A Global Informatics Journey Leads to UC Focus: Brett Harnett

The informatics career of Brett Harnett, assistant professor of biomedical informatics at the University of Cincinnati College of Medicine, has taken him to many interesting places—physically, virtually and academically. It's taken him to the bottom of the ocean, to the slopes of Mount Everest and to the Super Bowl.

Wherever Harnett wants to go, data, networks and computer technology take him there. Today, you'll find him serving as the director of the college's Center for Health Informatics, where he teaches graduate-level courses. But his present work is enriched by experiences that extend far beyond Cincinnati.

The Bottom of the Ocean

Aquarius is a National Oceanic and Atmospheric Administration laboratory operated by Florida International University for marine research and education. But the lab off the coast of Key Largo, Florida, and 60 feet underwater, has plenty of other uses, too. Researchers from around the globe test new underwater technologies, and NASA practices tasks that mimic microgravity in the weightless ocean environment. Astronauts and engineers can spend up to 10 days in the module, using saturation diving techniques for unrestricted work on the ocean floor.

The weightlessness in ocean depths offered a way for Harnett and his research team to experiment with a remote surgical robot in the spring of 2007 This technology allows surgeons in one location to perform an operation in another, called telesurgery, in which NASA has particular interest. Harnett and his team designed a portable staging platform, waterproof potting containers and assembly protocol to install the robot end effecter inside Aquarius. From a conference hall in Nashville, Tennessee, they were able to manipulate the robot's movements on the ocean floor from hundreds of miles away.

Back in Cincinnati, local youth entered a contest to control the robot. Harnett's team set up a connection from the Aquarius base to a second remote control base at the Cincinnati Children's Museum. The lucky winners manipulated the robot in real-time and watched it on video.

"You would think that establishing communications using a microwave link on a buoy in three-foot seas would the hard part—it wasn't," says Harnett. "Designing a platform, breaking it into small pieces and writing instructions for astronauts to reassemble and connect it to the network was immensely more difficult. But the astronauts pulled it off."

The Top of Mount Everest

In 1996, severe weather ripped through Mount Everest killing a dozen climbers and stranding several others. Two of the climbers died within close proximity of basecamp, narrowly missing safety. Another was left for dead, but made it to camp the next morning with frostbite so severe he lost his nose, right hand and fingers.

"A dozen people died in a short amount of time, some stricken within just 50 meters of help," Harnett says. "But nobody knew what condition they were in, or if they should risk their life to help them."

Directed by NASA, Harnett and the Everest Extreme Expedition (E3) team brought telemedicine to one of the most extreme locations on the planet. An elite group of medical specialists and technicians turned Everest Base Camp into communications central. Three expert climbers traveled to Camp One at 19,500 feet, outfitted with portable sensing devices, global positioning and radio telemetry.

Harnett and the team from NASA's Medical Informatics and Technology Applications Consortium (MITAC) at Yale University kept tabs on both the personnel at base camp as well as the climbers. With telemedicine and creative technologies, they were able to capture clinical data including heart rate, body core and surface temperature and acceleration.

"During the ascent, we were tracking their movement patterns and physiology. Suddenly, the acceleration dropped to almost zero and the heartrates spiked in the high 100s," says Harnett.

By plotting the exact coordinates, the cause became clear. 

"The climbers were walking very slowly across aluminum ladders fastened together end-to-end over a deep, icy crevasse—the notorious Khumbu Icefall," says Harnett. "That apparently causes a high degree of anxiety!"

Researchers used this experiment as an opportunity to test the limits of wearable sensors, wireless communications and telemedicine concepts. If climbers can be monitored on Mount Everest, people can be monitored wherever they are.

The Super Bowl

For a game as big as the Super Bowl, event coordinators prepare for a number of things that could go wrong. Tens of thousands of people gathered in one small area are bound to cause issues of overcrowding, disorderly conduct and the like. But after the events of Sept. 11, 2001, Super Bowl organizers realized the need to plan for far greater disturbances.

