Using Natural Language Processing (NLP) to Identify and Manage Patient Populations at Risk for Diabetes and Diabetic Complications

Transcription

1 Using Natural Language Processing (NLP) to Identify and Manage Patient Populations at Risk for Diabetes and Diabetic Complications James M. Maisel, MD USA CEO, ZyDoc CEO, Retina Group of New York 5th World Congress of Diabetes 2017 July 12-14, 2017 Prague, Czech Republic

2 Disclosure: James M. Maisel, MD Chairman of Retina Group of New York CEO, ZyDoc Medical Transcription and MediSapien Cloud based transcription and medical knowledge management platform for MTSOs, EHRs, Billing, Analytic and Pharma Companies Medical advisor, educator or consultant to Allergan, Genentech, Novartis, Regeneron, Pfizer, Alimera Patent-pending MediSapien knowledge management software

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6 What Causes all these Symptoms Malaise & Lethargy Curly Hair Shortness Of Breath Bone Pain Myalgias Anemia Skin Roughness Easy Bruising Petechiae Gum Disease Poor Wound Healing Personality Changes Dry Mouth Dry Eyes Poor Wound Healing Jaundice Generalized Edema Oliguria Neuropathy Fever Convulsions Death From Infection Or Bleeding

7 Scurvy Vitamin C Deficiency 7

8 Diabetes Strategies Patient Identification Prevention Delaying complications Identifying high risk Treatment Lowering costs Education Research Diabetic data Identifying preferred practice patterns

9 Diabetic Peripheral Neuropathy RWD Dashboard 1 9

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11 Complex Problem Approach Historical Data Define healthcare objectives Define variables Collect Data Build Diabetic Data Warehouse Perform Smart Analytics and Virtual Trials Identify Key Targets Make Dashboards and Applications

12 DPP-Diabetes Prevention Program Diet and Exercise Dramatically Delay Type 2 Diabetes Diabetes Medication Metformin Also Effective National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) 08 August 2001

13 Diabetes Control and Complications Trial Intensive Diabetic Control Retinopathy 76% Slowed progression of retinopathy 54% Clinical neuropathy by 60% Albuminuria by 54%. Arch Ophthalmol. 1995; 113:36-51

14 Diabetic Breakfast berries dark chocolate infused with espresso smoked salmon and mackerel vanilla soy milk stevia porridge green tea 14

15 Ray Kurzweil $1M/Yr on Diabetes Cure Insulin age 35 caused weight gain nutrition, exercise, weight management, and 100 supplements/day free of type II diabetes and complications > 20 years type II diabetes would return with unhealthy pattern of eating and lifestyle 15

16 Ray Kurzweil moderately low carb - about one sixth of calories, avoiding high glycemic index carbs such as sugar and simple starch anti-inflammatory fats - fish, nuts, extra virgin olive oil (because insulin resistance is caused by an inflammatory process) avoiding trans fatty acids and saturated fat weight loss - lower part normal weight range 16

17 Type 1 Diabetics with Longevity Reasonable glycemic control High HDL/Cholesterol Low daily insulin needs (sensitive) Normal body weight Non-smokers Lower Blood Pressure Microalbumin negative for over 15 years Family Hx longevity

18 Risk factors Ø Type 1 Ø Exact causes are unknown. Ø Type 2 Ø Risk is determined by genetic and metabolic factors Ø Overweight/obesity and physical inactivity are the strongest risk factors Ø Fetal & early childhood nutrition affect future risk

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20 Virtual Trials 20

21 21 Multiple RWD Dashboards

22 30-90% of Data is Unstructured Data

23 Unstructured text is like Dark Matter

24 NLP is disruptive, enabling technology extracting invisible data

25 ZyDoc 2014 Patents Pending NLP Unstructured Text to ICD-10, SNOMED, RxNorm, LOINC Codes

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27 Presented by James M. Maisel, MD for Diabetes Technology Meeting

28 Presented by James M. Maisel, MD for Diabetes Technology Meeting

29 Presented by James M. Maisel, MD for Diabetes Technology Meeting 2014 Presented by James M. Maisel, MD for Diabetes Technology Meeting

30 MediSapien in a Clinical Data Repository-Centric Model Clinical documents stored in Clinical Data Repository CLINICAL DATA REPOSITORY Specialized Apps Coded Data and text inserted into EHR Computer-Assisted Coding for Billing Analytics, Research, Outcomes, SAE 30

31 Reporting Analytics Research Group and Individual Patient-Level Data Undiagnosed and Pre-Diabetic Population Diabetic Patients 2014 ZyDoc. Confidential. Reproduce by permission only. MediSapien Clinical Data Repository 31

32 Chronic Disease Management: Diabeam s 2013 ZyDoc

33 Metformin Prevents, Suppresses Cancer Growth Wu, Lianfeng et al. An Ancient, Unified Mechanism for Metformin Growth Inhibition in C. elegans and Cancer. Cell, Volume 167, Issue 7, e13. DOI: /j.cell

34 SNOMED Exercise data

35 Diabetes Quality Measure Incentives Cardiovascular Self management Lipid Profile CAD on ASA or anti-thrombotic Tobacco use HbA1c <7.0% diet counseling eye exam foot exam BMI >25+ losing 10 lbs.

36 Real World Data vs. RCT Fast and inexpensive Multiple interventions Long-term benefits and harms Broad range of Outcomes Diverse population Dosing, compliance, adherence RCT not feasible Confirmation of RCT Interim evidence

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38 Inflammatory Cytokines Are Expressed at Higher Levels in Eyes With DME MCP-1 (pg/ ml) ,764 VEGF (pg/ml) ,086 IL-6 (pg/ml) ICAM-1 (ng/ ml) PEDF (ng/ml) DME (n = 53) Non-DR (n = 8) a Non-DM (n = 15) b Vitreous ConcentraSon (pg/ml) or(ng/ml) DME: CSME, 22 diffuse, 31 CME; Non-DM: non-diabescs with ocular disease; Non-DR: diabetes with no resnopathy. a DME vs non-dr pairwise comparison P <.05. b DME vs non-dm pairwise comparison P <.05. Funatsu H, et al. Ophthalmology. 2009;119:73-79.

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41 Twin Epidemics Obesity Diabetes

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43 Hyperinsulinar Obesity

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46 Diabetes is one of the four major NCDs Tobacco use CausaSve risk factors Unhealthy diets Physical inacsvity Harmful use of alcohol Non-communicable diseases Heart disease and stroke ü ü ü ü Diabetes ü ü ü ü Cancer ü ü ü ü Chronic lung disease ü

47 47 A calorie is not a calorie

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49 Additional Diabetic Factors? Industrial global diet Lack of exercise Breast feeding Behavioral Issues Antibiotics Antidepressants Hormones Toxins BIOME Intrauterine environment Environmental Pollution Stress Sleep patterns 49

50 PREVENTING DIABETES

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52 Contact Information James M. Maisel, MD USA CEO, ZyDoc CEO, Retina Group of New York