The informatics career of Brett Harnett, MS-IS, has taken him to interesting places—physically, virtually, and academically. It’s taken him to the bottom of the ocean. It’s taken him to the slopes of Mount Everest. It’s taken him to the Super Bowl. It’s even taken him to space.
Wherever Harnett wants to go, data, networks, and computer technology take him there. Today, you’ll find him serving as the director of UC’s Center for Health Informatics and assistant professor in Biomedical Informatics, where he teaches graduate-level courses. But his present work is enriched by experiences that extend far beyond Cincinnati—to places we usually only hear about in stories.
The Bottom of the Ocean
What better place to conduct ocean research than in an undersea lab? There’s only one facility in the world where scientists can live and work underwater—the Aquarius Reef Base.
Aquarius is a NOAA lab operated by Florida International University (FIU) for marine research and education. But the lab 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.
In order to find the lab, you’ll go about nine miles south of Key Largo, Florida, to a sandy patch near Conch Reef. Dive down beneath the ocean’s surface, and you’ll find Aquarius about 60 feet underwater.
The weightlessness in ocean depths offered a way for Harnett and his research team to experiment with a remote surgical robot. This technology allows surgeons in one location to perform an operation in another, called telesurgery, in which NASA has particular interest. Could the research team transport a surgical robot to the Aquarius—in pieces—then reassemble and connect it to another robot on the mainland using multiple communication topologies?
To find out, Harnett and his team designed a portable staging platform, waterproof potting containers, and assembly protocol to install the robot end effecter to Aquarius. From a conference hall in Nashville, 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—all the way from the bottom of the ocean.
“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 100’s,” says Harnett.
What was going on? 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 September 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 in 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—doing what? Yup, 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.
The first Ukranian cosmonaut to fly aboard a U.S. space shuttle was Leonid K. Kadenyuk. When he began his mission as a payload specialist in 1997, his personal mission was called the Collaborative Ukraine Experiment (CUE). In orbit aboard Space Shuttle Columbia, Kadenyuk experimented with plant growth in the shuttle’s microgravity environment. Pollinating plants with a dead bee glued to the end of a toothpick, he successfully produced seed-to-seed fertilization experiments.
The CUE was designed to allow high school students in both the United States and Ukraine to pollinate and grow plants in tandem with Kadenyuk, sharing progress as they went along. The cornerstone of the collaboration between students and cosmonaut was a 30-minute Q&A session.
At the time, only a small percentage of Ukraine had internet access. How could the students communicate with Kadenyuk from their classroom to space? Harnett was tapped to make the connection possible.
“We coordinated with internet providers in the Ukraine and NASA flight control so they could communicate with Kadenyuk,” says Harnett. “This was in 1999—the internet was not nearly as pervasive as it is now. I spent a week in Ukraine negotiating connectivity to a school in Kiev, and coordinated the network protocols and channels through Mission Control in Houston. This was an exciting experience for the students. There were huge hoops to jump through to provide access to connect to the shuttle, but we did it.”
The Collaborative Ukraine Experiment marked the first cooperative scientific payload between NASA and the National Space Agency of Ukraine. The experiments proved the internet could be used for such space-age 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. 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 to address this ‘text mining’ challenge. Harnett and his team are part of a 4.5-year effort with the University of Michigan 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 electrocadiography 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 Dr. Mark Eckman, 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 risk using the CHA2DS2VASc, risk of major hemorrhage using HASBLED, and intracerebral hemorrhage rates are extracted from Epic and fed into the decision analytic engine. 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.
Brett Harnett can be reached at the University of Cincinnati’s Center for Health Informatics within the Department of Biomedical Informatics. Contact him at firstname.lastname@example.org.