In my previous blog, I discussed how the 4 V’s of Big Data apply to healthcare. This time around, I would like to focus on a specific class of Big Data solutions; distributed computing solutions that utilize Hadoop. So what is it exactly? 

Hadoop is essentially a software framework that supports the storage and processing of large data sets in a highly parallelized manner.  Two of the obvious benefits that Hadoop brings to Big Data solutions are scale and flexibility:

• Scale: You might remember from my last blog that “volume” is one of the key Big Data challenges facing health-IT organizations. Hadoop is typically deployed on a cluster of commodity servers. As computing or storage demand grows, the system is scaled by adding new nodes to the cluster. This is the “scale out” model, as opposed to “scale up” where an existing system is replaced with a new, more powerful system. The “scale out” model is less disruptive (and typically less expensive) for IT organizations than the “scale up” model.

• Flexibility: Variety of data is another consideration that is driving interest in Hadoop. While much of healthcare data is structured, resides in a traditional relational database, and conforms to a well-defined schema, there is also a lot of unstructured information such as images, faxes, and dictated/narrative notes. This unstructured information contains significant clinical and analytical value, but many organizations are not making effective use of it today. Hadoop includes the HDFS (Hadoop Distributed File System) and HBase, a non-relational, distributed database that has no problem storing these differing data types in a schema-less fashion. Furthermore, all of this data is triple-replicated across the cluster improving the resiliency of solutions that make use of this infrastructure.

So how are healthcare organizations making use of Hadoop today? Take a look at a new paper which describes in more detail how the healthcare industry can take advantage of Hadoop. Examples from three domains are highlighted; provider, payor and life sciences:

Read Intel Distribution for Apache Hadoop Software Helps Cure Big Data Woes

You might have gleaned from the title of the link above that Intel is among the growing list of companies convinced that Hadoop is a critical component of the data center, and at Strata a few weeks ago, Intel announced the North American release of the Intel Distribution for Apache Hadoop (IDH). Details can be found here.

Do you have any thoughts or experiences to share? How has Hadoop helped your organization? Please add to the discussion below. For information on the role Intel plays in Big Data for healthcare, please visit this site: Big Data and Analytics in Healthcare and Life Sciences. You can also follow me @CGoughPDX on Twitter.

Healthcare IT is moving away from the top down, “command and control” model of 10 years ago. Back then, IT provisioned all devices and the mobile device environment was more homogeneous, strongly managed and secured, to a much more diverse heterogeneous environment including BYOD, often with less manageability and security. In this new diverse and rapidly changing environment, a strong and effective detection and response capability becomes much more important. We can compare the new environment and this security model to an immune system where when a pathogen appears it is detected by the body and an immune response starts to eliminate the pathogen and put out antibodies to prevent a future recurrence.

In this analogy a pathogen in healthcare IT security could be a new type of malware or phishing attack, or some risky healthcare worker action such as attempting to copy unencrypted patient records onto a USB key, or attempting on impulse a post of sensitive healthcare data to social media. SIEM, DLP and global threat intelligence capabilities are just a few great examples of security detection controls. An effective immune response in healthcare IT security needs to be holistic and multi-layered in the sense of incorporating several administrative, physical and technical controls complementing each other for effective risk mitigation. Administrative controls may include updates to policy, risk assessments, effective training, audit and compliance, and security incident management controls. Physical controls may include locks and other physical access and tamper proofing controls for data, assets and facilities. Technical controls may include anti-malware, IPS, whitelisting, encryption, anti-theft and many others.

Of this mix of safeguards, and with key healthcare trends such as BYOD, social media, mobile healthcare and others increasingly empowering healthcare workers with more tools and options to get their work done, the human factor and effective training is becoming incredibly important. Recent HIMSS research shows if solutions or security are lacking usability, healthcare workers use these tools and options to get their job done in workarounds that add non-compliance issues and additional risk.

Compounding this challenge, recent HHS OCR audit findings shows that many healthcare organizations lack effective training. To be effective training must move beyond the “once a year scroll to the bottom and click accept model” to a much more continuous, bite-sized, gamified, engaging form, and enable the healthcare worker to apply and solidify their knowledge as a part of their daily job. Penetration testing needs to include the human factor to help detect vulnerabilities in end user behavior that can then be remedied. Some innovators such as Wombat Security Technologies have emerged with capabilities in this area. Security safeguards such as DLP also offer special value in helping educate healthcare workers on the job in “teachable moments” where at the point where they attempt an action that is out of compliance with policy the DLP control can inform them and educate them on safer alternatives.

