantopeople,accordingtodatafromtheFDA。

Onecompanyhasdevelopedarapid,on-farmdiagnosticstooltoprovidelivestockproducerswithmoreaccuratediseasedetectiontomakemoreinformedmanagementandtreatmentdecisions,whichitsayshasdemonstrateda47%to59%reductioninantibioticusage。

Suchsystems,combinedwithpressureorregulationstoreduceantibioticuseinmeatproduction,couldalsohelpturntheAMRtide。

BreakingDownDataSilosIstheFirstStep

AddingtothecomplexityofthefightagainstAMRisthestructureandcultureoftheglobalhealthcaresystemitself。

Historically,healthcarehasbeenasiloedindustry,notoriousforitsscatteredapproachfocusedontransactionsratherthanhealthyoutcomesorthetruevalueoftreatment。

There’snodefinitivedataontheimpactofAMRworldwide;thebestwecandoisinferestimatesfromtheinformationthatdoesexist。

Thebiggestissueistheavailabilityofgooddatatosharethroughmobilesolutions,todriveHCIclinical-decisionsupporttools,andtofeedsupercomputersandmachine-learningplatforms。

“Wehaveafragmentedhealthcaredeliverysystemandthereforewehavefragmentedinformation。

Gettingthesesourcesofdataallintooneplaceandthenenablingthemalltotalktoeachotherhasbeenproblematic,”McDonaldsays。

Collecting,integrating,andsharingAMR-relateddataonanationalandultimatelyglobalscalewillbenecessarytobetterunderstandtheissue。

HCIandmobiletoolscanhelpdoctors,hospitals,andpublichealthauthoritiescollectmoreinformationwhileadvancedanalytics,machinelearning,andin-memorycomputingcanenablethemtoanalyzethatdatainclosetorealtime。

Asaresult,we’llbetterunderstandpatternsofresistancefromthebedsidetothecommunityanduptonationalandinternationallevels,saysSolomon。

ThegoodnewsisthatnewtechnologycapabilitieslikeAIandnewpotentialstreamsofdataarecomingonlineasaneraofdatasharinginhealthcareisbeginningtodawn,addsMcDonald。

Theidealgoalisadigitallyenabledvirtuouscycleofinformationandtreatmentthatcouldsavemillionsofdollars,lives,andperhapsevencivilizationifwecangetthere。

D!

Readmorethoughtprovokingarticlesinthe?

latestissueofthe?

DigitalistMagazine,ExecutiveQuarterly。

AbouttheAuthors:

Dr。

DavidDelaneyisChiefMedicalOfficerforSAP。

JosephMilesisGlobalVicePresident,LifeSciences,forSAP。

WaltEllenbergerisSeniorDirectorBusinessDevelopment,HealthcareTransformationandInnovation,forSAP。

SaravanaChandranisSeniorDirector,AdvancedAnalytics,forSAP。

StephanieOverbyisanindependentwriterandeditorfocusedontheintersectionofbusinessandtechnology。

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