<ul><li>perpetual analytics </li></ul><ul><li>health  in  motion </li></ul>join the conversation wethink.pbwiki.com
THE Opportunity <ul><li>Personalization </li></ul><ul><li>Integration </li></ul><ul><li>Participation </li></ul>
Ergo  <ul><li>Overview : why state-based computing </li></ul><ul><li>Technical : event streams & state machines </li></ul>...
Ergo <ul><li>Overview: state-based computing </li></ul><ul><li>Technical: event streams & state machines </li></ul><ul><li...
States maintain time and order <ul><li>Patient entered State 1 on 1/1/06 </li></ul><ul><li>Diagnosis moved patient to Stat...
Events trigger transitions between states STATE 1 STATE 2 STATE 3 STATE 4 EVENT 1 EVENT 2 EVENT 3
Transitions form patterns & pathways STATE 1 STATE 4 STATE 2 EVENT 2 EVENT 1 EVENT 5 STATE 5
Leaving breadcrumb trails of patient movement
Breadcrumbs create visualizations for populations
And visualizations for patients
Revealing previously unseen insights
And prompting action <ul><li>syndication </li></ul>data widgets
Ergo  <ul><li>Overview: state-based computing </li></ul><ul><li>Technical: event streams & state machines </li></ul><ul><l...
ERS Platform EVENT  TRANSLATOR (TCP/IP, FTP,  HTTP, SOAP)   SYNDICATION INTERFACE EVENT  QUEUE EVENT EVENT STATE MACHINE E...
Event translator <ul><li>is an  interface  between external data sources and the platform </li></ul><ul><li>supports vario...
What are ‘events’? <ul><li>reflect  change . </li></ul><ul><li>are  atomic  in scope. </li></ul><ul><li>are means to  stan...
Event structure <EVENT EventID=123309 Type=Diagnosis> <ERS_MEMBER_ID>19902</ ERS_MEMBER_ID> <EVENT_DATE>20050912</ EVENT_D...
Event flow <ul><li>Events circulate through the platform, keeping it ‘ live ’ </li></ul><ul><li>Event Queue: is a temporar...
Business rules engine STATE MACHINE ENGINE EVENT EVENT DISPATCHER Subscription Rules:  govern the delivery of events  to t...
State Machines A state machine is the oldest known formal  model for sequential behavior  i.e. behavior that cannot be def...
State machine attributes <ul><li>Sequence neutrality : Regardless of the order in which events arrive, the end-state, once...
State machine engine <ul><li>Interacts with Event Dispatcher to deliver events to the correct state machines. </li></ul><u...
Sample state machines:  HEDIS Breast Cancer Screening UNILATERAL  MASTECTOMY 1 BILATERAL  MASTECTOMY 3 4 6 2 5 1. PROC EVE...
Syndication Interface The syndication interface makes state and  event data available  to entities accessing  the ERS plat...
Ergo principles <ul><li>Open Source  </li></ul><ul><li>Open Standards  </li></ul><ul><li>Loosely Coupled, Component Based ...
Consideration of technologies and tools Java JBoss (Platform) Eclipse (RDE) MySQL (Database) OSMQ (Queue) Tomcat JSP Ruby ...
Ergo  <ul><li>Overview: state-based computing </li></ul><ul><li>Technical: event streams & state machines </li></ul><ul><l...
Social Modeling Health care is  intrinsically   social   –  people , not machines 1. Capture and analyze  social  aspects ...
Ingenium (Latin):  personal attributes  or  qualities ,  disposition Social tendencies Value hierarchies Behavioral trigge...
Ingenium Matrices Internal (Emotions) External (Information) Support (Community) System (Navigation) Mainstream Maximizer ...
Methodology A B D C Lit E=MC 2 Data Sources Demographic Survey HRA Case Management Websites Ethnography State Machines Bre...
Whole Twins Physiology Ingenium + = Whole Twin
Applications <ul><ul><li>Attention </li></ul></ul><ul><ul><li>Intention </li></ul></ul><ul><ul><li>Content Selection </li>...
Opportunities Bring  THEM TOGETHER   to help build 1 You built  IT   and no ONE came
Ergo  <ul><li>Overview: state-based computing </li></ul><ul><li>Technical: event streams & state machines </li></ul><ul><l...
Methodology 08454328211199999454545313131272727 146454328885546464646463333334763982 239388543223856552090098744886660111 ...
