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  • This is a multi-purpose slide with the circle representing visually the phenomenon that require crowd sourced approaches to predicting and preventing the broken symmetry of the previous relationship.Example: China a nation of white rice eaters seemed immune to the effects of highly refined CHOs yet as they moved from 80% activity based employment to 80% knowledge-based employment the activity level of the nation plummeted and the expected CHO response was exposed in this population. China now the highest rate of DMII conversion on the globe…biggest population.Consistently high yield health behaviors…refined CHO exposure and low activity levels.1980’s in the US, trans fats on the rise, increasing sedentary behavior and a crowd shift towards refined CHO’s fueling the 66% overweight or obese. Free living systems do not follow the simple laws of thermodynamics…energy in vs. energy out. Difficult to track but clinical practice would suggest that environmentally induced altered gene expression is a fundamental mediator of these free living systems outcomes.
  • [1] Strong American Schools analysis of data from the Organization for Economic Cooperation and Development. Based on data from Volume 2, table 6.2a (p. 227). Rank is based on students performing at Level 6 in each country on the 2006 PISA math assessment.[2] Schmidt, W. (2003, February 4). “Presentation to Mathematics and Science Initiative.”
  • This is a multi-purpose slide with the circle representing visually the phenomenon that require crowd sourced approaches to predicting and preventing the broken symmetry of the previous relationship.Example: China a nation of white rice eaters seemed immune to the effects of highly refined CHOs yet as they moved from 80% activity based employment to 80% knowledge-based employment the activity level of the nation plummeted and the expected CHO response was exposed in this population. China now the highest rate of DMII conversion on the globe…biggest population.Consistently high yield health behaviors…refined CHO exposure and low activity levels.1980’s in the US, trans fats on the rise, increasing sedentary behavior and a crowd shift towards refined CHO’s fueling the 66% overweight or obese. Free living systems do not follow the simple laws of thermodynamics…energy in vs. energy out. Difficult to track but clinical practice would suggest that environmentally induced altered gene expression is a fundamental mediator of these free living systems outcomes.
  • # of friends vs. retention rate
  • # of friends vs. retention rate

Transcript

  • 1. 2011Tech Venture Series
    Manchester
    Brigitte Piniewski, MD Chief Medical Officer
    PeaceHealth Laboratories, OregonVice Chair MAWG
    Continua Health Alliance
    2011 PeaceHealth Laboratories
    1
    Enabling high performance crowds
    with innovative business models
  • 2. Overview:
    Problem state: Out dated man-made constructs
    Centralized Currency, Traditional Medical model, concept of “normal”, Policy and Regulatory model…
    Transforming Health Value/Cost landscape
    Modern Health Intelligence Procurement Engines
    Re-writing history using crowd-based approaches
    Innovative Business models: Universal Academic Campus use-case and tuition fee lift
    Global Health Economy
    2011 PeaceHealth Laboratories
    2
  • 3. 2011 PeaceHealth Laboratories
    3
    Outdated Man-made constructs: Failure to predict or prevent the human performance gap
    As modernization advances…
    Yesterday’s
    Economic Models
    Advance
    Performance
    Gaps and
    Social justice
    Gaps
    Good
    Assumptions
    Crowd Performance erodes
    Poor
    Time = 1980’s
  • 4. 1964 Thinking…
    Medical costs are skyrocketing.
    Doctors are often scarce.
    Hospitals are misused.
    The Medical Profession is in Turmoil.
    4
    2011 PeaceHealth Laboratories
  • 5. 2011 PeaceHealth Laboratories
    5
    Low expectations for American students.
    America’s top math students rank 25thout of 30 countries
    when compared with top students elsewhere in the world. [1]
    By the end of 8th grade, U.S. students are two years behind in the math
    being studied by peers in other countries. [2]
    Seventy percent of 8th graders can’t read at their grade level, and most will
    never catch up.
    Project at Bristol University shows [3]
    Kids diet affects IQ perhaps permanently
    [1] Strong American Schools analysis of data from the Organization for Economic Cooperation and Development.
    Based on data from Volume 2, table 6.2a (p. 227). Rank is based on students performing at Level 6 in each country
    on the 2006 PISA math assessment.
    [2] Schmidt, W. (2003, February 4). “Presentation to Mathematics and Science Initiative.”
