Adil Alaoui

Diabetes home monitoring project

The objective is to study the feasibility of remotely monitoring people with diabetes using low-cost technology. Using a personal computer, randomly chosen people with type I diabetes transmit their diabetes related data to their physician at Georgetown University Medical Center on a weekly basis where he analyzes it and contacts the patient every week to make safe adjustments to diet, exercise plan and insulin dose to prevent different kinds of diseases. Based on the data received the physician at the Endocrinology Department was able to early correct blood glucose levels for many patients enrolled in the program and prevent many possible clinical complications. This preliminary study indicates that tight monitoring people with diabetes and frequent patient physician communication and feedback utilizing a low-cost technology can significantly lower the risk of getting diseases and avoid costly short and long term hospitalizations and ER visits thus increase the quality of life and life expectancy.

Development of a secure medical research environment

The confidentiality of medical information, including patient data security, is an increasingly important issue in todays health care environment. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires the Department of Health and Human Services to create specific rules for managing the security and privacy of computer-based patient medical records. In November 1999, the Department of Health and Human Services implemented the privacy requirements of the HIPAA proposal to improve the effectiveness of public and private health programs by protecting individually identifiable health information. We give a brief description of some widely used security measures. We also address the steps that were taken at the Imaging Science and Information Systems (ISIS) Center at Georgetown University to secure our research environment and the patient medical information used within the network, and describe our efforts to become more HIPAA compliant. The paper concludes with some clinical applications.

An Internet-Based Writing Intervention for PTSD in Veterans: A Feasibility and Pilot Effectiveness Trial.

Objective: Veterans suffering from posttraumatic stress disorder (PTSD) may avoid or fail to follow through with a full course of face-to-face mental health treatment for a variety of reasons. We conducted a pilot effectiveness trial of an online intervention for veterans with current PTSD to determine the feasibility, safety, and preliminary effectiveness of an online writing intervention (i.e., Warriors Internet Recovery & EDucation [WIRED]) as an adjunct to face-to-face psychotherapy. Method: Veterans (N = 34) who had served in Iraq or Afghanistan with current PTSD subsequent to deployment-related trauma were randomized to Veterans Affairs (VA) mental health treatment as usual (TAU) or to treatment as usual plus the online intervention (TAU + WIRED). All research participants were recruited from the Trauma Services Program, VA Medical Center, Washington, DC. They completed baseline assessments as well as assessments 12 weeks and 24 weeks after the baseline assessment. The online intervention consisted of therapist-guided writing, using principles of prolonged exposure and cognitive therapy. The intervention was adapted from an evidence-based treatment used in The Netherlands and Germany for individuals who had been exposed to nonmilitary traumas. Results: In addition to showing that the online intervention was both feasible to develop and implement, as well as being safe, the results showed preliminary evidence of the effectiveness of the TAU + WIRED intervention in this patient population, with particular evidence in reducing PTSD symptoms of hyperarousal. Conclusion: With minor modifications to enhance the therapeutic alliance, this intervention should be tested in a larger clinical trial to determine whether this method of online intervention might provide another alternative to face-to-face treatment for veterans with PTSD.

Database Schema Models of Integrated Biomedical Information in Relational Database System

The creation of an integrated biomedical information database requires diverse and flexible schemas. Although relational database systems seem to be an obvious choice for storage, traditional designs of relational schemas cannot support integrated biomedical information in the most effective ways. Therefore, new models for managing diverse and flexible schemas in relational databases are required for such systems. This paper proposes several schema models for integrated biomedical information using relational tables, and presents an experimental evaluation of their efficiency.

Web survey data collection and retrieval to plan teleradiology implementation

This case study details the experience of system engineers of the Imaging Science and Information Systems Center, Georgetown University Medical Center (ISIS) and radiologists from the department of Radiology in the implementation of a new Teleradiology system. The Teleradiology system enables radiologists to view medical images from remote sites under those circumstances where a resident radiologist needs assistance in evaluating the images after hours and during weekends; it also enables clinicians access to patients’ medical images from different workstations within the hospital. The Implementation of the Teleradiology project was preceded by an evaluation phase to perform testing, gather users feedback using a web site and collect information that helped eliminate system bugs, complete recommendations regarding minimum hardware configuration and bandwidth and enhance system’s functions, this phase included a survey-based system assessment of computer configurations, Internet connections, problem identification, and recommendations for improvement, and a testing period with 2 radiologists and ISIS engineers; The second phase was designed to launch the system and make it available to all attending radiologists in the department. To accomplish the first phase of the project a web site was designed and ASP pages were created to enable users to securely logon and enter feedback and recommendations into an SQL database. This efficient, accurate data flow alleviated networking, software and hardware problems. Corrective recommendations were immediately forwarded to the software vendor. The vendor responded with software updates that better met the needs of the radiologists. The ISIS Center completed recommendations for minimum hardware and bandwidth requirements. This experience illustrates that the approach used in collecting the data and facilitating the teamwork between the system engineers and radiologists was instrumental in the project’s success. Major problems with the Teleradiology system were discovered and remedied early by linking the actual practice experience of the physicians to the system improvements.

