Bodies and buildings nyu itp 2 11 2013

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Bodies and buildings nyu itp 2 11 2013

  1. 1. BODIES &BUILDINGSNYU ITP LECTURE COURSE SPRING 2013CLASS 3: FEBRUARY 11, 2013JEN VAN DER MEER @JENVANDERMEER WWW.JENVANDERMEER.COM
  2. 2. BODIES IN THE NEWSuBiome Nears $200,000 on Indiegogo To Crowdsource DataAbout The Bacteria That Lives Within Us All.Y Combinator Backs Its First Non-Profit, WatsiJawbone purchases two startups to boost design and healthtech credentials February 10, 2013 2  
  3. 3. READING Read: Networked Medicine: From m Obesity to the “Diseasome”. Editorialby Albert-László Barabási, Ph.D. NEJM. July 26, 2007. Optional: Deeper Reading: Original Study by Christakis and Fowler:The Spread of Obesity in a Large Social Network over 32 Years. NEJM. July26, 2007. Critique of this study: Lyons. The Spread of Evidence-Poor Medicine via Flawed Social-Network Analysis.Statistics, Politics, and Policy: (2011) Vol. 2 : Iss. 1, Article 2. Last revised 5May 2011Watch:Catherine Kerr on Cortical Measures in Mindfulness Meditation atQuantified Self. Personal account of Weight Watchers by Laura Beck at Jezebel. February 10, 2013 3  
  4. 4. ASSIGMENTWhen developing ideas and concepts for our student projects,and future projects, business ideas, and save-the-world ideas, weoften 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 becontributing to a growth in the prevalence of obesity. You maychoose to write a non-fiction account or take this as a creativewriting assignment – imagining a first person day-in-the-lifeaccount of what it feels like to live here. February 10, 2013 4  
  5. 5. 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 flows10. The structure of material stocks and flows (transport networks, population age structures)9. Length of delays, relative to the rate of system change8. The strength of negative feedback loops, relative to the impacts they are trying to correct against7. The gain around driving positive feedback loops6. 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 structure3. The goals of the system2. The mindset or paradigm out of which the system – its goals, power structure, rules, its culture-arises1. The power to transcend paradigmsFebruary 10, 2013 5  
  6. 6. 6. THE STRUCTURE OF INFORMATION FLOWSThere was this subdivision of identical houses,the story goes, except that for some reason theelectric meter in some of the houses wasinstalled in the basement and in others it wasinstalled in the front hall. What happened? February 10, 2013 6  
  7. 7. 6. THE STRUCTURE OF INFORMATION FLOWSA 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 easierthan 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 pointis 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 makeit happen anyway).Donella Meadows. Leverage Points. February 10, 2013 7  
  8. 8. THE OPEN HEALTHDATA MOVEMENTBODIES & BUILDINGS 8  
  9. 9. THE STATE OF USHEALTH CARE BODIES & BUILDINGS 9  
  10. 10. HEALTH CARE COSTS 10  February 10, 2013
  11. 11. RISE IN SPENDING 11  February 10, 2013
  12. 12. HEALTH CARE COSTS 12  February 10, 2013
  13. 13. HEALTH OUTCOMESOur health system—or better, anti-system—consumes nearly $2 trillionannually and does not deliver the value that it should. Those who thinkwe have the best system in the world come up against the cold hard facts(if they matter in political debate anymore) of health outcomes, whichindicate that we’re ranked 37th in the world and trending downward, notimproving. Despite one of the most robust ecosystems for innovation inbiotechnology 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 CanRevolutionize Health Care. Dr. Jody Ranck. Forbes.com. February 6,2012. 13  February 10, 2013
  14. 14. HITECH BODIES & BUILDINGS 14  
  15. 15. ARRA + HITECH 2009: ARRA provides many different stimulus opportunities, one ofwhich is $19.2 billion on health IT. Title XIII of ARRA was given asubtitle: Health Information Technology for Economic and ClinicalHealth Act (HITECH). It is this section that deals with many of thehealth information communication and technology provisions includingSubpart D – Privacy. 15  February 10, 2013
  16. 16. HITECH FUNDING 16  February 10, 2013
  17. 17. WHY DOES THE MEDICALPROFESSION HAVE TO BE PAID To be digital? 17  February 10, 2013
  18. 18. COST OF MEDICAL ERRORS 18  February 10, 2013
  19. 19. TO ERR IS HUMAN 19  February 10, 2013
  20. 20. MEANINGFUL USEThe goal of meaningful use is to promote the spread of electronic health records toimprove health care in the United States.The benefits of the meaningful use of EHRs include:Complete and accurate information. With electronic health records, providers havethe information they need to provide the best possible care. Providers will know moreabout their patients and their health history before they walk into the examinationroom.Better access to information. Electronic health records facilitate greater access to theinformation providers need to diagnose health problems earlier and improve thehealth outcomes of their patients. Electronic health records also allow information tobe 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 totake a more active role in their health and in the health of their families. Patients canreceive electronic copies of their medical records and share their health informationsecurely over the Internet with their families. 20  February 10, 2013
