Computation modelling to be at the heart of Europe's new healthcare model, hears conference

Healthcare systems around Europe are facing major challenges related to chronic diseases, demographic changes, nursing shortages, medical accidents and rising costs. The proportion of people over 65 is expected to almost double by 2050. More elderly people will require prolonged medical care and assistance to ensure they live independently. Furthermore, chronic diseases are on the increase, as are their management costs. All these factors are starting to place additional strain on European healthcare systems. By 2050, average public spending for health and long-term care in countries of the Organisation for Economic Cooperation and Development (OECD) may rise to 10-13 per cent of Gross Domestic Product (GDP). The emerging situation will not be sustainable unless action is taken at all levels to change the way healthcare is delivered.

In a webcast to the conference, Ms Reding referred to these challenges and spoke of the work undertaken by the European Commission to support the development of new technologies for improving the quality of access and efficacy of healthcare for all citizens. Initiatives include the 2004 eHealth Action Plan, which aims to stimulate investment and beneficial deployment of eHealth solutions across Europe. In addition, e-Health was made one of the 10 priorities of the e-Europe 2005 action plan, which is carried on into the i2010 initiative.

This has placed Europe in a leading position in the use of regional health networks, electronic records in primary care and the deployment of healthcare. "The provision of online health services, including the training of health professionals, is becoming part of daily life in many regional and national health care systems," said the Commissioner, who noted that the e-health industry is growing rapidly and is expected to be worth €20 billion by 2007.

But the deployment of medical care based on ICT solutions has still some way to go. "Can any of you imagine to handle the storage of biomedical knowledge without computers, networks and digital libraries? I doubt it," said Ms Reding. 'But I bet you can probably imagine delivering healthcare services without ICT.'

"There's a challenge to boost research in ICT for medical sciences. But I believe that together the ICT and biomedical industries are greater than the sum of their separate significant parts," noted the Commissioner.

Ms Reding referred to work currently underway on the ICT work programme of the Seventh Framework Programme (FP7), which she said would focus on two main axes of research on healthcare delivery, namely the personalisation of healthcare and the impact of healthcare delivery systems. In the former, the focus will be on the development of modelling and simulation of diseases for treatment and surgery through the 'virtual physiological human'. This will be the programme's flagship activity, the Commissioner said, intended to enable scientists and medical practitioners to predict the outcome of surgical intervention or the impact of a drug on an individual patient using models, simulation and visualisation techniques.

"This is a new area in which the Commission is investing substantially and will impact the way clinicians understand diseases and surgeons perform operations," said Ms Reding. "It will provide new safer and more effective drugs by first simulating their effects on a computer."

Using computer-generated human organs to test the impact of a medicine is not new. In 1960s Dr Denis Noble from University of Oxford pioneered the modelling of cardiac cell electrophysiology and its incorporation into the first detailed biophysical models of the whole organ. He showed that mathematical equations could model how the electrical activity of a heart cell is influenced by the movement of sodium and potassium ions in and out, transported by pumps, channels that sit in the cell's membrane.

Such models reveal the complexity of the heart and how it is influenced by many factors, not least the genes of an individual. In his conference presentation, Dr Noble demonstrated the model he developed on the potassium ion channel in the heart, which when blocked can lead to cardiac arrhythmias, a disturbance in the normal rhythm that makes the heart pump less effectively. Such arrhythmias can lead to dizziness, fainting, chest pain, and kill hundreds of thousands of people every year. Approximately 40 per cent of all manufactured drugs produce cardiac arrhythmias, whether anticancer drugs, diabetes drugs, or antihistamines. It is one of the biggest causes of failure for drugs in clinical trials. "Simulation is now at a stage where we can advise the pharmaceutical industry on how to design drugs to avoid this kind of problem," explained Dr Noble.

While Dr Noble is modelling individual heart cells, other researchers are looking at modelling the heart's large-scale structure and mechanics, such as the beating of the heart muscle itself. Since the 1990s he has been collaborating with Professor Peter Hunter of the University of Auckland in New Zealand on whole-heart models, whose behaviour reflects the independently calculated activities of up to 12 million virtual cardiac cells. This is a huge challenge considering that it can take up to eight hours or more to model a single heartbeat. The models are expected to show how electrical activity originates at the cellular level, how it spreads to other cells, and how the electricity is converted to mechanical contraction of the heart wall. The models will also simulate how the contracting walls cause blood to flow through the heart, and how energy is distributed through the whole system.

While modelling the entire heart may appear colossal, an even more daunting challenge is integrating the wealth of information to allow the determination of structure and function at all levels of the biological organisation. This is the aim of STEP, an EU funded Coordination Action under the Sixth Framework Programme (FP6) which is developing the concept of the 'Virtual Physiological Human' (VPH) - models that will improve the description of the human physiome. The VPH project runs alongside the larger Physiome Project, which is organised under the auspices of the International Union of Physiological Sciences (IUPS).

Professor Gordon Clapworthy from the University of Luton in the UK, project coordinator, explained the concept: "[VPH] is an integrated model of human physiology at multiple levels, going from the organism, the whole body down to the genomes via the organs, tissue, cells, molecules. It's an attempt to integrate all these models into one model."

Why is such a concept necessary? "It's all about providing personalised healthcare," said Professor Clapworthy. "A certain amount of data can be obtained on an individual by standard means but there's other information about the human physiology that can only be acquired using very invasive techniques."

A database of generic information on the human body into which personal data can be fed provides a doctor with a richer picture in order to make diagnosis. "If you integrate [a patient's data] into a bigger model, a generic simulation could lead to a personalised imaging, for example of someone's own heart," surmised the professor.

The project brings together nine partners from five Member States and a total of 100 experts who are working to produce a roadmap for the development of an integrated database of models. The aim is to break down the body into strands and discuss how to produce coherent data, while avoiding overlapping. "A lot of grassroots work is going on worldwide, in individual laboratories, which is normally associated with an organ," Prof Clapworthy explained. "We are trying to get away from multi-level modelling taking place in isolation. The idea is to get everybody working in this area around the table."

But the project is not just about research. "It's also about infrastructure: how do you ensure that the data and software is compatible? What are the ethical and legal issues associated with this? There are lots of non-technical problems involved which need to be addressed to ensure that the package makes sense," said Professor Clapworthy.

"Having access to a database for a modelling on say genetic diseases, you have to think about a user-friendly interface. But you are just looking at only one area, you have to imagine that a database for all the organs of the body," said the professor.

"We need to look at long term sustainability if you are developing large-scale databases which need to be shared. Somebody has got to maintain that, someone has to keep generating data and entering data into it," said Professor Clapworthy. "So we will look at how that can be achieved, whatever the level of available funding", said Professor Clapworth, referring to FP7.

Although the IT Industry is not involved in the consortium, Professor Clapworthy said that experts from academia and industry are invited to participate in its conferences and fora. "It's clear that clinical and industrial aspects are key to the success of the project in the future," said the professor. "If we want to get into the real world, we clearly have to have the acceptance of the clinician and the cooperation of industry both ensuring that data is available and of good quality. They [Industry] can help us to understand how the academic research can best be implemented in an industry context."

As for the rollout of the first 'virtual human simulator', "It depends what you consider it to be, how detailed it should be," said Professor Clapworthy. "We are probably looking at about 10 years before we can get a serious clinical impact. But the important thing is that awareness is raised that it is on the horizon. I think once the momentum builds, acceleration will take place."

For further information, please visit: http://www.europhysiome.org