    [3] http://www.dailymail.co.uk/health/article-1354683/Junk-food-diet-hits-childs-IQ-reveals-major-UK-study.html
  • 6. Fall from freedom…
    6
    5-6 Million Years
    30-40 Years
    The Economist 2003
    One billion adults overweight world wide
    2011 PeaceHealth Laboratories
  • 7. Key Problem:
    Ignoring biologically-mediated constraints is not without consequence
    Our pure pursuit of profit violates interdependencies crippling system performance
    Mankind is limited through our man-made structures; our medium of exchange, policy, medical model, concept of normal and others
    These old models fail to advance at the pace of change
    As a result, we remain blind to high yield performance intelligence
    Marketplaces are limited in capacity to exchange and build wealth due to an under-performing transactional tool
    2011 PeaceHealth Laboratories
    7
    Arthur Brock, Founder, Software designer, Systems Architect at the Geek Gene
    http://wiki.thetransitioner.org/English/Free_currencies/Free_Currencies:_the_next_global_currency_system
  • 8. Wayne Gretzky
    2011 PeaceHealth Laboratories
    8
    “You miss 100% of the shots
    you don’t take.”
    “You miss 100% of the health intelligence
    you fail to monetize.” Brigitte Piniewski
  • 9. Out dated Medical model
    “Traditional acute care model is a relic of a by-gone era.”
    “Normal is of low utility in a world where we are no longer accidentally well”
    2011 PeaceHealth Laboratories
    9
  • 10. 10
    Actual
    Goal
    Non-modifiable Contributors to Disease (Age, Gender, Genes)
    Modifiable Contributors to Disease (Lifestyle)
    Hu et al. Diet, lifestyle and the risk of type 2 Diabetes in women. NEJM 2001 Sep 13;345(11):790-7.
    Opportunity:60-80% Adverse Health is Modifiable
    Non-modifiable contributors
    Age, gender and genes
    Modifiable contributors
    Lifestyle choices
    Today, poor lifestyle choices increasingly are the largest contributors to common adverse health outcomes
    83% Heart Disease
    91% Diabetes
    69% Cancer
    2011 PeaceHealth Laboratories
  • 11. Modifiable contributors
    2011 PeaceHealth Laboratories
    11
    • 58% Reduction in Diabetes with lifestyle modification
    • 12. Tuomilehto, 2001 NEJM 344(18): 1343-50
    • 13. 60% Less Cancer
    • 14. De Lorgeril, Arch Int Med 1998;158:1181-87
    • 15. 83%less Heart Disease
    • 16. 91%less Diabetes
    • 17. Nurses Health Study, NEJM 2000;343:16-22, NEJM 2001;345:790-97
    • 18. 73% less CHD
    • 19. 69% less Cancer
    • 20. HALE Project. Knoops JAMA 2004;292:1433-1439
    • 21. 60% Fewer Cardiac Events
    • 22. Hambrecht Circulation 2004;109:1371-78
    • 23. 44% Reduction in total mortality (NNT=16)
    • 24. Lyon Heart Study, Circulation 1999;99:779-85
    • 25. 45% Reduction in total mortality (NNT=2.4)
    • 26. Indian Heart Study, BMJ 1992;304:1015-19
    • 27. 40% Mortality Reduction
    • 28. GISSI-Prevenzione, Med.Diet AHA11/01: Marchioli
    • 29. 67% Mortality Reduction
    • 30. Indo-Med Study, Lancet 2002;360:1455-61]
  • 2011 PeaceHealth Laboratories
    12
    Modern Crowd health landscape…
    Age
    0 25 65 years
    Illness Pre-Illness Wellness
    60-80% Preventable
    Death
    Crowd Achievable Health
    Crowd Actual Health Outcomes
  • 31. “Normal” means prevalent not “Optimal”
    Age
    0 25 65
    Illness Pre-Illness Wellness
    Death
    2008
    13
    13
    2011 PeaceHealth Laboratories
  • 32. Transforming Health Cost Landscape
    “Is there a reciprocal relationship between Health value efficiency and health dollars spent?”
