The Digital Patient

C. Donald Combs, PhD, is Vice President and Dean of the School of Health Professions at Eastern Virginia Medical School and is also a senior faculty member in the Department of Modeling, Simulation, and Visualization Engineering at Old Dominion University.   John A. Sokolowski, PhD, is Associate Professor and Executive Director of the Virginia Modeling, Analysis, and Simulation Center at Old Dominion University.   Catherine M. Banks, PhD, is Research Associate Professor at the Virginia Modeling, Analysis, and Simulation Center at Old Dominion University.

List of Contributors xiii Preface xvii

Part 1 The Vision: The Digital Patient—Improving Research, Development, Education, and Healthcare Practice 1

1 The Digital Patient 3
C. Donald Combs

Health, The Goal, 4

Personalized Medicine, 4

The Best Outcomes, 5

The Emergence of the Digital Patient, 5

The Human Physiome, 6

Enabling the Digital Patient, 8

P4 Medicine, 11

Conclusion, 11

References, 12

2 Reflecting on Discipulus and Remaining Challenges 15
Vanessa Díaz]Zuccarini, Mona Alimohammadi, and César Pichardo]Almarza

Introduction, 15

A Brief Contextual Background and a Call for Integration: Personalized Medicine is Holistic, 16

The Many Versions of the Digital Patient: On the Road to Medical Avatars, 18

Discipulus: The Digital Patient Technological Challenges and Main Conclusions, 19

The Remaining Challenges and Big Data, 24

Conclusion, 25

References, 26

3 Advancing the Digital Patient 27
Catherine M. Banks

Introduction, 27

The Digital Patient: Its Early Start, 28

Engaging the Digital Patient, 30

Conclusion, 31

4 The Significance of Modeling and Visualization 33
John A. Sokolowski and Hector M. Garcia

Introduction, 33

Modeling a Complex System: Human Physiology, 34

Medical Modeling, Simulation, and Visualization, 35

Modes and Types of Visualization, 40

Visualization for Patient]Specific Usefulness, 43

Conclusion, 43

References, 45

Part 2 State of the Art: Systems Biology, the Physiome and Personalized Health 49

5 The Visible Human: A Graphical Interface for Holistic Modeling and Simulation 51
Victor M. Spitzer

Introduction, 51

Education, 53

Modeling, 55

Virtual Reality Trainers and Simulators, 56

Conclusion, 58

References, 59

6 The Quantifiable Self: Petabyte by Petabyte 63
C. Donald Combs and Scarlett R. Barham

Introduction, 63

Smarr’s Quantified Self, 64

Extending Smarr’s Research, 67

The Quantified Self]Vision, Simplified, 69

Criticism, 69

Conclusion, 71

References, 72

7 Systems Biology and Health Systems Complexity: Implications for the Digital Patient 73
C. Donald Combs, Scarlett R. Barham, and Peter M. A. Sloot

Introduction, 73

Systems Biology, 75

The Institute for Systems Biology, 76

The Complexity Institute, 78

The Potential of Systems Biology, 81

Criticism, 82

Conclusion, 83

References, 83

8 Personalized Computational Modeling for the Treatment of Cardiac Arrhythmias 85
Seth H. Weinberg

Introduction, 85

Basics of Cardiac Electrophysiology, 86

Cardiac Modeling Advancements, 89

Regulation of Intracellular Calcium, 90

From Cells to Cables to Sheets to Tissue to the Heart, 91

Where Can we go from Here? What is the Cardiac Model in the Digital Patient? 95

References, 96

9 The Physiome Project, openEHR Archetypes, and the Digital Patient 101
David P. Nickerson, Koray Atalag, Bernard de Bono, and Peter J. Hunter

Introduction, 101

Multiscale Physiological Processes, 102

Physiome Project Standards, Repositories, and Tools, 103

Archetype Specialization, 112

Archetype Definition Language, 113

Linking Archetypes to External Knowledge Sources (Terminology and Biomedical Ontologies), 114