What kinds of trends and risks, and detection and response safeguards, are you seeing in your healthcare organization?

At HIMSS 13, Dave Diamond, chief strategist at EMC, talked about how the IT and business sides of healthcare are now more aligned than ever, and how meeting Meaningful Use advanced that relationship. Watch the above video as he explains the opportunity going forward to analyze unstructured data and use that knowledge to benefit patient care.

What questions do you have?

When security technologies are introduced together with usability improvements in healthcare solutions they have a much greater chance of being approved and winning acceptance by healthcare workers. This is in contrast to introducing security technologies into healthcare organizations without usability improvements which at best have no usability impact, and may in fact have negative usability impact.

In my last blog, Improving Healthcare Solution Usability with Single Sign-On, I describe how too many layers of login is one of the most cumbersome usability challenges that compels healthcare workers to do risky workarounds out of compliance with privacy and security policy. Single Sign On (SSO) solutions provide a solution that can greatly reduce the number of sets of credentials as well as the number of actual logins required by healthcare workers during their day, providing major usability benefits. When such a solution is combined with more usable forms of multi-factor authentication such as wireless proximity cards (RFID, NFC or other) it can greatly improve both security and usability. In this type of solution once the healthcare worker has logged into a device they can start up multiple apps within their session without having to re-authenticate to each app. As more healthcare apps are integrated with such a SSO solution the number of separate credentials needed for the healthcare worker can be reduced, eventually to a single set of credentials required to login to the SSO solution.

Many SSO solutions also enable healthcare organizations to implement policy where the first login of the day requires 2 factors, perhaps the proximity card and a password, but thereafter as long as the clinician authenticates at another point in the network with their proximity card within a configurable amount of time defined by policy, eg 2 hours, then the proximity card alone is sufficient to authenticate and no password is required. This effectively enables the clinician to move between devices throughout the day with a simple tap of their proximity card.

SSO may also provide patient context sharing where different healthcare apps running in the same session track the same patient automatically so a clinician that searches and finds a patient in the Electronic Health Record (EHR) system can then switch over to a Picture Archiving and Communication System (PACS) and it has already automatically found the same patient, freeing the clinician from having to search for the patient again in each application. Such patient context capability may be based on the Clinical Context Object Workgroup (CCOW) standard. Clearly another major usability benefit that also mitigates risk of a clinician accidentally looking at different patients across different apps.

Just as important as easy login is minimizing risk of a live session being hijacked once the authenticated healthcare worker moves away from the device with the open live session. This can be done by setting an inactivity timeout to a low number of minutes, which in practice is workable from a usability standpoint since a simple tap of the wireless proximity card gets the healthcare worker back into their session. In the future technologies such as facial recognition may also enable the device to detect when the healthcare worker moves away, closing the session automatically and further reducing the window of opportunity for session hijacking.

Biometrics holds promise in further freeing the healthcare worker from having a wireless proximity card. This is especially compelling in healthcare where not having to touch anything can be a significant healthcare improvement since healthcare workers need to keep sterile hands. To achieve this improvement biometrics need to be both highly reliable and resilient to spoofing. For example viable facial recognition would need to have negligibly low false accept and false reject rates, and would have to be able to detect if a face in front of a device was a picture or a real person. Several strategies are emerging for this including multiple cameras able to detect depth, and facial recognition strategies that require some motion such as blinking to ensure the subject is not a static picture. The reality in healthcare is many healthcare workers, such as doctors working in multiple healthcare organizations, need separate credentials for each organization, and in a worst case a separate proximity card for each facility. As more healthcare organizations implement biometrics this has potential to reduce the number of tokens such as proximity cards required by a given healthcare worker. Furthermore, strategic initiatives such as National Strategy for Trusted Identities in Cyberspace (NSTIC) have the potential to separate Identity Providers from Service Providers where healthcare workers have one set of credentials to authenticate with the Identity Provider and could then access multiple Service Providers such as healthcare organizations without having to be issued a separate set of credentials from each healthcare organization.