Abstract B1-44: G-DOC Plus: A cloud based next-generation systems medicine platform for precision medicine

Systems medicine leverages complex computational tools and high dimensional data offering the potential for effective individualized diagnosis, prognosis and treatment options. Our flagship web platform, the Georgetown Database of Cancer (G-DOC), was deployed with the goal of enabling translational research by integrating patient characteristics and clinical outcome data with a variety of high-throughput research data in a unified environment. With the goal of improving health outcomes through genomics research, we present G-DOC Plus, our enhanced web platform offering precision medicine, translational research and population genetics workflows. This enhanced platform takes advantage of cloud computing to handle next generation sequencing (NGS) data so that they can be analyzed in the full context of other omics and clinical information. G-DOC Plus uses cloud computing and other advanced computational tools to enable analysis of NGS and medical images in the full context of other omics and clinical information. It allows translational science researchers to explore data one sample at a time, as a sub-cohort of samples; or as a population as a whole, providing the user with a comprehensive view of the data. G-DOC Plus tools have been leveraged in cancer to support detection of prognostic markers for relapse in colorectal cancer samples, and to detect key metabolites related to disease severity; hypothesis generation; biomarker detection and multi-omic analysis, in-silico and population genetics analysis; and to explore somatic mutation and breast cancer MRI images. The long-term vision of G-DOC Plus is to extend this systems medicine platform to hospital networks to provide clinical decision support using multi-omics and relevant clinical information to support personalized patient care. G-DOC Plus was released in October 2014, and is available at: https://gdoc.georgetown.edu. Citation Format: Krithika Bhuvaneshwar, Anas Belouali, Varun Singh, Robert M. Johnson, Lei Song, Adil Alaoui, Michael Harris, Yuriy Gusev, Robert Clarke, Subha Madhavan. G-DOC Plus: A cloud based next-generation systems medicine platform for precision medicine. [abstract]. In: Proceedings of the AACR Special Conference on Computational and Systems Biology of Cancer; Feb 8-11 2015; San Francisco, CA. Philadelphia (PA): AACR; Cancer Res 2015;75(22 Suppl 2):Abstract nr B1-44.

Framework design and development of an informatics architecture for a systems biology approach to traumatic brain injury

Traumatic Brain Injury (TBI) is a problem of major medical and socioeconomic significance, although the pathogenesis of its sequelae is not completely understood. As part of a large, multi-center project to study mild and moderate TBI, a database and informatics system to integrate a wide-range of clinical, biological, and imaging data is being developed. This database constitutes a systems-based approach to TBI with the goals of developing and validating biomarker panels that might be used to diagnose brain injury, predict clinical outcome, and eventually develop improved therapeutics. This paper presents the architecture for an informatics system that stores the disparate data types and permits easy access to the data for analysis.

System architecture and information model for integrated access to distributed biomedical information

The current trend towards systems medicine will rely heavily on computational and bioinformatics capabilities to collect, integrate, and analyze massive amounts of data from disparate sources. The objective is to use this information to make medical decisions that improve patient care. At Georgetown University Medical Center, we are developing an informatics capability to integrate several research and clinical databases. Our long term goal is to provide researchers at Georgetowns Lombardi Comprehensive Cancer Center better access to aggregated molecular and clinical information facilitating the investigation of new hypotheses that impact patient care. We also recognize the need for data mining tools and intelligent agents to help researchers in these efforts. This paper describes our initial work to create a flexible platform for researchers and physicians that provides access to information sources including clinical records, medical images, genomic, epigenomic, proteomic and metabolomic data. This paper describes the data sources selected for this pilot project and possible approaches to integrating these databases. We present the different database integration models that we considered. We conclude by outlining the proposed Information Model for the project.

Building a secure medical research organization

We are witnessing a dramatic increase in the use of complex technological systems for better management and exploitation of abundant data from different sources. The Imaging Science and Information Systems (ISIS) Center, a medical research center at Georgetown University is an agile organization that is subject to fast changing requirements and new application deployments. ISIS requires an agile, secure IT infrastructure based on network management best practices that enables rapid business implementations, accommodates innovative deployments and applications, and supports its business plan. Adapting emerging technologies can facilitate communication, productivity and access but, also entails higher security risks, more assets to manage and increased requirements for compliance with established standards and security rules. In this paper we will describe the approaches we took to build and secure an IT infrastructure at the ISIS Center that enables researchers, collaborators, vendors and contractors to work in an environment that hosts systems for different purposes with no compromise to security and data confidentiality.

ImTK: An Open Source Multi-Center Information Management Toolkit

The Information Management Toolkit (ImTK) Consortium is an open source initiative to develop robust, freely available tools related to the information management needs of basic, clinical, and translational research. An open source framework and agile programming methodology can enable distributed software development while an open architecture will encourage interoperability across different environments. The ISIS Center has conceptualized a prototype data sharing network that simulates a multi-center environment based on a federated data access model. This model includes the development of software tools to enable efficient exchange, sharing, management, and analysis of multimedia medical information such as clinical information, images, and bioinformatics data from multiple data sources. The envisioned ImTK data environment will include an open architecture and data model implementation that complies with existing standards such as Digital Imaging and Communications (DICOM), Health Level 7 (HL7), and the technical framework and workflow defined by the Integrating the Healthcare Enterprise (IHE) Information Technology Infrastructure initiative, mainly the Cross Enterprise Document Sharing (XDS) specifications.