Multi-dimensional archetypes form  ‘care chromosomes’ Patient 1 Patient 2 Patient 3 Patient 4 Patient 5 for patients…
And care chromosomes for… physicians treatment protocols geographies facilities
Care chromosomes do what? Predict future pathways & Connect ‘Twins’
Care chromosomes: other applications   ‘live’ and change over time Patient 1 Start date: End date: 03.01.2005 10.01.2005 S...
Care chromosomes: other applications mapped to visualize  health care delivery practice patterns shape: ‘geography of care...
More on methodology Algorithm Toolbox <ul><li>Rather than argue about whether this algorithm is better than that algorithm...
Algorithms applied One state machine Many state machines Person Population
Ergo  <ul><li>Overview: state-based computing </li></ul><ul><li>Technical: event streams & state machines </li></ul><ul><l...
Action Everyone spoke of an information overload,  but what there was in fact  was a non-information overload.   Richard S...
Syndication Interface External Apps Patterns & Pathways SYNDICATION INTERFACE Request/Response Publish/Subscribe ERS DATAB...
Widgets for people  I can create my own or plug&play with existing apps Personal Health Record Patient panel manager Healt...
Ergo   <ul><li>Overview: state-based computing </li></ul><ul><li>Technical: event streams & state machines </li></ul><ul><...
Loosely coupled value constellations <ul><li>-Broad Institute : connectivity map </li></ul><ul><li>-One World Health : ope...
What we could do… Simple standards that allow easy exchange of events & measures   global community program:   communities...
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Perpetual Analytics - Health in Motion

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Perpetual Analytics - Health in Motion

  1. 1. <ul><li>perpetual analytics </li></ul><ul><li>health in motion </li></ul>join the conversation wethink.pbwiki.com
  2. 2. THE Opportunity <ul><li>Personalization </li></ul><ul><li>Integration </li></ul><ul><li>Participation </li></ul>
  3. 3. Ergo <ul><li>Overview : why state-based computing </li></ul><ul><li>Technical : event streams & state machines </li></ul><ul><li>Social Modeling : ingeniums & twins </li></ul><ul><li>Predictive Modeling : patterns & pathways </li></ul><ul><li>Action : widgets for people </li></ul><ul><li>Vision : what we could do… </li></ul>
  4. 4. Ergo <ul><li>Overview: state-based computing </li></ul><ul><li>Technical: event streams & state machines </li></ul><ul><li>Social Modeling: ingeniums & twins </li></ul><ul><li>Predictive Modeling: patterns & pathways </li></ul><ul><li>Action: widgets for people </li></ul><ul><li>Vision: what we could do… </li></ul>
  5. 5. States maintain time and order <ul><li>Patient entered State 1 on 1/1/06 </li></ul><ul><li>Diagnosis moved patient to State 2 on 2/1/06 </li></ul><ul><li>Patient in State 1 (30 days) </li></ul><ul><li>Patient currently in State 2 </li></ul>STATE 1 STATE 2
  6. 6. Events trigger transitions between states STATE 1 STATE 2 STATE 3 STATE 4 EVENT 1 EVENT 2 EVENT 3
  7. 7. Transitions form patterns & pathways STATE 1 STATE 4 STATE 2 EVENT 2 EVENT 1 EVENT 5 STATE 5
  8. 8. Leaving breadcrumb trails of patient movement
  9. 9. Breadcrumbs create visualizations for populations
  10. 10. And visualizations for patients
  11. 11. Revealing previously unseen insights
  12. 12. And prompting action <ul><li>syndication </li></ul>data widgets
  13. 13. Ergo <ul><li>Overview: state-based computing </li></ul><ul><li>Technical: event streams & state machines </li></ul><ul><li>Social Modeling: ingeniums & twins </li></ul><ul><li>Predictive Modeling: patterns & pathways </li></ul><ul><li>Action: widgets for people </li></ul><ul><li>Vision: what we could do… </li></ul>
  14. 14. ERS Platform EVENT TRANSLATOR (TCP/IP, FTP, HTTP, SOAP) SYNDICATION INTERFACE EVENT QUEUE EVENT EVENT STATE MACHINE ENGINE EVENT BUSINESS RULES ENGINE MEMBER STATES EVENT DISPATCHER EVENT HANDLER Patterns/Pathways Research Ergo Widgets External Applications CLIENT DATA SOURCES ADMINISTRATIVE, CLAIMS, CLINICAL, SURVEY, BIOMETRIC, GENETIC TEXT, XML, X12N, HL7, EDI, EDIFACT, RSS EVENT Devices
