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

1. BODIES &
BUILDINGS
NYU ITP LECTURE COURSE FALL 2014
CLASS 3: SEPTEMBER 22, 2013
JEN VAN DER MEER @JENVANDERMEER WWW.JENVANDERMEER.COM

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
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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
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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
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September 23, 2014

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?
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September 23, 2014

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.
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September 23, 2014

7. THE STATE OF
GLOBAL HEALTH
CARE
BODIES & BUILDINGS
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8. HEALTH CARE COSTS
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September 23, 2014

9. September 23, 2014
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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. 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
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12. VACCINE PREVENTABLE
OUTBREAKS
Source: CFR.Org. We are unlearning what we already know.
September 23, 2014
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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
http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001547

14. THE STATE OF US
HEALTH CARE
BODIES & BUILDINGS
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15. RISE IN SPENDING
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September 23, 2014

16. HEALTH CARE COSTS
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September 23, 2014

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. Forbes.com.
February 6, 2012.
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September 23, 2014

18. HITECH FUNDING
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September 23, 2014

19. WHY DOES THE MEDICAL
PROFESSION HAVE TO BE
PAID
To be digital?
September 23, 2014
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20. COST OF MEDICAL ERRORS
September 23, 2014
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21. TO ERR IS HUMAN
September 23, 2014
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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
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23. HOW ELSE DO WE DEFINE
PATIENT EMPOWERMENT?
To be digital?
September 23, 2014
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24. GENOTYPES +
PHENOTYPES
BODIES & BUILDINGS
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25. GENOTYPE  PHENOTYPE
September 23, 2014
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26. GENOTYPE  PHENOTYPE
September 23, 2014
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27. GENOTYPE  PHENOTYPE
September 23, 2014
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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
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29. OPEN DATA FOR
HEALTH
BODIES & BUILDINGS
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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. NYGenome.org.
Dec 10, 2012.
September 23, 2014
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31. OPEN DATA IN HEALTH
September 23, 2014
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U.S. government’s work to “liberate” data to spur entrepreneurship and
innovation that improves health care and simultaneously contributes to
economic growth.

32. HEALTH DATA .GOV
September 23, 2014
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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
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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
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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
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36. ASSIGNMENT:
SEPTEMBER 29
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September 23, 2014

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.
Openhealthdata.org
September 23, 2014
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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
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