Bringing informatics to the bedside
Few people could have predicted the information revolution of the 21st century, and we are only just beginning to understand its consequences, both positive and negative. The digital revolution has transformed many walks of life, including travel and retail, but it has not yet transformed the experience of healthcare. However, the blossoming of informatics – the scientific analysis and study of huge datasets – has the potential to deliver real changes to how health is delivered.
The term “bioinformatics” – which has been with us for nearly half a century now – remains strongly associated with genetics and genomics, a field which has seen enormous strides in recent decades. These advances have been accompanied by deservingly high levels of scientific and public interest, but genomics is not the only field of human health with the potential to be transformed by the information revolution.
Informatics has revealed completely new ways of understanding complex systems, and the human mind is ideally suited to such an approach. “Big data” and informatics approaches to mental health are now showing extremely promising results, yet investment and interest in these approaches still lags far behind other fields. This is despite the huge progress that has been made in this area in recent years, and the enormous potential it holds to transform the care of people with mental health disorders.
At the NIHR Maudsley Biomedical Research Centre, we are exploring a number of different informatics approaches to mental health, which have already delivered startling new insights, and promise to deliver much more as technology (and our understanding of it) develops.
Our Clinical Record Interactive Search (CRIS) system allows researchers to access and analyse a unique set of anonymised information from electronic patient records with multiple record linkages. These approaches have unlocked the vast quantity of information available in health records, and has already led to landmark findings, such as our study showing that people with mental health disorders die (depending on their mental health condition) 10-17 years earlier than the general population. We are now acting on these findings, for instance by testing and implementing policies and interventions addressing medication side effects and smoking.
Perhaps unsurprisingly, health workers tend to input most information in patient records as a narrative of continuous text, rather than filling out boxes in forms. This is good clinical practice – we understand our patients by hearing their stories, but it makes the information very difficult to analyse for research. So our researchers have developed Natural Language Processing algorithms to automatically extract meaning from free text fields. This is allowing us to understand patients’ symptoms, health behaviours, social difficulties and treatments, rather than simply relying on diagnoses.
Unlocking the information within health records is already having a huge impact on what we can do in mental health research. However, the way we collect information is also changing, and our IMPARTS (Integrating Mental and Physical Health: Research Training and Services) project is using tablet computers in medical clinics to understand and address the mental health needs of people presenting for skin problems, arthritis or diabetes.
Moreover, mobile and wearable technologies mean that we can now collect data of a type and scale that was previously unprecedented. Many people now use smart watches or wrist worn fitness devices, which provide data in real time on activity levels, sleep, heart rate, and so on. Our SleepSight and RADAR-CNS projects are exploring how these mobile and wearable technologies can help a variety of conditions, including schizophrenia and major depression. Instead of just getting a “snapshot” of a person’s condition when they visit a clinic, we can collect continuous information from wearable devices, which might eventually allow us to predict when somebody is going to become unwell, or require medical assistance.
We are rapidly developing our understanding of what the data from mental health informatics mean, how to analyse them, and how to make the best use of them for people with mental health disorders.
The field of informatics may have been dominated by genomics until now, but the examples I’ve discussed here show just a few ways in which big data is revolutionising mental health. The potential is enormous – to transform clinical care by bringing informatics to the bedside.
Director of the NIHR Maudsley Biomedical Research Centre
If you’ve got a solution that could address unmet clinical need in mental health through medical technology don’t miss your chance to apply for the NIHR Invention for Innovation (i4i) Challenge Award, open until 5 April.
- Summary:Professor Matthew Hotopf, NIHR Maudsley Biomedical Research Centre Director, explores the potential of informatics and 'big data' in mental health research; a field that could benefit from i4i Challenge Award funding.