  15. 15. Event translator <ul><li>is an interface between external data sources and the platform </li></ul><ul><li>supports various data formats both industry specific and generic </li></ul><ul><li>translates all incoming data into standardized health events </li></ul><ul><li>is protocol agnostic, accepting data as discrete batches or continuous flows </li></ul><ul><li>handles data cleansing, member matching, de-duping tasks </li></ul>DATA SOURCES: ADMINISTRATIVE, CLAIMS, CLINICAL, SURVEY, BIOMETRIC, GENETIC TEXT, XML, X12N, HL7, EDI, EDIFACT, RSS External Applications Ergo Widgets Event translator: SYNDICATION INTERFACE EVENT TRANSLATOR (TCP/IP, FTP, HTTP, SOAP) BUSINESS RULES ENGINE
  16. 16. What are ‘events’? <ul><li>reflect change . </li></ul><ul><li>are atomic in scope. </li></ul><ul><li>are means to standardize and integrate data. An event type can be generated from multiple data sources and a data source can create multiple events. </li></ul><ul><li>support two-time concept: when an event arrives is different than when the event has occurred. The impact of an event depends on both. </li></ul>Events are medically significant occurrences. Events: Event types: 1. external data based 2.system based 3.state based EVENT EVENT
  17. 17. Event structure <EVENT EventID=123309 Type=Diagnosis> <ERS_MEMBER_ID>19902</ ERS_MEMBER_ID> <EVENT_DATE>20050912</ EVENT_DATE> <SYSTEM_DATE>20060620</ SYSTEM_DATE> <CODE> <TYPE>ICD9</TYPE> <CODE_VALUE>250.02</ CODE_VALUE> </CODE> … . </EVENT> A rich, flexible and standard way of defining healthcare data XML structures provide the flexibility events need Events have attributes both generic and specific Events can become the foundation for standardized data exchange Events can be easily mapped to other standards such as HL7
  18. 18. Event flow <ul><li>Events circulate through the platform, keeping it ‘ live ’ </li></ul><ul><li>Event Queue: is a temporary home for events until they are delivered to destination state machines </li></ul><ul><li>Event Dispatcher: retrieves events from the queue and publishes them to subscribed state machines </li></ul><ul><li>Business rules: define complex subscription criteria </li></ul>Event flow: EVENT QUEUE EVENT EVENT BUSINESS RULES ENGINE EVENT DISPATCHER EVENT HANDLER STATE MACHINE ENGINE MEMBER STATES
  19. 19. Business rules engine STATE MACHINE ENGINE EVENT EVENT DISPATCHER Subscription Rules: govern the delivery of events to target state machines Transition Rules: govern state transitions based on the arrival of events State Rules: govern actions based on states reaching thresholds Data Rules: govern the translation of data sources into events and enforce Data Quality and Referential Integrity BUSINESS RULES ENGINE EVENT TRANSLATOR
  20. 20. State Machines A state machine is the oldest known formal model for sequential behavior i.e. behavior that cannot be defined by the knowledge of inputs only, but depends on the history of the inputs. <ul><ul><ul><ul><ul><li>State Machines are built by coupling a set of predefined states through transitions , which are governed by business rules that detail conditions necessary for transitions. Actions can be triggered when a state is entered, exited, or during its existence. </li></ul></ul></ul></ul></ul>STATE 1 STATE 2 STATE 3 STATE 4 EVENT EVENT EVENT EVENT EVENT EVENT Default Transition Conditional Transition Final Transition Action: Event Generation
  21. 21. State machine attributes <ul><li>Sequence neutrality : Regardless of the order in which events arrive, the end-state, once all events are applied, is the same. </li></ul><ul><li>Continuous and real time execution : Information received is processed, its impact persisted, and disseminated immediately. </li></ul><ul><li>Two-time : The time an event occurred is distinguished from the time an event is known . State machines track of both and use them to perform complex time based decisions. </li></ul><ul><li>Changing history : History can be changed by events nullifying prior events. </li></ul>
