BioTIFF: Articulating Self-Documenting Personal Health Digital Information Artefacts

Medicine 2.0

Although the Web 2.0 world of participatory, web-based collaboration and social networking has just been launched, a Web 3.0 is emerging where ubiquitous data and virally distributed free and open applications for interacting with that data, is leading to new and useful forms of socio-technical articulation. The University of Toronto Laboratory for Collaborative Diagnostics (www.lcd.utoronto.ca) is developing an electronic personal health record (ePHR) system that anticipates Web 3.0. The BioTIFF is a self-documenting digital file structure designed to bind typical ePHR clinical information to digital files that record results of diagnostic tests. It consists of a highly extensible multi-page tagged image file format (TIFF) record in which digital image representations of the results of diagnostic tests can be annotated with richly informative metadata providing the substrate for generating bio-referenced overlay maps useful in interpreting that information. For example, the first digital CT image of a newly diagnosed brain tumor can be entered into an articulated and indexable person-centered digital file envelope containing all of the persons relevant health diagnostic data and metadata as well as pointers to bioinformatic and eHealth information concerning tumors of that type. What is more, this image can act as a navigation beacon and record-anchor for asynchronous communication, info(r)mediation and other forms of transactions within the persons circle of care concerning the tumor. The BioTIFF is inspired by GeoTIFF (www.remotesensing.org/geotiff/geotiff.html) that evolved as an open standard for creating multi-page TIFF relating overlapping maps and images of particular geospatial locations and linking those maps to associated metadata. GeoTIFF exploited the self-documenting properties of geographical coordinate systems to uniquely identify a location within a satellite image and thereby allow cross-referencing to other information artefacts relevant to that location. The BioTIFF approach uses molecular, cellular, anatomical, and biomedical coordinate systems to specify biological inner space domains where biological systems dynamics happen in ways that express themselves as health and disease. These coordinate systems allow mapping of the progression of treatment and of health status in individuals as represented by the continuous stream of results from diagnostic and laboratory tests guiding treatment. This biomedical mapping can be further articulated with socio-technical systems frameworks describing how individuals interact with technologies and places in their healthcare systems. In this way the BioTIFF record can contain all of the information needed to drive interpretive applications aimed at mapping a persons experiences with their treatment. The BioTIFF is not only self-documenting but also enables members of the circle of care, especially the person at the center, to document, reflect, and comment upon opinions and narratives within the circle of care concerning goals, experiences and interpretation of outcomes. This enables a multilateral, dialogical, and person centric approach to negotiating optimized health care trajectories. The BioTIFF has been designed as a distributed and easily scalable and transportable application that is well adapted to emerging commoditized cloud storage and computational infrastructure. In this talk we describe BioTIFF's architecture and design constraints.

BioTIFF:...