Another technology that holds major promise is virtualization with “follow me session” where a healthcare worker that has logged into a given device to start up a secure session, started up healthcare apps within their session, and located a given patient medical record, may then move to another device, login and get access to the same session without having to start the apps and search for that patient again. This becomes particularly compelling as the number and types of devices healthcare workers use increases and their use cases require them to move between the devices seamlessly. This capability can also be especially beneficial where healthcare workers must use many shared workstations throughout their day and switching of devices is frequent even within a given patient encounter. Along with this type of compute model one can do centralized patching and management, leading to major security, manageability and operational efficiency benefits. Where virtualized healthcare clients running on mobile devices have the ability for secure local storage of limited healthcare data, for example just records for the patients a healthcare worker will see that day, they enable healthcare workers to be productive even in areas lacking network coverage or performance, such as rural areas or patient homes. This improved availability is particularly important has healthcare becomes more decentralized.

What kinds of solutions that combine usability and security improvements are you seeing in your healthcare organization?

Middle East oil producers have accumulated handsome budget surpluses thanks to sustained oil prices during the last decade and governments are doing the right thing by spending these on social development. Healthcare and education are the key sectors that are benefiting from this boon and information technology is claiming a fair share of government spending.

Qatar has already been spending a good part of its oil wealth in education and the Kingdom of Saudi Arabia is investing heavily into healthcare services including large IT deployments which include setting up three data centres and one of the largest national PACS deployments in the world. All these initiatives are tapping on cutting edge cloud solutions which offer seamless access to patient data across the care continuum as well as securely and cost effectively storing patient data.

Intel and our technology partners are increasingly shifting focus to healthcare IT projects in the region. We recently held a workshop in Riyadh with Dell on mobile healthcare to learn from leading healthcare providers how they are planning to improve care coordination with technology. Hamad Medical Corporation in Qatar has just delivered a Clinical Information System (CIS) Conference in Doha to more than 1,400 clinicians which offered CME, CNE and CPD credits to participants. How is that for a change that awards our caregivers for learning effective use of technology?

While the region is on a fast track preparing their health workforce for improved patient care, we have been researching how the Middle East is faring with respect to mobility and care coordination vis-à-vis the developed world. We have just completed a regional survey with HIMSS Analytics and the results are fairly surprising.

In some aspects, the region is way ahead and in some respects catching up. Among mobile devices provided to clinicians, tablets specifically for healthcare use is expected to rise to 41 percent this year from about 24 percent, while all types of cellular phones and pagers are on decline. This does not mean clinicians won’t be using them. They will simply become Bring Your Own Devices, a big challenge for device manageability. Only 3 percent of the health workforce is expected to get a smartphone or feature phone compared to as high as 45 percent procured by the healthcare institutions before.

I will present the survey details at a HIMSS Middle East Regional Event in Riyadh next week, and have the honor of addressing distinguished participants from regional governments, healthcare industry and the IT sector. I would like to share one worry that keeps me awake at night. A recent report from Bank of America is forecasting that the oil price will halve within two years due to a number of factors including yet again greater use of technology. Should this occur, would the Middle East governments have the same enthusiasm to continue with the social investments in healthcare and education or start to cut back just like the developed world is doing today?

How do we keep the momentum going to finally reap the benefits of current investments in healthcare IT? What do you think?

Rick Cnossen is the Worldwide Director, Healthcare IT, at Intel Corp.

At HIMSS 13, Will Morris, MD, associate chief medical information officer at Cleveland Clinic, unveiled the organization's new patient care app that is a heads-up dashboard of clinical care information for physicians. This application allows clinicians to view a risk-stratified list of patients based on their health status via a live Windows* 8 interface tile. Users can then select a patient and view the updated medical record in the Windows 8 touchscreen experience.

In the above video, learn how the app was designed and the benefits that clinicians, and patients, will realize with its deployment on the front lines of healthcare.

What questions do you have?

It is beginning to feel to me like cancer has become as common as the common cold. Almost everyone I know—in every aspect of my life—is going through a cancer experience either directly themselves or via a friend or family member.

The grand challenge to end cancer has certainly brought significant improvements to treatment over the past few decades, but there is still much to learn about the underlying mechanisms that cause so many diverse kinds of cancer to emerge and how they might possibly be slowed or stopped. There is still too much painful experimentation and expensive guesswork involved in treating an individual patient based on what medicine can glean from randomized studies of large populations. Healthcare today really can't know the individual in his or her genetic and disease complexity, and thus, often fails to deliver a treatment protocol with precision or positive results.