    “The crowd, not the medical community,
    controls the card game”
    2011 PeaceHealth Laboratories
    14
  • 33. 2011 PeaceHealth Laboratories
    15
    Health Cost Landscape
    Age
    0 25 65
    $ $ $
    60-80% Lifestyle
    Illness Pre-Illness Wellness
    Unpredictable Health
    Predictable (Rules-based) Health
    Death
    2008
    15
  • 34. 2011 PeaceHealth Laboratories
    16
    Business Model Landscape
    Age
    0 25 65
    60-80% Lifestyle
    Illness Pre-Illness Wellness
    $ $ $
    Unpredictable Health
    Predictable (Rules-based) Health
    Death
    2008
    16
  • 35. 2011 PeaceHealth Laboratories
    17
    $ $ $
    Evidence-based Medicine
    Age
    0 25 65
    $ $ $
    60-80% Lifestyle
    Illness Pre-Illness Wellness
    Unpredictable Health
    Predictable (Rules-based) Health
    Death
    2008
    17
  • 36. 2011 PeaceHealth Laboratories
    18
    High definition living
    Age
    0 25 65
    Illness Pre-Illness Wellness
    Unpredictable Health
    Predictable (Rules-based) Health
    Death
    2008
    18
  • 37. New Currency models:
    2011 PeaceHealth Laboratories
    19
    Money is a narrow expression of wealth
    Gaming expands our currency skill set
    Reliable unit of Health value
    efficiency
    Centralized
    Currency
    Frivolous
    Gaming
  • 38. Modern Health Intelligence Procurement Engines
    “Household and individual data trumps institutional data”
    “Communities as co-producers of their own health futures”
    2011 PeaceHealth Laboratories
    20
  • 39. 2011 PeaceHealth Laboratories
    21
    Modern Knowledge procurement
    Age
    0 25 65
    Crowd-accelerated
    Strategic Intelligence
    60-80% Lifestyle
    Illness Pre-Illness Wellness
    Legacy Knowledge Systems
    Death
  • 40. New Knowledge Paradigm
    2011 PeaceHealth Laboratories
    22
    Historical data
    “Old stuff”
    Continua Linked
    Current per unit
    co-occurrences
    Relative Clinical
    Relevance
    Lightly-instrumented Crowds
    Malignant vs. Benign
    Co-occurrences
  • 41. 2011 PeaceHealth Laboratories
    23
    “Powered” to affect Reachability
    Reachability Gap
    • High Yield data
    • 42. Crowd sourcing
    • 43. Crowd sharing
    • 44. Modern Knowledge Systems
    • 45. Abundance Models
    modernization
    Good
    Crowd Performance
    Poor
    Time = 1980’s
  • 46. Reachability Gap Management
    Radical transformation in how we create our information environment or knowledge engines
    Set of shared, accessible community health resources
    Citizens are not passive recipients of goods but co-creators of health value
    Ultra large scale systems continuously evolving and providing sufficient correctness
    Encourage community custodianship and crowd co-management
    “One cannot conceive of a crowdsourced systems
    functionality in terms of “releases” and more than
    a city has a release.
    Metropolis Model , A New logic for development of Crowdsourced systems
    by Rick Kazman and Hong-meiChen, 2010
    2011 PeaceHealth Laboratories
    24
  • 47. 2011 PeaceHealth Laboratories
    25
    Data Aggregation & AnalyticsNew knowledge engines: University of Oregon, Kent State, UNCC
    Yellow Node = Obesity (i.e BMI)
    Social Network = Behavior Changes
    Per-unit
    Co-Occurrences
    Personally
    Relevant Health Knowledge
    Predictive Individual trend from Crowd trends
  • 48. Re-writing history using crowd-based approaches
    “Light instrumentation of the crowd tracking high yield health adjustment and delivering high definition living”
    2011 PeaceHealth Laboratories
    26
  • 49. 2011 PeaceHealth Laboratories
    High Yield health data…
    • Weight change
    • 50. Activity change
    • 51. Response to
    nutrition
    27
  • 52. 28
    Sync up the biological space with the digital space
    Old segmentation models:
    New segmentation models: Digitize units of high yield health contributors that span age,
    gender, and diagnostic category …
    Young
    Modifiable
    Health
    60-80%
    Old
    Un-modifiable health
    (Everything else)
    2011 PeaceHealth Laboratories
  • 59. 29
    DNA
    DNA
    DNA
    DNA
    DNA
    DNA
    IR as a common metabolic portal
    Obesity
    Diabetes T2
    Hypertension
    Cardiovascular Disease
    Liver Disease
    Some Cancers
    Alzheimer's
    Other adverse health
    outcomes
    Insulin
    Resistance
    Jerald Reaven MD, 1988 Banting lecture: Insulin Resistance
    2011 PeaceHealth Laboratories
  • 60. n = 1 vs. n = many
    Larger group of people
    Sally
    Insulin
    resistance= X
    Insulin
    resistance= X + 2
    Insulin
    resistance= X
    Insulin
    resistance= X + 2
    Medical view
    Average quality of outcome for this group
    Quality of outcome
    for Sally
    Average healthcare costs for this group
    Healthcare costs
    for Sally
    Policy view
    30
    2011 PeaceHealth Laboratories
  • 61. 2011 PeaceHealth Laboratories
    31
    Crowd Data Lowering the barriers to participate
    Device Interface
    XHR Interface
    Community
    Data Commons
    Wireless Pulse Oximeter
    PHR
    Weighing Scale
    Secure PHR
    Wireless
    Ultra Low Power
    Ultra low cost
    Blood Pressure Monitor
  • 62. Crowd SharingiWell Study at PeaceHealth Laboratories
    Web sensors
     
    Activity
    Employers
    Personalized motivational Interventions
    Weight
    Health
    Coach
    Cloud Informatics
    H-Pod
    Events, User Content,
    Measured KPIs
    Pulse rate &
    Blood pressure
    Health Payer
    (Insurance)
    +
    Lab Draws
    DM program
    provider
    Consumers
    Other device
    Medical Lab
    Other device
    Analytic Engine
    Recommendation
    Trainer / Nutritionist / Physicians
    Other device
    2011 PeaceHealth Laboratories
    32
  • 63. iMPak; Meridian and Cypak JV
    33
  • 64. Activity and Progress Tracking
    34
    9/29/2011
  • 65. Social Network Impact
    9/29/2011
    35
    SPD vs. SN size
    SPD
    The larger your social network, the more active you are.
