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Bodies and Buildings 3 NYU ITP 09 22 2014


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Global health systems, US health systems, the structure of information flows in a system, open data, genotypes and phenotypes

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Bodies and Buildings 3 NYU ITP 09 22 2014

  2. 2. BUILDINGS AND BUILDINGS IN THE NEWS De Blasio Orders a Greener City, Setting Goals for Energy Efficiency of Buildings (NY Times) September 23, 2014 2
  3. 3. ASSIGMENT When developing ideas and concepts for our student projects, and future projects, business ideas, and save-the-world ideas, we often start by designing for ourselves. For this assignment, research a part of the world at a local level (city, state, province, county) that has a problem with obesity. The only requirement: pick somewhere that you have never been. In a one page essay, describe the social, cultural, technological, economic, and other conditions of this region that may be contributing to a growth in the prevalence of obesity. You may choose to write a non-fiction account or take this as a creative writing assignment – imagining a first person day-in-the-life account of what it feels like to live here. September 23, 2014 3
  4. 4. PLACES TO INTERVENE IN A SYSTEM: 12. Constants, parameters, numbers (subsidies, taxes, standards) 11. The sizes of buffers and other stabilizing stocks, relative to their flows 10. The structure of material stocks and flows (transport networks, population age structures) 9. Length of delays, relative to the rate of system change 8. The strength of negative feedback loops, relative to the impacts they are trying to correct against 7. The gain around driving positive feedback loops 6. The structure of information flows (who does and does not have access to what kinds of information) 5. The rules of the system (such as incentives, punishments, constraints) 4. The power to add, change, evolve, or self-organize system structure 3. The goals of the system 2. The mindset or paradigm out of which the system – its goals, power structure, rules, its culture-arises 1. The power to transcend paradigms 4 September 23, 2014
  5. 5. 6. THE STRUCTURE OF INFORMATION FLOWS There was this subdivision of identical houses, the story goes, except that for some reason the electric meter in some of the houses was installed in the basement and in others it was installed in the front hall. What happened? 5 September 23, 2014
  6. 6. 6. THE STRUCTURE OF INFORMATION FLOWS A new loop. Missing feedback is one of the most common causes of system malfunction. Adding or restoring information can be a powerful intervention, usually much easier than rebuilding physical infrastructure. We humans have a systematic tendency to avoid accountability for our own decisions. That’s why so many feedback loops are missing – and why this kind of leverage point is so often popular with the masses, unpopular with the powers that be, and effective, if you can get the powers that be to permit it to happen (or go around them and make it happen anyway). Donella Meadows. Leverage Points. 6 September 23, 2014
  8. 8. HEALTH CARE COSTS 8 September 23, 2014
  9. 9. September 23, 2014 9
  10. 10. 10 GLOBAL BURDEN OF DISEASE Percent of Disability-Adjusted Life Years Lost to NCDs (Non Communicable Disease) in 2010. Source: IHME. September 23, 2014
  11. 11. GBD REPORT One of the big headlines from the GBD is that there are now more people dying of obesity related diseases than starvation and malnutrition–that non communicable diseases like cancer are overtaking communicable diseases as the leading cause of premature death–how should that effect how the world makes decisions about global health resources? - Impatient Optimists September 23, 2014 11
  12. 12. VACCINE PREVENTABLE OUTBREAKS Source: CFR.Org. We are unlearning what we already know. September 23, 2014 12
  13. 13. Figure 3. YLD rates (per 100,000) by country for depressive disorders in 2010. Ferrari AJ, Charlson FJ, Norman RE, Patten SB, et al. (2013) Burden of Depressive Disorders by Country, Sex, Age, and Year: Findings from the Global Burden of Disease Study 2010. PLoS Med 10(11): e1001547. doi:10.1371/journal.pmed.1001547
  15. 15. RISE IN SPENDING 15 September 23, 2014
  16. 16. HEALTH CARE COSTS 16 September 23, 2014
  17. 17. HEALTH OUTCOMES Our health system—or better, anti-system—consumes nearly $2 trillion annually and does not deliver the value that it should. Those who think we have the best system in the world come up against the cold hard facts (if they matter in political debate anymore) of health outcomes, which indicate that we’re ranked 37th in the world and trending downward, not improving. Despite one of the most robust ecosystems for innovation in biotechnology and information technology that the world has ever seen, converting this into tangible health outcomes is an “innovation space” that we’ve yet to get a handle on. How Connected Health, Public-Private Cooperation, And Big Data Can Revolutionize Health Care. Dr. Jody Ranck. February 6, 2012. 17 September 23, 2014
  18. 18. HITECH FUNDING 18 September 23, 2014
  19. 19. WHY DOES THE MEDICAL PROFESSION HAVE TO BE PAID To be digital? September 23, 2014 19
  20. 20. COST OF MEDICAL ERRORS September 23, 2014 20
  21. 21. TO ERR IS HUMAN September 23, 2014 21
