Introducing a new tool in the healthcare toolbox that aims to develop an individual’s comprehensive health profile by combining their genetics, personal exposure, clinical disposition and ultimately integrating the data into the Electronic Health Record called the Individual Exposure Health Risk Profile (IEHRP).

1. I n t e g r i t y - S e r v i c e - E x c e l l e n c e
Headquarters U.S. Air Force
Enhancing Health Risk Assessment:
The Individual Exposure Health
Risk Profile (IEHRP)
Richard Hartman, PhD
Chief Strategist
Air Force Medical Support Agency
23 August 2018
Cleared for Public Release, SAF/PA Case Number: 2018-0490

2. I n t e g r i t y - S e r v i c e - E x c e l l e n c e
Disclosure
 No conflicts of interest
 No discussion of off-label uses

3. I n t e g r i t y - S e r v i c e - E x c e l l e n c e
Reimagining Healthcare with
Total Exposure Health (TEH)

4. I n t e g r i t y - S e r v i c e - E x c e l l e n c e
Individual Exposure Health Risk Indices (IEHRI) = (v1,1) + (v1,2) + (v1,3)
IEHRInoise = (vnoise, measure) + (vnoise, genes) + (vnoise, history)
Individual Exposure Health Risk Profile (IEHRP) =
[(v1,1) + (v1,2) + (v1,3)], [(v2,1) + (v2,2) + (v2,3)], … , (vn,j)
IEHRP = [(vnoise, mea.) + (vnoise, gen.) + (vnoise, his.)] , [(vradon, mea.) + (vradon, gen.) + (vradon, his.)], … ,(vi,j)
IEHRP: Introduction
IEHRP
 Support TEH to enhance the electronic health record (MHS-GENESIS)
 Identify and integrate “Big Data” (DOEHRS, DMSS), genomics, sensors...
 GOAL: build a mathematical model defining individual’s exposure profile
 $1.7M in Joint Program Committee (JPC-1) funding

5. I n t e g r i t y - S e r v i c e - E x c e l l e n c e
IEHRI Example: Noise

6. I n t e g r i t y - S e r v i c e - E x c e l l e n c e
IEHRI Example: Noise
 Basic linear equation for noise:
Individual Exposure Health Risk Index (Noise) = Personal Monitored Exposure (Noise) +
Medical/Clinical Disposition (Noise) + Genetic Proclivity (Noise)
 Adding chemical exposure the equation changes to:
Individual Exposure Health Risk Index (Noise) = Personal Monitored Exposure (Noise) +
Medical/Clinical Disposition (Noise) + Genetic Proclivity (Noise) + Ototoxins (Noise)
 The Individual Exposure Risk Index becomes more refined as we identify
confounding factors that affect the risk of NIHL:
Individual Exposure Risk Index (Noise) = Personal Monitored Exposure (Noise) +
Medical/Clinical Disposition (Noise) + Genetic Proclivity (Noise) + Ototoxins (Noise)
– Protective factors (Noise) – Protective Interventions (Noise)

7. I n t e g r i t y - S e r v i c e - E x c e l l e n c e
2 2
3
1
IEHRP Visualization &
Normalization
X
RADONNOISE BENZENE
MEASURED
EXPOSURE
Genetics
Medical Record
GLUTEN
Graphing the raw data we get the
following IERP. However, to address
censored data requires - Normalization
= censored data

8. I n t e g r i t y - S e r v i c e - E x c e l l e n c e
1 11 1
IEHRP Visualization &
Normalization
X
RADONNOISE BENZENE
MEASURED
EXPOSURE
Genetics
Medical Record
GLUTEN
Normalization = all indices will have
values between 0 and 1. Accounting for
the censored data we get the following
IEHRP

9. I n t e g r i t y - S e r v i c e - E x c e l l e n c e
IEHRI & IEHRP: Expanded
9
IEHRP
 IEHRI – Which vi,j value is more important?
 WFi,j = weighting factor– importance of each variable (vi,j) when
compared with all the variables with in the IEHRI (e.g. are genes more
important than exposure measure?-
 CFi,j = correction factor – variability (confidence) in the (vi,j) based on
the process, procedures, methods, device, etc. for each (vi,j)
Individual Exposure Health Risk Index (IEHRI) (exposure) =
[(v1,1)(CF1,1)(WF1,1) + (v1,2)(CF1,2)(WF1,2) + … (vi,j)(CFi,j)(WFi,j)
Individual Exposure Health Risk Profile (IEHRP) =
[(v1,1)(CF1,1)(WF1,1) + (v1,2)(CF1,2)(WF1,2) + (v1,3)(CF1,3)(WF1,3)] , [(v2,1)(CF2,1)(WF2,1) +
(v2,2)(CF2,2)(WF2,2) + (v2,3)(CF2,3)(WF2,3)] , … ,
[(vi,1)(CFi,1)(WFi,1) + (vi,2)(CFi,2)(WFi,2) +…+ (vi,j)(CFi,j)(WFi,j)]

10. I n t e g r i t y - S e r v i c e - E x c e l l e n c e
IEHRP: Future
Future
 Leverage noise demo to expand into physical, chemical, biological exposures
 Implementation into Clinical Decision Support System (CDSS)
 Full integration into individual EHR: Individual Longitudinal Exposure Record (ILER)
Plan Ahead
 Phase I: IEHRI basic equation: 3 variables, 1 exposure each (v1,1) + (v1,2) + (v1,3)
 Phase II: Introduce correction (CFi,j) & weighted factors (WFi,j) for IEHRI
(v1,1)(CF1,1)(WF1,1) + (v1,2)(CF1,2)(WF1,2) + (v1,3)(CF1,3)(WF1,3) + … (v1,j)(CF1,j)(WF1,j)
 Phase III: Multiple variables and exposures
[(v1,1)(CF1,1)(WF1,1) + (v1,2)(CF1,2)(WF1,2) + (v1,3)(CF1,3)(WF1,3)] , [(v2,1)(CF2,1)(WF2,1) + (v2,2)(CF2,2)(WF2,2) + (v2,3)(CF2,3)(WF2,3)] , … ,
[(vi,1)(CFi,1)(WFi,1) + (vi,2)(CFi,2)(WFi,2) +…+ (vi,j)(CFi,j)(WFi,j)]
 Phase IV: Build IEHRP array w/ censored data* - - (v1,3) (v1,4)
(v2,1) (v2,2) - (v2,4)
*variables may be missing or not measured - (v3,2) - -

11. I n t e g r i t y - S e r v i c e - E x c e l l e n c e
IEHRP Benefits: Tailorability
A
B
“Policymaker”“Healthcare Provider”
NOISE BENZENE GLUTEN RADON
NOISE BENZENE GLUTEN RADON
NOISE GLUTEN RADON BENZENE
RADON NOISE BENZENE GLUTEN

12. I n t e g r i t y - S e r v i c e - E x c e l l e n c e
Headquarters U.S. Air Force
Richard Hartman
Richard.t.hartman3.ctr@mail.mil
Comm: (703)-681-7626
DSN: 761-7626
QUESTIONS?
Cleared for Public Release, SAF/PA Case Number: 2018-0490