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Bodies and buildings nyu itp 2 11 2013
1. BODIES &
BUILDINGS
NYU ITP LECTURE COURSE SPRING 2013
CLASS 3: FEBRUARY 11, 2013
JEN VAN DER MEER @JENVANDERMEER WWW.JENVANDERMEER.COM
2. BODIES IN THE NEWS
uBiome Nears $200,000 on Indiegogo To Crowdsource Data
About The Bacteria That Lives Within Us All.
Y Combinator Backs Its First Non-Profit, Watsi
Jawbone purchases two startups to boost design and health
tech credentials
February 10, 2013
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3. READING
Read: Networked Medicine: From m Obesity to the “Diseasome”. Editorial
by 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. July
26, 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 5
May 2011
Watch:
Catherine Kerr on Cortical Measures in Mindfulness Meditation at
Quantified Self.
Personal account of Weight Watchers by Laura Beck at Jezebel.
February 10, 2013
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4. 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.
February 10, 2013
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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 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
February 10, 2013
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6. 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?
February 10, 2013
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7. 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.
February 10, 2013
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13. 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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February 10, 2013
15. ARRA + HITECH
2009: ARRA provides many different stimulus opportunities, one of
which is $19.2 billion on health IT. Title XIII of ARRA was given a
subtitle: Health Information Technology for Economic and Clinical
Health Act (HITECH). It is this section that deals with many of the
health information communication and technology provisions including
Subpart D – Privacy.
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February 10, 2013
20. 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.
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February 10, 2013
25. ACCOUNTABLE CARE
An accountable care organization (ACO) is a healthcare organization
characterized by a payment and care delivery model that seeks to tie
provider reimbursements to quality metrics and reductions in the total
cost of care for an assigned population of patients.
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February 10, 2013
26. ACO – TV
Think of it as buying a television, says Harold Miller, president and CEO of
the Network for Regional Healthcare Improvement and executive director of
the Center for Healthcare Quality & Payment Reform in Pittsburgh.
A TV manufacturer like Sony may contract with many suppliers to build
sets. Like Sony does for TVs, Miller says, an ACO would bring together the
different component parts of care for the patient – primary care, specialists,
hospitals, home health care, etc. – and ensure that all of the "parts work well
together."
"People want to buy individual circuit boards, not a whole TV,” he says. “If
we can show them that the TV works better, maybe they'll buy it," rather
than assembling a patchwork of services themselves. "But ACOs will need to
prove that the overall health care product they’re creating does work better
and costs less in order to encourage patients and payers to buy it.”
-Kaiser Health News
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February 10, 2013
27. ACO VS. HMO
The HMO model used statistics to provide models of what treatments
were appropriate at given times, and denied treatments that fell outside
the model. These simplistic models tended to second-guess healthcare
providers about what pa- tients needed, frequently denying coverage for
sensible treatments.
An ACO, however, should be capable of measuring the end result of a
provider’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 will
an ACO accomplish this? By leveraging data from meaningful use
certified EHR systems.
- Hacking Healthcare. . Fred Trotter & David Uhlman.
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February 11, 2013
32. 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
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February 11, 2013
33. 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.
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February 11, 2013
34. INFORMED CONSENT
…Privacy protections are about building an ecosystem in health care
that people will trust. When they need to seek care that might be deemed
to be sensitive to them, they feel like they can go get care and have some
degree of confidence that that information isn’t going to be shared
outside of those who have a need to know it, like health care providers or
their insurance company if they are seeking to be reimbursed for care.
-Deven McGraw interviewed.
Balancing health privacy with innovation will rely on
improving informed consent. Strata. August 23, 2012. by Alex
Howard.
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February 11, 2013
37. OPEN DATA IN HEALTH
U.S. government’s work to “liberate” data to spur entrepreneurship and innovation
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February 10, 2013
that improves health care and simultaneously contributes to economic growth.
39. 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.
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February 10, 2013
40. 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
2. McKesson
3. Siemens
4. GE
5. Epic
6. Allscripts
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February 10, 2013
41. 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.
Ford: The Ford Connected Services team offers its warm welcome to the developer
community. The Ford Developer Program offers a complete set of software
development tools and technical services to developers and partners enabling the
creation of a global development and distribution ecosystem that will drive innovation
and usage.
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February 11, 2013
44. THOUSANDS OF
INCREMENTAL ADVANCES
The improvements to healthcare that happen because of
computerization will not be a revolution, but an evolution.
Fundamental to the ambitions in the health IT community is a humble
acknowledgment that these huge game-changing insights are rare. We
can expect fewer and fewer of them as the science of medicine
progresses. Instead, medicine must now begin the difficult work of
chronicling the immense complexity of a single cell’s DNA, proteins and
other structures, and how that cell cooperates with other cells in the
human organism. We can no longer expect that individual insights will
leap medical science forward, but instead the medical community will
make hundreds of thousands of small incremental advances on tens of
thousands of diseases.
-Hacking Healthcare. Fred Trotter & David Uhlman.
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February 10, 2013
45. DIGITAL HIGH DEFINITION OF
HUMANS
“digital high definition of humans will shape the great
inflection of medicine”. He specifies that the drivers of this
inflection are wireless devices (e.g. mobile smartphones) and
sensors (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 Digital
Revolution Will Create Better Health Care. Eric Topol, MD.
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February 10, 2013
47. READING/VIEWING
Read: The quantified self, Counting every moment. The
Economist, March 3, 2012.
Additional videos from Todd Park
Todd Park: Opening Data for Social Change
Optional:
Social fMRI: Investigating and shaping social mechanisms in the
real world. Nadav Aharonya, Wei Pana, Cory Ipa, Inas
Khayala,b, Alex Pentlanda. Persuasive and Mobile Computing.
Vol 7, 2011, 643-659.
Hacking Healthcare
Chapter 6: Patient Facing Software
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February 11, 2013
48. ASSIGNMENT
Write a one page essay to be presented in class. Do you find
the quantified self movement appealing? Give examples of
how you would imagine using data to monitor your own
health, or the health of someone you care for.
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February 11, 2013
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 at
Annotary.
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February 11, 2013