  22. 22. State machine engine <ul><li>Interacts with Event Dispatcher to deliver events to the correct state machines. </li></ul><ul><li>Manages all state machine internal activity. </li></ul><ul><li>Interacts with Syndication Interface to respond to application requests </li></ul>SYNDICATION INTERFACE EVENT MEMBER STATES STATE MACHINE ENGINE State machine engine: BUSINESS RULES ENGINE
  23. 23. Sample state machines: HEDIS Breast Cancer Screening UNILATERAL MASTECTOMY 1 BILATERAL MASTECTOMY 3 4 6 2 5 1. PROC EVENT (UNILATERAL MASTECTOMY) 2. PROC EVENT (UNILATERAL MASTECTOMY) 3. BIRTH DAY EVENT AGE=69 {GENDER=‘F’} 4. BIRTH DAY EVENT AGE=69 {GENDER=‘F’} 5. PROC EVENT (BILATERAL MASTECTOMY) 6. BILATERAL MASTECTOMY EVENT CREATED 1. NEW MEMBER EVENT {SYSDATE - MEM.DOB >= 50 AND GENDER=‘F’}, EXPIRE: +365 DAYS 1. BIRTH DAY EVENT AGE=50 {GENDER=‘F’} , EXPIRE: +365 DAYS 2. STATE EXPIRATION 3. PROC EVENT (BCS) EXPIRE: +365 DAYS 4. STATE EXPIRATION 5. BIRTH DAY EVENT AGE=69 {GENDER=‘F’} 5. BILATERAL MASTECTOMY EVENT 6. BIRTH DAY EVENT AGE=69 {GENDER=‘F’} 6. BILATERAL MASTECTOMY EVENT 7. BIRTH DAY EVENT AGE=69 {GENDER=‘F’} 7. BILATERAL MASTECTOMY EVENT 8. PROC EVENT (BCS) EXPIRE: +365 DAYS 1 4 5 2 7 3 6 PENDING GAP NO GAP 8 Screening Gap Mastectomy
  24. 24. Syndication Interface The syndication interface makes state and event data available to entities accessing the ERS platform External Devices External Apps Patterns & Pathways SYNDICATION INTERFACE Request/Response Publish/Subscribe ERS DATABASE XML, CCR, openEMR, HL7
  25. 25. Ergo principles <ul><li>Open Source </li></ul><ul><li>Open Standards </li></ul><ul><li>Loosely Coupled, Component Based Architecture </li></ul><ul><li>Architecture of Participation </li></ul><ul><li>Collective Intelligence </li></ul><ul><li>Lightweight Applications </li></ul>
  26. 26. Consideration of technologies and tools Java JBoss (Platform) Eclipse (RDE) MySQL (Database) OSMQ (Queue) Tomcat JSP Ruby on Rails Ajax Esper (CEP) UNIMOD (State Machine) Simulink (State Machine) ruleCore Thingamy iLogic ruleML BPEL BRML Middleware & Backend Frontend State Machine Rules & Workflow
  27. 27. Ergo <ul><li>Overview: state-based computing </li></ul><ul><li>Technical: event streams & state machines </li></ul><ul><li>Social Modeling: ingeniums & twins </li></ul><ul><li>Predictive Modeling: patterns & pathways </li></ul><ul><li>Action: widgets for people </li></ul><ul><li>Vision: what we could do… </li></ul>
  28. 28. Social Modeling Health care is intrinsically social – people , not machines 1. Capture and analyze social aspects of health care as data 2. Understand and act upon all data in social environments
  29. 29. Ingenium (Latin): personal attributes or qualities , disposition Social tendencies Value hierarchies Behavioral triggers Psychological attributes Care preferences Decision processes Learning styles Emotional processes
  30. 30. Ingenium Matrices Internal (Emotions) External (Information) Support (Community) System (Navigation) Mainstream Maximizer Naturalist Minimalist Moderate Intentional Sporadic Specific Distrust Ease Quantity Necessity Quality Systematic Low Programmatic Ad hoc Gain Self Security
  31. 31. Methodology A B D C Lit E=MC 2 Data Sources Demographic Survey HRA Case Management Websites Ethnography State Machines Bread crumb trails Ingenium Archetypes Outcomes Data Literature/Science Pattern Analysis / +
  32. 32. Whole Twins Physiology Ingenium + = Whole Twin
  33. 33. Applications <ul><ul><li>Attention </li></ul></ul><ul><ul><li>Intention </li></ul></ul><ul><ul><li>Content Selection </li></ul></ul>What article should I read to learn more about my arthritis? Should I have back surgery or physical therapy? <ul><ul><li>Choice of Treatment </li></ul></ul>
  34. 34. Opportunities Bring THEM TOGETHER to help build 1 You built IT and no ONE came
  35. 35. Ergo <ul><li>Overview: state-based computing </li></ul><ul><li>Technical: event streams & state machines </li></ul><ul><li>Social Modeling: ingeniums & twins </li></ul><ul><li>Predictive Modeling: patterns & pathways </li></ul><ul><li>Action: widgets for people </li></ul><ul><li>Vision: what we could do… </li></ul>
