A model for reversing the rising trajectory of health care burden associated with Chronic Diseases (overwhelmingly lifestyle related).

1. mHealth 3.0
AI Assisted Lifestyle Modification
in
Prevention and Management of Chronic Disease
(Asthma model)
Mark Lazarovich MD
Timberlane Allergy and Asthma
South Burlington VT
USA
asthmavt@gmail.com

2. Clinical Vignette
55 y.o., overweight woman with cat allergy, asthma,
diabetes and High Blood Pressure. Asthma and allergy
managed and stable for 15 years. Lives alone with dog.
Yearly follow-up visti: out of control asthma, diabetes
and blood pressure.
What happened?
1. Developed Sinusitis
2. Developed Dog Allergy
3. Got a cat
4. Dog died
5. Non-compliance

3. Chronic disease in America
$2.3 of $2.7 trillion spent. 2011.
45% of Americans
133 million. 2000
15%
85%
Gerteis J, Izrael D, Deitz D, LeRoy L, Ricciardi R, Miller T, Basu J. Multiple Chronic Conditions Chartbook.[PDF - 10.62 MB] AHRQ Publications No, Q14-0038.
Rockville, MD: Agency for Healthcare Research and Quality; 2014. Accessed November 18, 2014.

4. USA Asthma Numbers
CDC. National Health Interview Survey (NHIS) data: 2011 lifetime and current asthma.
Atlanta, GA: US Department of Health and Human Services, CDC: 2012
$53 B
$56 B

5. World Asthma Numbers1
World Health Organization. Global surveillance, prevention and control of chronic respiratory diseases: a comprehensive approach, 2007.
The changing epidemiology of asthma in Shanghai, China J Asthma 2015 Jun:52(5):465-70

6. Cost of asthma therapy
$$-$$$$$$$$$$$
a-PGD2
? a-IL4/IL13
$-$$
SABA
PDE-I SS
a-IL5a-IgE
$$$$$$$$$$$$$$$
$$$$$$$$$$$$$$$
$$$$$$$$$$$$$$$
$$$$$$$$$$$$$$$
$$$$$$$$$$$$$$$
$$$$$$$$$$$$$$$
$$$$$$$$$$$$$$$
a-IL4
ICS
IT
LABA
LTRA
LTRsi

7. Actionable Co-factors and Asthma
Obesity
Inactivity
Air Quality
Mental Health Problems
Lack of sleep
Food Quality

8. USA Trends in Obesity
Ogden CL, Carroll MD. Prevalence of overweight, obesity, and extreme obesity among adults: United States, Overweight and Obesity Statistics | National Institute of
Diabetes and Digestive and Kidney Diseases (NIDDK) 10/16/16, 12:13 PMhttps://www.niddk.nih.gov/health-information/health-statistics/Pages/overweight-obesity-
statistics.aspx Page 10 of 11 trends 1960–1962 through 2007–2008. NCHS Health E-Stat. Hyattsville, MD: National Center for Health Statistics; 2010.

9. Reducing obesity makes asthma better
n
Surg/Life
style
QL
Asthma
Control
FEV-1
Inflam.
Markers
Eos AHR
Macgregor and
Greenberg, 1993
(USA)
40 S NA NA NA NA
Dixon JB et al
1999
(Aus)
32 S NA NA NA NA
Stenius-Aarniala
et al, 2000
2000 (Fin)
38 L NA NA NA
Dixon AE et al
2011
(USA)
46 S
Dias-Junior
2014
(Bra)
33 L

10. USA Trends in (in)Activity
Troiano RP, Berrigan D, Dodd KW, Mâsse LC, Tilert T, McDowell M. Physical activity in the United States measured by accelerometer.
Medicine & Science in Sports & Exercise. 2008;40(1):181–188.
Brownson RC et al. Declining Rates of Physical Activity in The United States: What Are the Contributors? Annual Review of
Public Health. First published online as a Review in Advance on December 8, 2004
Recommended duration of activity
Before age 11 = 42%, after = 7.6%
Girls 34.7% to 5.4%.

