"The Future of Clinical Practice will be Optimizing Health" - Molly Maloof (Physician/Technologist/Scientific Wellness Pioneer, Independent) Delivered at the inaugural Hyper Wellbeing Summit, 14th November 2016, Mountain View, California. For more information including details of subsequent events, please visit http://hyperwellbeing.com The summit was created to foster a community around an emerging industry - Wellness as a Service (WaaS). Consumer technologies, in particular wearables and mobile, are powering a consumer revolution. A revolution to turn health and wellness into platform delivered services. A revolution enabling consumer data-driven disease risk reduction. A revolution extending health care past sick care towards consumer-led lifelong health, wellness and lifestyle optimization. WaaS newsletter sign-up http://eepurl.com/b71fdr @hyperwellbeing

2. ONTOLOGY CREATION FOR A WELLNESS
PARADIGM
BY
DR. MOLLY MALOOF MD

4. WHAT IS AN ONTOLOGY?
• EXPLICIT, FORMAL SPECIFICATION OF A SHARED CONCEPTUALIZATION OF A
PARTICULAR DOMAIN OF DISCOURSE.
• A THESAURUS OF WORDS AND INFERENCE RULES THAT OPERATE ON THE
RELATIONSHIPS OF WORDS
• WE HAVE ROBUST ILLNESS ONTOLOGIES
• SNOMED, MESH, OBO FOUNDRY, GENE ONTOLOGY, UMLS, ICD, ICPC, ICF

5. WHY DO WE NEED ONTOLOGIES?
• THEY LIMIT COMPLEXITY
• THE ORGANIZE INFORMATION
• THEY HELP WITH INFORMATION RETRIEVAL
• THEY ALLOW DOMAIN KNOWLEDGE SHARING
• THEY ALLOW KNOWLEDGE INTEGRATION
• THEY CAN BE APPLIED TO PROBLEM SOLVING…

6. OUR GREATEST PROBLEM: DIETARY RISKS
US Burden of Disease
Collaborators, JAMA 2013

7. HEALTH CARE IS BASED ON
THE PATHOGENIC PARADIGM
• ILLNESS ONTOLOGIES ARE USED TO SATISFY THE NEEDS OF ORGANIZATION-CENTRIC
HEALTHCARE.
• THEY SERVE THE HEALTH CARE PROVIDERS AND INSURANCE COMPANIES
• TRAINING IS FOCUSED ON DISEASE
• PAYMENTS ARE FOCUSED ON DISEASE CODING
• TREATMENTS ARE FOCUSED ON DRUGS AND SURGICAL PROCEDURES CODING
• DISEASE IS WHAT THE SYSTEM PAYS FOR.
• THE SYSTEM IS DESIGNED TO PERPETUATE THE SYSTEM, NOT TO BRING INDIVIDUALS TO A
GREATER STATE OF HEALTH.
• THE SYSTEM DOES NOT PAY FOR HEALTHY, NOURISHING FOOD (YET).

8. YET WHEN YOU LOOK UP “WELLNESS” IN MESH
• YOU GET THE WORD “HEALTH” AND, IF YOU LOOK UP THE WHO DEFINITION OF HEALTH,
IT SAYS, “HEALTH IS A STATE OF COMPLETE PHYSICAL, MENTAL AND SOCIAL WELL-
BEING, AND NOT MERELY THE ABSENCE OF DISEASE AND INFIRMARY.”