    SN size
  • 66. 9/29/2011
    36
  • 67. 9/29/2011
    37
  • 68. CVD Risk Reduction of 12.3% in 3 months
    38
    9/29/2011
    0 mo
    3 mos
    Reduced
    CVD risk
  • 69. Diabetes Risk Reduction of 15.8% in 3 months
    39
    9/29/2011
  • 70. Innovative Business models:The Universal Academic Campus use-case creates infectious action
    “Gone are the passively prematurely unwell…
    “Leveraging connectivity to co-produce your own performance futures”
    2011 PeaceHealth Laboratories
    40
  • 71. Youth as super nodes
    2011 PeaceHealth Laboratories
    41
    • Digital natives
    • 72. Already connected to large numbers
    • 73. Have influence over each other’s behavior
    • 74. Used to uniting to get things done
    • 75. Are early in their health journey
    • 76. Share information
    • 77. Comfortable with alternative currencies (gaming)
    • 78. Have a common enemy : Tuition Fees
  • 2011 PeaceHealth Laboratories
    42
    Sample use cases:
    Flu epidemics
    Breast Cancer
  • 79. Global Health Economy
    2011 PeaceHealth Laboratories
    43
    Crowd-relevant
    Benchmarking
    Cloud
    Health Intelligence
    To leapfrog
    Sub-Optimal
    Outcomes
    Disruptive Innovation
  • 80. Who is Connecting?
    C. Codagnone, Institute for Prospective Technology Studies, EU Commission Spain
    D. Osimo, Tech4i2,Pursuasive Technologies, Brussels Belgium
    Trevor Cooper,Connected Embedded Cloud Solutions, Intel US
    David Kil, SKT Americas, CSO Informatics, Sunnyvale, CA USA
    Dejing Dou, Associate Professor in the Department of Computer and Information Science, University of Oregon, USA
    Jessica Greene,Associate Professor in the Department of Planning, Public Policy & Management , U of Oregon, USA
    Xintao Wu PhD, Associate professor of Computing and Informatics at the University of N Carolina at Charlotte
    RuomingJin PhD, Assistant professor of Computer Science at Kent State University
    Prof. Iain E. BuchanDirector NIBHI & NWeH Science, University of Manchester
    Others…
    2011 PeaceHealth Laboratories
    44
  • 81. 2011 PeaceHealth Laboratories
    45
    US EU collaborative technical report,
    “Nudging lifestyles for better health outcomes:
    crowdsourced data and persuasive technologies
    for behavior change”
    Piniewski et al. EUR 24785 EN - 2011
    Brigitte Piniewski, MD
    Chief Medical Officer
    PeaceHealth Laboratories
    1201 Lloyd Blvd, Suite 200
    Portland, OR 97232
    503 720 0655 (c)
    541-222-7461 (o)       541-431-9152 (f)
    bpiniewski@peacehealthlabs.org
    http://www.peacehealth.org/
    The END
  • 82. Extra slides:
    2011 PeaceHealth Laboratories
    46
  • 83. Student Community data commons: Online & Mobile
    Fast access to goals, guidance, support to stay motivated and connected
    • Real-time Activity Tracking
    • 84. Personalized Goals
    • 85. Virtual Coaching
    • 86. Wellness Games & Competitions
    • 87. Social Network & Nudging
    47
    2011 PeaceHealth Laboratories
  • 88. System at a Glance: How it Works
    Sensor network
    Informatics Engine
    Consumer touch
    Simple and effective
    Identifying behavior-change genes
    Advanced Activity Capture
    • Dashboard
    • 89. Wellness meter
    • 90. Level + role model
    • 91. SN messages
    • 92. UGC with social nudging
    • 93. Virtual coaching
    • 94. Competition
    • 95. Games + goals
    • 96. Steps per minute captured
    • 97. Automatic wireless data aggregation from additional sensors
    • 98. Accuracy : SPM to speed, height, weight, and gender
    • 99. Activity-type recognition
    • 100. Activity-pattern clustering
    • 101. Part of recommendation
    • 102. Complex event processing
    • 103. User models with predictive algorithms for intent
    • 104. Adaptive micro intervention
    • 105. Social network computing
    • 106. Causal network-based outcomes analytics
    • 107. Web3 analytics
    Data
    Modeling
    Action
    Impact
    48
    2011 PeaceHealth Laboratories
  • 108. Social Network Impact
    9/29/2011
    49
    SPD vs. SN size
    SPD
    The larger your social network, the more active you are.