From roulette to precision

As a cancer patient advocate for more than two decades, I have witnessed firsthand what the lack of precision brings us. It leads to a kind of "diagnosis and drug cocktail roulette," as one oncologist described it to me years ago, because physicians lack the tools to really understand an individual's case. Thus, the grand challenge for thousands of patients I have worked with has been to survive the experimentation, the trials, and the side effects from the treatment. We all laugh but also cringe at the all-too-common mantra: "It's not the disease you have to worry about, it's the cure!" We must give medicine the means to customize cancer care—and all care—for each and every one of us.

Given these challenges, I am excited about today’s announcement that Intel and Oregon Health & Science University (OHSU) have formed a multi-year strategic collaboration to explore this kind of individually targeted cancer therapy. We will deploy next-generation computing to help solve the data-intensive challenges that personalized medicine for cancer really requires. Very complex problems—like developing the ability to “turn off” the spread of cancer in a particular person—demand multidisciplinary teams of experts working side by side. Together, Intel’s engineers and OHSU’s biomedical experts are optimizing supercomputing clusters and software to isolate the genetic variations that contribute to the root causes of illness.

From weeks to hours

For more than a decade, Intel technologists and social scientists have worked with OHSU (my first clinical fieldwork for Intel was in several OHSU hospitals and clinics back in 1999!) to move toward a vision of what I call "Personal Health." Our prior work together has focused on two of the three pillars of Personal Health: care anywhere and care networking.  We have developed technologies and care models for helping to care for people—especially seniors—in their own homes through telehealth, remote patient monitoring, online coaching, intelligent prompting, and care coordination of virtual, networked teams.

Today's announcement continues our innovation partnership with OHSU and focuses on the third pillar of Personal Health: care customization. Scientists can now gather billions of data points on how a specific patient’s cells are malfunctioning. Genetic abnormalities that cause these tumors manifest differently in each of us. What’s more, even a healthy human body creates millions of these mutations.  So it’s an enormous scientific challenge to determine, for each individual, which mutations are relevant in creating "my" disease. But that's where medicine must go.

We're bringing together Intel’s strengths in developing energy-efficient, extreme-scale computing solutions with OHSU’s pioneering work in imaging an individual's complex biological information in four dimensions (three-dimensional space and time). The calculations required to advance in this field are mind-boggling. Today, it takes weeks to analyze this information for an individual, but through this collaboration, we hope to shorten the data-crunching from weeks to hours and bring the costs down to something that can be clinically viable for every patient.

Digging into the ‘circuitry’ of cancer

If we succeed, this would mean more tests can be performed in a given time, with hopefully quicker discoveries. Eventually, this all leads to the promise of highly precise diagnostic tests to customize care for someone going through cancer because we can now understand that person’s particular mutations in enormous detail. But our joint team plans to do research not only into the mutations but also the "circuitry" that enables malignant cells to spread. The ultimate hope here is to learn how, for a specific individual, this circuitry can be “turned off” to stop the spread of cancer cells!

I know well what these kinds of breakthroughs could mean for patients. I have experienced my own "roulette game" of trials and experimentation for kidney disease for almost 25 years. In fact, I write this blog about our new OHSU-Intel collaboration from a hospital bed, as I recover from a routine biopsy of my new kidney transplant to make sure that it continues to do well. One of the things that helped get me to this amazing state of normal kidney function and good health again was having my whole genome sequenced.  It, too, took weeks of computing and then months upon months of analysis to make sense of my own unique case. Today, these tools are too slow, too expensive, and too rare—I want to make sure everyone has access to the kind of customized care that I lucked into.

Of course, there are no guarantees in this type of grand endeavor. We cannot know now how successful such investigations will be, or how soon average patients will benefit. But we do know that it is high time time to end the dangerous roulette game of diagnoses and drug cocktails that cancer patients must endure. It is time to stop the guesswork by giving physicians the tools to deliver true care customization for an individual. It is time to end the war on cancer by ending cancer once and for all. I hope and believe that this pioneering collaboration between Intel and OHSU will make significant contributions to these ends. And that one day these kinds of efforts will help make "cancer" one of those historical diseases that future generations will have heard about but not really understand because they have never seen anyone go through it.