10. LET’S GO BACK 200 YEARS
• HISTORICALLY, THE ROOTS OF WELLNESS MAY BE TRACED BACK TO THE EARLY
TEACHINGS OF THE TWO DAUGHTERS OF AESCULAPIAS, THE ANCIENT GREEK
GOD OF HEALING.
• THE FIRST, PANACEA, BELIEVED THAT TREATING EXISTING ILLNESS WAS THE WAY TO
PROMOTE HEALING.
• HYGEIA, ON THE OTHER HAND, BELIEVED THAT WE SHOULD TEACH POSITIVE WAYS
OF LIVING TO HELP PREVENT ILLNESS.
Meyers, J and Sweeney T. “Wellness in Counseling: An

11. WHY IS THERE SUCH A FOCUS ON DISEASE?
• EMPIRICISM AND SCIENCE: MEDICINE IS ORIENTED TOWARD BIOLOGICAL APPROACH AND
AWAY FROM SUPERSTITION (ROHMAN 2002:180).1
• “WHY IS IT THAT DOCTOR’S AND NURSES AND HEALTH WORKERS SO FREQUENTLY FORGET
THE MEANING OF THIS DEFINITION? FOR, EVEN WHILE THEY QUOTE THE WORDS, THEY TEND
TO FOCUS UPON DISEASE, DISABILITY, AND DEATH, TO EXCLUSION OF THESE OTHER FACTORS.
PERHAPS IT IS BECAUSE THEIR TRAINING HAS BEEN ORIENTED TOWARDS DISEASE RATHER
THAN TOWARD POSITIVE WELLNESS; AND THEREFORE FIND DISEASE MORE INTERESTING THAN
WELLNESS. ALSO, IT’S EASIER TO FIGHT AGAINST SICKNESS THAN TO FIGHT FOR A CONDITION
OF GREATER WELLNESS. AFTER ALL, PEOPLE—THEIR PATIENTS—WANT TO GET WELL; THAT IS,
THEY WANT TO BE FREE FROM SICKNESS. YET WHEN THEY ARE FREE FROM SICKNESS, THESE
SAME PEOPLE ARE RARELY INTERESTED IN BECOMING MORE WELL.”
• ~HALBERT DUNN, HIGH LEVEL WELLNESS (1961)

12. THOUGHT EXPERIMENTS
• WHAT WOULD THE WORLD LOOK LIKE IF WE INVESTED HALF OF WHAT WE SPEND
ON SICK CARE ON OPTIMIZING THE HEALTH OF OUR CITIZENS?
• WHAT WOULD THE WORLD LOOK LIKE IF WE TOOK THE MARKETING BUDGETS OF
BIG PHARMA AND INVESTED THEM INTO MARKETING FRUITS AND VEGETABLES?

13. A PARADIGM SHIFT IS HAPPENING
• P4 MEDICINE: PERSONALIZATION, PARTICIPATION, PREDICTION, PREVENTION
c/o: Nathan Price

14. WEARABLE COMPUTING
• PERVASIVE
COMPUTING
TECHNOLOGIES
ARE ENABLING US
TO COLLECT A
LOT OF DATA –
ANYTIME,
ANYWHERE.
• BUT, THERE IS
STILL A LOT WE DO
NOT KNOW ABOUT
HOW TO GET TO
OPTIMAL HEALTH.
• DECENTRALIZATIO
N: MOVING
HEALTHCARE
OUTSIDE THE
HOSPITAL
ENVIRONMENT
• PEOPLE MANAGING
THEIR PERSONAL
HEALTH AND
WELLNESS OUTSIDE
OF THE PROVIDER
NETWORK.

16. WHY WE NEED A WELLNESS ONTOLOGY:
• TO CLASSIFY AN INDIVIDUAL’S LEVEL OF VITALITY, THRIVING AND WELLBEING, SKILLS
ASSOCIATED WITH WELLNESS, AND HIGHER FUNCTIONING.
• TO COME TO A CONSENSUS REGARDING WHAT PERSONAL WELLNESS ACTUALLY IS AND ITS
COMPONENTS.
• TO IDENTIFY EMPIRICAL CORRELATES OF HEALTH, QUALITY OF LIFE, AND LONGEVITY.
• TO CREATE DEVELOP TECHNOLOGY-BASED SOLUTIONS TO IMPORTANT AND RELEVANT HEALTH AND
BUSINESS PROBLEMS.
• ON THE SOCIAL LEVEL: FOR POLICY, EDUCATION, OUTCOME EVALUATION, ENVIRONMENTAL
ASSESSMENT, RESOURCE PLANNING & DEVELOPING, FOR ACCOUNTABLE AND VALUE BASED
CARE HEALTH CARE MODELS.
• ON THE INDIVIDUAL LEVEL: FOR GOAL SETTING, ASSESSMENT, SELF-EVALUATION,
INTERVENTIONS, COMMUNICATION