    Mean CVD risk reduction = 12.3%
    Mean DMII risk reduction =15.8%
    …in 3 months !!!
    SN size
  • 109.
  • 110. Biological systems: Digitization road map
    Simple user experience
    Low cost & scalable
    easy to track high yield contributors (IR, activity)
    easy to share (social networking)
    low security risk (benign data)
    Wide therapeutic window (lifestyle adjustment strategies)
    etc.
    2011 PeaceHealth Laboratories
    51
    Start here………………………………..and learn how to get…………………….here!!
  • 115. 2011 PeaceHealth Laboratories
    52
    Monetizing a community data commons…
    Payers sell de-identified claims data to pharmaceutical companies
    anywhere from $100K to millions of dollars, combining the data with simple
    research models.Ingenix packages United Healthcare claims data with their analytics components,
    and charges premium pricing to pharmaceutical companies,
    Contract Research Organizations (CROs), and other healthcare R&D institutions. Archimedes has an IndiGO engine that basically suggests
    possible intervention options given claims and lab data.
    Active Health Management
    did the same in the Evidenced Medicine Guideline (EBM) space,
    charging payers PMPM on the order of <$1.00.
    Large undefined future landscape for much higher yield health information…
  • 116. Using Segmentation
    53
    2011 PeaceHealth Laboratories
  • 117. Global Health Economy
    “Developing nations as late arrivals to western modernization have a health asset ready to be monetized;
    Crowd-relevant bench-marking data to pull modern nations out of their poor health expression”
    2011 PeaceHealth Laboratories
    54
  • 118. 2011 PeaceHealth Laboratories
    55
    The future is here. It is just not evenly distributed.
    At least 80% of humanity lives on less than $10 a day.
  • 119. Blue Zones Longevity Society
    ~Emphasis on strong family values~Strong community values~Exclusively plant based diets (little to no animal products)~Whole food lifestyles focused on fruits and veggies~Antioxidants and anti-aging herbs are plentiful~Daily benefits of physical exercise~Everyone knows how to deal with stress~All the elders and centenarians still work~Daily consumption of small amounts of alcohol~A sense of purpose in life (Ikigai is the Japanese word for this)~Spirituality is part of life in all of the blue zones~A complete absence of smoking and obesity~Everyone knows the benefits of a positive attitude
    2011 PeaceHealth Laboratories
    56
  • 120. Making Better Choices??
    57
    2011 PeaceHealth Laboratories
  • 121. G-G-G-G-G-G-G-G-G-G-G-G-G-G
    G-G-G-G-G-G-G-G-G-G-G-G-G-G
    G-G-G-G-G-G-G-G-G-G-G-G-G-G
    Sugar
    G-G
    58
    2011 PeaceHealth Laboratories
  • 122. Carbs, carbs, and carbs
    59
    2011 PeaceHealth Laboratories
  • 123. Slow food
    Fast food
    Insulin Resistance
    Sedentary
    Activity
    60
    2011 PeaceHealth Laboratories
  • 124. 2011 PeaceHealth Laboratories
    61
    Insulin
    Insulin Receptor
    Mitochondria
    Fat Cell
    G
    G
    G
    G
    G
    G
    G
    G
    G
    G
    G
    Ectopic
    Fat