  21. 21. HEALTH CARE COSTS 21  February 10, 2013
  22. 22. HOW ELSE DO WE DEFINEPATIENT EMPOWERMENT? To be digital? 22  February 10, 2013
  23. 23. AFFORDABLEACCOUNTABLECAREBODIES & BUILDINGS 23  
  24. 24. AFFORDABLE CARE 24  February 10, 2013
  25. 25. ACCOUNTABLE CAREAn accountable care organization (ACO) is a healthcare organizationcharacterized by a payment and care delivery model that seeks to tieprovider reimbursements to quality metrics and reductions in the totalcost of care for an assigned population of patients. 25  February 10, 2013
  26. 26. ACO – TV Think of it as buying a television, says Harold Miller, president and CEO ofthe Network for Regional Healthcare Improvement and executive director ofthe Center for Healthcare Quality & Payment Reform in Pittsburgh. A TV manufacturer like Sony may contract with many suppliers to buildsets. Like Sony does for TVs, Miller says, an ACO would bring together thedifferent component parts of care for the patient – primary care, specialists,hospitals, home health care, etc. – and ensure that all of the "parts work welltogether.""People want to buy individual circuit boards, not a whole TV,” he says. “Ifwe can show them that the TV works better, maybe theyll buy it," ratherthan assembling a patchwork of services themselves. "But ACOs will need toprove that the overall health care product they’re creating does work betterand costs less in order to encourage patients and payers to buy it.”-Kaiser Health News 26  February 10, 2013
  27. 27. ACO VS. HMOThe HMO model used statistics to provide models of what treatmentswere appropriate at given times, and denied treatments that fell outsidethe model. These simplistic models tended to second-guess healthcareproviders about what pa- tients needed, frequently denying coverage forsensible treatments. An ACO, however, should be capable of measuring the end result of aprovider’s actions to determine whether treatment was successful,making second-guessing unnecessary. An HMO meddled with doctors’methods, whereas an ACO focuses only on the doctors’ results. How willan ACO accomplish this? By leveraging data from meaningful usecertified EHR systems. - Hacking Healthcare. . Fred Trotter & David Uhlman. 27  February 11, 2013
  28. 28. GENOTYPES +PHENOTYPESBODIES & BUILDINGS 28  
  29. 29. GENOTYPE à PHENOTYPE 29  February 10, 2013
  30. 30. GENOTYPE à PHENOTYPE 30  February 10, 2013
  31. 31. GENOTYPE à PHENOTYPE 31  February 10, 2013
  32. 32. GATHERING THEPHENOTYPESIf we hope to continue the rate of improvement in healthcare we must find away to coordinate the contributions of countless clinicians, researchers, andpatients. To make any sense out of the genotype, we must have aunderstanding of phenotype —the manifest characteristics of individuals,such as their age, weight, medical symptoms, mental status, and many othermeasurable traits —than is several orders of magnitude deeper than it istoday. We must be able to gather and parse a hundred times more dataabout each patient than we do today, and we must be able to compare thatrich data among millions of patients. Today, the sciences and thesoftware that support clinical trials, genomics, and standardclinical operations are separate and distinct, with infrequentoverlap. Tomorrow, these disciplines will merge into a single enormouseffort to improve healthcare. Science on this scale is impossible without masshigh-quality computerization. There is no reason why all of thiscannot be accomplished while respecting patient privacy andother basic notions of human dignity.-Hacking Healthcare. Fred Trotter & David Uhlman 32  February 11, 2013
  33. 33. VALUE OF ALL OF THIS DATAIn an era of “big data,” when personal health information can bederived from sources as diverse as credit card records and GPS, andwhen individuals can acquire a genome sequence without consulting adoctor, Wilbanks urged the medical research and entrepreneurialcommunity to take the lead in integrating and applying these variousdata in useful ways-John Wilbanks Interviewed.OPEN-DATA ADVOCATE SAYS HEALTH INFORMATIONMUST BE SHARED. NYGenome.org. Dec 10, 2012. 33  February 11, 2013
  34. 34. INFORMED CONSENT …Privacy protections are about building an ecosystem in health carethat people will trust. When they need to seek care that might be deemedto be sensitive to them, they feel like they can go get care and have somedegree of confidence that that information isn’t going to be sharedoutside of those who have a need to know it, like health care providers ortheir insurance company if they are seeking to be reimbursed for care.-Deven McGraw interviewed.Balancing health privacy with innovation will rely onimproving informed consent. Strata. August 23, 2012. by AlexHoward. 34  February 11, 2013
  35. 35. OPEN DATA FORHEALTH BODIES & BUILDINGS 35  
  36. 36. TODD PARK, CTO,WHITE HOUSE 36  February 10, 2013
  37. 37. OPEN DATA IN HEALTH U.S. government’s work to “liberate” data to spur entrepreneurship and innovation 37  February 10, 2013that improves health care and simultaneously contributes to economic growth.