  36. 36. Methodology 08454328211199999454545313131272727 146454328885546464646463333334763982 239388543223856552090098744886660111 444388543885567023145006898823224660 901388543001119999934337656888222781 082900032300455601198987232732050069 727963088333098903222561149077226398 331963088444609609877232323011098934 865774777668866889049049043338788788 State machines produce Bread crumb trails over time Patterns inform archetypes Bread crumb trails allow us to discover patterns
  37. 37. Multi-dimensional archetypes form ‘care chromosomes’ Patient 1 Patient 2 Patient 3 Patient 4 Patient 5 for patients…
  38. 38. And care chromosomes for… physicians treatment protocols geographies facilities
  39. 39. Care chromosomes do what? Predict future pathways & Connect ‘Twins’
  40. 40. Care chromosomes: other applications ‘live’ and change over time Patient 1 Start date: End date: 03.01.2005 10.01.2005 Snapshot Patient 1 Start date: End date: 03.01.2005 Today Live t = 1 t = 2
  41. 41. Care chromosomes: other applications mapped to visualize health care delivery practice patterns shape: ‘geography of care’—physicians, physician groups, hospitals colors: variable of interest - cost - rate of treatment - rate of diagnosis - re-admissions - etc.
  42. 42. More on methodology Algorithm Toolbox <ul><li>Rather than argue about whether this algorithm is better than that algorithm, all you have to do is get ten times more training data. And now all of a sudden, the worst algorithm ... is performing better than the best algorithm on less training data. Worry about the data first before you worry about the algorithm. </li></ul><ul><li>Peter Norvig, Google </li></ul>n-gram Predictive Clustering Pattern Discovery Hidden Markov Models stochastic trees dynamic time warping LCSS dendogram
  43. 43. Algorithms applied One state machine Many state machines Person Population
  44. 44. Ergo <ul><li>Overview: state-based computing </li></ul><ul><li>Technical: event streams & state machines </li></ul><ul><li>Social Modeling: ingeniums & twins </li></ul><ul><li>Predictive Modeling: pathways & patterns </li></ul><ul><li>Action: widgets for people </li></ul><ul><li>Vision: what we could do… </li></ul>
  45. 45. Action Everyone spoke of an information overload, but what there was in fact was a non-information overload.   Richard Saul Wurman, What-If, Could-Be (1976)
  46. 46. Syndication Interface External Apps Patterns & Pathways SYNDICATION INTERFACE Request/Response Publish/Subscribe ERS DATABASE Controls External Devices Model View ergo widgets Record Set Queue List Measure
  47. 47. Widgets for people  I can create my own or plug&play with existing apps Personal Health Record Patient panel manager Health Coaching application My Application Existing Application
  48. 48. Ergo <ul><li>Overview: state-based computing </li></ul><ul><li>Technical: event streams & state machines </li></ul><ul><li>Social Modeling: ingeniums & twins </li></ul><ul><li>Predictive Modeling: patterns & pathways </li></ul><ul><li>Action: widgets for people </li></ul><ul><li>Vision: what we could do… </li></ul>
  49. 49. Loosely coupled value constellations <ul><li>-Broad Institute : connectivity map </li></ul><ul><li>-One World Health : open source treatment discovery </li></ul><ul><li>Linden Labs : life in the virtual world & rapid prototyping </li></ul><ul><li>Walmart : supply chain </li></ul><ul><li>Amazon : S3 & E2, storage and computing as utilities </li></ul><ul><li>Netflix : ‘Cinematch’ predictive modeling competition </li></ul><ul><li>Home Depot : ‘toolbox’ extension of health coverage </li></ul>
  50. 50. What we could do… Simple standards that allow easy exchange of events & measures global community program:   communities partner across the globe to collaboratively improve health Medical research program:   make data, ERS platform, and pattern library available to medical researchers Work with Mozilla foundation to create a “health” browser Health communities &quot;scrapbook&quot; online about ways they are taking control of their own health What can we take that is currently 'closed' and make it 'open' P2P health insurance:  rewards for 'buddy' team Sponsor an open competition to devise new insurance models Widget maker: allow user to create new widgets towards a widget library

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