Archetype Annotations, 114

OpenEHR Model Repository and Governance, 115

Fast Healthcare Interoperability Resources, 115

A Disease Scenario, 116

Summary and Conclusions, 121

References, 122

10 Physics]Based Modeling for the Physiome 127
William A. Pruett and Robert L. Hester

Introduction, 127

Modeling Schemes, 128

Future Challenges, 142

Conclusion, 142

Acknowledgments, 143

References, 143

11 Modeling and Understanding the Human Body with SwarmScript 149
Sebastian von Mammen, Stefan Schellmoser, Christian Jacob, and Jörg Hähner

Introduction, 149

Related Work, 150

Multiagent Organization, 152

Designing Interactive Agents, 152

Speaking SwarmScript, 153

Answering Demand: The Design of SwarmScript, 153

Graph]Based Rule Representation, 153

The Source–Action–Target, 154

SwarmScript INTO3D, 154

A SwarmScript Dialogue, 155

Discussion, 159

Summary, 161

References, 162

12 Using Avatars and Agents to Promote Real]World Health Behavior Changes 167
Sun Joo (Grace) Ahn

Introduction, 167

Avatars and Agents, 168

Using Agents and Avatars to Promote Health Behavior Changes, 169

Conclusion, 174

References, 174

13 Virtual Reality and Eating, Diabetes, and Obesity 179
Jessica E. Cornick and Jim Blascovich

Introduction, 179

Virtual Reality, 179

Obesity and Weight Stigma, 184

Virtual Reality as a Tool for Combatting Health Issues, 185

Conclusion, 189

References, 189

14 Immersive Virtual Reality to Model Physical: Social Interaction and Self]Representation 197
Eric B. Bauman

Introduction, 197

Theory for Immersive Virtual Learning Spaces, 197

Conclusion, 202

References, 203

Part 3 Challenges: Assimilating the Comprehensive Digital Patient 205

15 A Roadmap for Building a Digital Patient System 207
Saikou Y. Diallo and Christopher J. Lynch

Introduction, 207

Approach, 210

Building the Digital Patient Through Interoperability, 211

Conclusion, 221

Acknowledgments, 221

References, 221

16 Multidisciplinary, Interdisciplinary, and Transdisciplinary Research: Contextualization and Reliability of the Composite 225
Andreas Tolk

Introduction, 225

Interdisciplinarity and Interdisciplinary Research, 226

Data Engineering to Support Interdisciplinarity and Interoperability, 228

Base Object Models to Support Transdisciplinarity and Composability, 233

Open Challenges on Reliability, 235

Summary and Conclusion, 237

References, 239

17 Bayes Net Modeling: The Means to Craft the Digital Patient 241
Joseph A. Tatman and Barry C. Ezell

Introduction, 241

Other Interesting Applications, 246

Conclusion, 251

References, 253

Part 4 Potential Impact: Engaging The Digital Patient 255

18 Virtual Reality Standardized Patients for Clinical Training 257
Albert Rizzo and Thomas Talbot

Introduction, 257

The Rationale for Virtual Standardized Patients, 258

Conversational Virtual Human Agents, 259

Usc Efforts to Create Virtual Standardized Patients, 260

Conclusion, 269

References, 270

19 The Digital Patient: Changing the Paradigm of Healthcare and Impacting Medical Research and Education 273
V. Andrea Parodi

Introduction, 273

Overview Digital Medicine Projects, 275

Personalized Patient Care Clinical Use, 279

Recommended Education and Training for VPH Project Participation, 281

From Flexner to the 2010 Carnegie Report, 284

Summary Statements, 286

References, 287

20 The Digital Patient: A Vision for Revolutionizing the Electronic Medical Record and Future Healthcare 289
Richard M. Satava

Introduction, 289

Applications of the Digital Patient as the EMR, 291

Discussion, 296

Conclusion, 297

References, 297

21 Realizing the Digital Patient 299
C. Donald Combs and John A. Sokolowski

Index 305