  38. 38. HEALTH DATA .GOV 38  February 10, 2013
  39. 39. THE VA AND BLUE BUTTON The Blue Button enables users of personal health records to downloadtheir personal health information as an ASCII text file.The Blue Button Initiative emerged out of the US Department ofVeterans Affairs (VA) with a simple goal – create a big blue button ontheir website that would enable a logged in user to download their healthrecords. 39  February 10, 2013
  40. 40. CURRENT SYSTEMS:FRAGMENTED, NOT YET OPENAccording to Kalorama Information, six vendors dominatehalf of the $18 billion EHR market in terms of revenue.1. Cerner2. McKesson3. Siemens4. GE5. Epic6. Allscripts 40  February 10, 2013
  41. 41. OPENING APIsAllscripts: The Open App Challenge encourages a broad community of developersand vendors to “Start a Revolution” by designing and integrating applications thatbecome an extension of Allscripts Open Electronic Health Records software. Walgreens: Walgreens will be offering access to its data through a variety ofApplication 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 thesupport 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+ platformgives select partners access to the real activity data captured by the Nike+ FuelBandand Nike+ Running devices, used by millions of Nike+ users.Ford: The Ford Connected Services team offers its warm welcome to the developercommunity. The Ford Developer Program offers a complete set of softwaredevelopment tools and technical services to developers and partners enabling thecreation of a global development and distribution ecosystem that will drive innovationand usage. 41  February 11, 2013
  42. 42. FULL DISCLOSURE 42  
  43. 43. REVOLUTION OREVOLUTION? BODIES & BUILDINGS 43  
  44. 44. THOUSANDS OFINCREMENTAL ADVANCESThe improvements to healthcare that happen because ofcomputerization will not be a revolution, but an evolution.Fundamental to the ambitions in the health IT community is a humbleacknowledgment that these huge game-changing insights are rare. Wecan expect fewer and fewer of them as the science of medicineprogresses. Instead, medicine must now begin the difficult work ofchronicling the immense complexity of a single cell’s DNA, proteins andother structures, and how that cell cooperates with other cells in thehuman organism. We can no longer expect that individual insights willleap medical science forward, but instead the medical community willmake hundreds of thousands of small incremental advances on tens ofthousands of diseases.-Hacking Healthcare. Fred Trotter & David Uhlman. 44  February 10, 2013
  45. 45. DIGITAL HIGH DEFINITION OFHUMANS “digital high definition of humans will shape the greatinflection of medicine”. He specifies that the drivers of thisinflection are wireless devices (e.g. mobile smartphones) andsensors (e.g. wearable and embedded wireless nanosensors),DNA sequencing, information systems, the data universe,cloud computing, the Internet, and social networking.The Creative Destruction of Medicine: How the DigitalRevolution Will Create Better Health Care. Eric Topol, MD. 45  February 10, 2013
  46. 46. ASSIGNMENT:FEBRUARY 25 46  February 10, 2013
  47. 47. READING/VIEWING Read: The quantified self, Counting every moment. TheEconomist, March 3, 2012. Additional videos from Todd ParkTodd Park: Opening Data for Social Change Optional: Social fMRI: Investigating and shaping social mechanisms in thereal world. Nadav Aharonya, Wei Pana, Cory Ipa, InasKhayala,b, Alex Pentlanda. Persuasive and Mobile Computing.Vol 7, 2011, 643-659. Hacking Healthcare Chapter 6: Patient Facing Software 47  February 11, 2013
  48. 48. ASSIGNMENT Write a one page essay to be presented in class. Do you findthe quantified self movement appealing? Give examples ofhow you would imagine using data to monitor your ownhealth, or the health of someone you care for. 48  February 11, 2013
  49. 49. LINKS AND PRESENTATION Today’s class presentation is available http://jenvandermeer.com/2013/02/class-3-bodies-and-buildings-february-11-2012/And Links from this presentation are available here atAnnotary. 49  February 11, 2013

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