11. Activity makes asthma better
n Duration QL
Asthma
Control
FEV-1
Inflam.
Markers
Eos AHR
Fanelli et al
2007
(Bra)
38p 16 week NA NA NA
Mendes et al
2010
(Bra)
101 3 mo NA NA NA
Eichenberger
2013 (meta)
(Swiss)
599 NA NA NA
Franca-Pinto
2015
(Bra)
43 12 week NA

12. Dagstuhl Perspetives Workshop
Exploring Interdisciplinary Grand Challenges in
ICT Design to Support Proactive Health and
Wellbeing,
Jun. 29–Jul. 2, 2014
http://drops.dagstuhl.de/opus/volltexte/2015/4887/pdf/dagrep_v004_i006_p108_s14272.pdf

13. Companion agenda to technologically
managed Healthcare
http://drops.dagstuhl.de/opus/volltexte/2015/4887/pdf/dagrep_v004_i006_p108_s14272.pdf
Technologically supported, proactive well-being
Technologically supported well-being in
management of
chronic and acute illness
mHealth + Proactive Well-Being = Wellth
Elizabeth F. Churchill and m.c. schraefel mHealth+Proactive WEll-Being = Wellth Creation .
Forum: Health Matters ACM 2015 Gillian R. Hayes Editor

14. “Wellth Creation”
Developing sustained strategies for increasing the experience of
well-being. (emotional and visceral.)
(translating into micro, meso and macro socio-economic gain).
Well-being has an N=1
Wellth creation will involve rethinking:
1. notions of health
2. interactive technology design
3. the form and role of health-related data
4. engagement with stakeholder groups (micro, meso, macro)
Elizabeth F. Churchill and m.c. schraefel mHealth+Proactive Well-Being = Wellth Creation . Forum:
Health Matters ACM 2015 Gillian R. Hayes Editor

15. Barriers to successful mHealth application
- Tyrannical
- App fatigue
- Data fatigue
- Lack of contextual integration
- No long term studies
- Poor UX
- Quantitative Tedium
- How to choose?
- Poor integration
- Not fun
- Inflexible
- Impersonal
- Too personal
- Other………

16. Emotion
Logic
Subconscious Conscious
Clustering
of current
health apps
Modified from: Report from Dagstuhl Perspectives Workshop 14272 Exploring Interdisciplinary Grand Challenges in ICT Design to Support Proactive Health and Wellbeing
Edited by m. c. schraefel1 and Elizabeth F. Churchill 2
1 University of Southampton, UK, mc@ecs.soton.ac.uk 2 formerly of eBay Research Labs, San Jose, CA, US, churchill@acm.org
Current Motivational Models

17. Is health the primary motivator?
No
Dara Torres 41, Swimming
5th Olympic Games.
2008 Silver Medal
No
Obese
De-conditioned
Unmotivated

18. Emotion
Logic
Subconscious Conscious
Area to
explore?
Modified from: Report from Dagstuhl Perspectives Workshop 14272 Exploring Interdisciplinary Grand Challenges in ICT Design to Support Proactive Health and Wellbeing
Edited by m. c. schraefel1 and Elizabeth F. Churchill 2.
1 University of Southampton, UK, mc@ecs.soton.ac.uk 2 formerly of eBay Research Labs, San Jose, CA, US, churchill@acm.org
Needed Motivational Models

19. Emotional motivation
I use Facebook, Instagram, Twitter, Google because:
“I want to:”
-know
-be included
-be validated
-be recognized
-be praised
-be special
-matter
-have
-be aware
-be current

20. Moving beyond e-Health and the Quantified Self
ACM CSCW Vancouver March 2015
1. “Me”, “Us”, “Them”
2. Social
3. Non-tyrannical
4. Assistive, Aspirational (not Prescriptive)
5. Playfull (explorable, interrogable)
6. Contextual
Qualities of Wellth promoting Systems
Moving beyond e-Health and the Quantified Self. Workshop at 2015 ACM Conference on Computer-Supported Cooperative Work and Social
Computing. March 14-18 Vancouver, BC, Canada

21. in5 (Dr. m.c. Schraefel)
Move
Eat
Cogitate
Engage
Sleep
All of the above are done daily.
All require skills.
All are essential.
All need to be actively engaged.
MoreLess
QualityCalories
Tune rather then change
Modified from; in5 working brain body connection for creative excellence. m.c. Schraefel 2014 @mcphoo

24. Acknowledgements
Director of UX,
Google
Distinguished Visiting
Scholar, Media X,
Stanford University
Vice President ACM
SigCHI
Prof. Computer Science and
Human Performance
University of Southampton
UK
Research Associate, CSAIL
MIT
NSCA Strength and
Conditioning Coach
Master Trainer, Z-health
Nutrition Coach
Functions Movement Trainer
dr. m.c schraefel Dr. Elizabeth Churchill Stephen Yanow
Chairman
3CE Technologies