During the weekend of Super Bowl 37 in 2003, a group of scientists and engineers came to San Diego to test various technologies that could be used to counter terrorism. They called it the "Shadow Bowl." The Shadow Bowl's purpose was to create a model for homeland security, community readiness and medical response. On Christmas Eve 2002, Harnett received a call from the organizers: Could he modify his experimental portable medical telemetry equipment to detect terrorist activity?

After making a few calls, Harnett agreed. He and his team had a month to retrofit the hardware and software—including swapping out a physiologic monitor for an air particulate analyzer—with a smoke sensor. The equipment was then put to the test in a simulated terrorist attack of an exploding tanker.

"We had our sensors ready," Harnett says. "To simulate the smoke, I lit a cigar and puffed it next to the sensor. The sensor transmitted combustion of the tobacco to indicate possible toxic smoke."

Harnett expected that part to go off without a hitch—the primary experiment was testing the communication infrastructure. "The established communication methodology was cellular, but in the event of an emergency, cellular circuits can overload and fail," he says. "We had to incorporate a redundant topology and simulate that system failing. In our research, we had already done that using a low earth orbit satellite system (LEOS)."

The team never had to simulate the cellular system breaking down—because it actually did. "At the time we were to begin the simulation, thousands of people were in a long security line entering Qualcomm Stadium trying to make calls," Harnett says. "We noticed data transport over cellular slowed to a crawl. So we switched to the LEOS, reconnected with the command center and continued sending air quality data."

The Shadow Bowl was a first-of-its-kind experiment with communications assets, sensor networks and online connectivity to centralized medical emergency resources. Going beyond mass casualty events, the results of the experiment accentuated the value of redundant communications.

Recent UC Biomedical Informatics Projects

While Harnett's recent work is more locally focused, it is no less impactful.

HiLois, a social support network app, is one example. In 2011, Harnett's mom, Lois, was diagnosed with Alzheimer's disease. Harnett and his brothers lived in different parts of the country, making frequent physical visits difficult. As her disease progressed, it became more and more difficult for Lois to enjoy phone conversations, stay on topic and remember who was on the other side.

To address this challenge, Harnett created an app to help his mother—and other patients—more easily communicate with family and friends.

The app has been funded by the UC Technology Accelerator program for commercialization. HiLois combines a digital photoframe app specifically for the iPad or Android tablet with a feature-rich mobile app for the iPhone, Android smartphone or tablet, giving patients easy access to a seamless social support network. The app, now in beta testing, promises to enrich the lives of both Alzheimer's patients and their families.

Some of his team's other recent projects include:

• EMERSE (Electronic Medical Record Search Engine) Electronic health record (EHR) data are routinely used in research, yet the promise of utilizing those vast data stores is limited because much of the richest, most comprehensive data are "trapped" within free text clinical notes. EMERSE is a tool originally developed at the University of Michigan (UM) to address this 'text mining' challenge. Harnett and his team are part of a four-year effort with the UM and four other institutions to improve on the system's capabilities and achieve scale.
• Asclepius, research cohort identification tool. Harnett's team has developed Asclepius, a self-service research and cohort identification tool to integrate data from disparate imaging systems—like electrocardiography systems—into the EHR for research purposes. It extracts selected data from those proprietary imaging systems and moves that data to the EHR. The data are then available to researchers, who can freely query selected patient cohorts based on research questions.
• AFDST, Atrial Fibrillation Decision Support Tool. Working under the direction of Mark Eckman, Alice Margaret Posey Endowed Chair in the Department of Internal Medicine, and the biomedical informatics team at UC has developed an Atrial Fibrillation Decision Support Tool (AFDST) that uses a decision analytic engine to generate patient-level recommendations for thromboprophylaxis. Information required to calculate atrial fibrillation-related stroke and intracerebral hemorrhage risk profiles came from published standards and individual's patient data from Epic.  Treatment recommendations are then generated for patients based upon projections of quality-adjusted life expectancy calculated by the decision analytic model. The tool is now in clinical practice.