  22. 22. MEANINGFUL USE The goal of meaningful use is to promote the spread of electronic health records to improve health care in the United States. The benefits of the meaningful use of EHRs include: Complete and accurate information. With electronic health records, providers have the information they need to provide the best possible care. Providers will know more about their patients and their health history before they walk into the examination room. Better access to information. Electronic health records facilitate greater access to the information providers need to diagnose health problems earlier and improve the health outcomes of their patients. Electronic health records also allow information to be shared more easily among doctors' offices, hospitals, and across health systems, leading to better coordination of care. Patient empowerment. Electronic health records will help empower patients to take a more active role in their health and in the health of their families. Patients can receive electronic copies of their medical records and share their health information securely over the Internet with their families. September 23, 2014 22
  23. 23. HOW ELSE DO WE DEFINE PATIENT EMPOWERMENT? To be digital? September 23, 2014 23
  25. 25. GENOTYPE  PHENOTYPE September 23, 2014 25
  26. 26. GENOTYPE  PHENOTYPE September 23, 2014 26
  27. 27. GENOTYPE  PHENOTYPE September 23, 2014 27
  28. 28. GATHERING THE PHENOTYPES If we hope to continue the rate of improvement in healthcare we must find a way to coordinate the contributions of countless clinicians, researchers, and patients. To make any sense out of the genotype, we must have a understanding of phenotype —the manifest characteristics of individuals, such as their age, weight, medical symptoms, mental status, and many other measurable traits —than is several orders of magnitude deeper than it is today. We must be able to gather and parse a hundred times more data about each patient than we do today, and we must be able to compare that rich data among millions of patients. Today, the sciences and the software that support clinical trials, genomics, and standard clinical operations are separate and distinct, with infrequent overlap. Tomorrow, these disciplines will merge into a single enormous effort to improve healthcare. Science on this scale is impossible without mass high-quality computerization. There is no reason why all of this cannot be accomplished while respecting patient privacy and other basic notions of human dignity. -Hacking Healthcare. Fred Trotter & David Uhlman September 23, 2014 28
  30. 30. VALUE OF ALL OF THIS DATA In an era of “big data,” when personal health information can be derived from sources as diverse as credit card records and GPS, and when individuals can acquire a genome sequence without consulting a doctor, Wilbanks urged the medical research and entrepreneurial community to take the lead in integrating and applying these various data in useful ways -John Wilbanks Interviewed. OPEN-DATA ADVOCATE SAYS HEALTH INFORMATION MUST BE SHARED. Dec 10, 2012. September 23, 2014 30
  31. 31. OPEN DATA IN HEALTH September 23, 2014 31 U.S. government’s work to “liberate” data to spur entrepreneurship and innovation that improves health care and simultaneously contributes to economic growth.
  32. 32. HEALTH DATA .GOV September 23, 2014 32
  33. 33. THE VA AND BLUE BUTTON The Blue Button enables users of personal health records to download their personal health information as an ASCII text file. The Blue Button Initiative emerged out of the US Department of Veterans Affairs (VA) with a simple goal – create a big blue button on their website that would enable a logged in user to download their health records. September 23, 2014 33
  34. 34. CURRENT SYSTEMS: FRAGMENTED, NOT YET OPEN According to Kalorama Information, six vendors dominate half of the $18 billion EHR market in terms of revenue. 1. Cerner (just bought Siemens) 2. McKesson 3. Siemens 4. GE 5. Epic 6. Allscripts September 23, 2014 34
  35. 35. OPENING APIs Allscripts: The Open App Challenge encourages a broad community of developers and vendors to “Start a Revolution” by designing and integrating applications that become an extension of Allscripts Open Electronic Health Records software. Walgreens: Walgreens will be offering access to its data through a variety of Application Programming Interfaces (APIs) and Software Development Kits (SDKs). Aetna: The CarePass Developer portal offers unique and powerful APIs from Aetna, HHS, and other innovators in the health and wellness community, plus all of the support you’ll need to work with these APIs. Check out our APIs and then register. Nike: Nike+ data helps athletes know more - and do more. The Nike+ platform gives select partners access to the real activity data captured by the Nike+ FuelBand and Nike+ Running devices, used by millions of Nike+ users. Healthkit: Aetna and Nike shut down their apps ecosystems and wearables ahead of Apple’s healthkit announcement September 23, 2014 35
  36. 36. ASSIGNMENT: SEPTEMBER 29 36 September 23, 2014
  37. 37. READING/VIEWING The quantified self, Counting every moment. The Economist. US CTO seeks to scale agile thinking and open data across federal government via Strata Rx The Business Case for Open Data Omidyar Network Video: Changing Behavior and Changing Policies: Todd Park Further Learning: Todd Park: Opening Data for Social Change Social fMRI: Investigating and shaping social mechanisms in the real world. Nadav Aharonya, Wei Pana, Cory Ipa, Inas Khayala,b, Alex Pentland. Persuasive and Mobile Computing. Vol 7, 2011, 643-659. September 23, 2014 37
  38. 38. ASSIGNMENT Assignment for September 29, 2014: Write a one-page essay to be presented in class. Assume someone you love has been prescribed a wearable device to track their glucose levels, heart rate, and emotional state, and the doctor is at a research organization asking for the data to be donated to a larger research effort. What do you advise and why? Would this change if the research study was also measuring the quality and quantity of interactions between caregivers (yourself) and your loved one? September 23, 2014 38