17. LET’S DEFINE WHAT WELLNESS IS
• THE DEFINITION OF WELLNESS ACCORDING TO MYERS, SWEENEY, AND WITMER
(2000):
• “A WAY OF LIFE ORIENTED TOWARD OPTIMAL HEALTH AND WELL-BEING, IN WHICH
BODY, MIND, AND SPIRIT ARE INTEGRATED BY THE INDIVIDUAL TO LIVE LIFE MORE
FULLY WITHIN THE HUMAN AND NATURAL COMMUNITY. IDEALLY, IT IS THE OPTIMUM
STATE OF HEALTH AND WELL-BEING THAT EACH INDIVIDUAL IS CAPABLE OF
ACHIEVING. (P. 252)
• PENDER ET AL. (2002) DEFINED HEALTH AND WELL-BEING AS:
• “ACTUALIZATION OF INHERENT AND ACQUIRED HUMAN POTENTIAL THROUGH GOAL
DIRECTED BEHAVIOR, COMPETENT SELF-CARE, AND SATISFYING RELATIONSHIPS WITH
OTHERS, WHILE ADJUSTMENTS ARE MADE TO MAINTAIN STRUCTURAL INTEGRITY AND
HARMONY WITH RELEVANT ENVIRONMENTS.”
• IN SHORT: IT’S BOTH THE JOURNEY AND THE DESTINATION -- IN THE OPPOSITE
DIRECTION OF ILLNESS.

18. WHERE DOES WELLNESS LEAD US?
• VITALITY, THRIVING, SELF-ACTUALIZATION
• PEOPLE HAVING MORE OF THEIR NEEDS MET (MASLOW’S HIERARCHY OF NEEDS).
• DEVELOPING THE POSITIVE ASPECTS AND STRENGTHS OF HUMAN BEHAVIOR.
• GREATER ADAPTABILITY, SELF-MANAGEMENT, AND RESILIENCE WHEN FACED WITH LIFE
STRESS.
• LESS DISEASE, DYSFUNCTION, AND DISABILITY.
• OPTIMAL INDIVIDUALIZED FITNESS SO THAT ONE LIVES A FULL, CREATIVE LIFE
(GOLDSMITH, 1972).
• BEING ABLE TO FEEL GOOD DURING A LIFE OF MOBILITY, ENJOYMENT, AND SOCIAL
RELATIONSHIPS (BRESLOW, 1999)

19. WHERE DO WE BEGIN IN CREATING A
WELLNESS ONTOLOGY?
• LOOK AT EXISTING WELLNESS RESEARCH
• LOOK AT EXITING ILLNESS ONTOLOGY SYSTEMS
• CREATE A THESAURUS AND MAP THE RELATIONSHIPS
• COME UP WITH A NEW META-MODEL

20. • SOME EXITING WELLNESS ONTOLOGY
SYSTEMS & META-MODELS MAPPING THE
RELATIONSHIPS

21. Context-aware and Trust-based Personal Wellness Information Framework for Pervasive Health

22. WE WILL HAVE TO BUILD MANY ONTOLOGIES
• THE ACTIVITY ONTOLOGY CONTAIN INFORMATION ABOUT THE EXERCISE TYPE, DURATION, INTENSITY ETC. THE ENTRIES MAY ALSO INCLUDE SETS OF
MEASUREMENTS, SUCH AS THE HEART BEAT RATE.
• THE NUTRITION ONTOLOGY DESCRIBES THE NUTRITIONAL VALUES OF MEALS AND FOOD. IT ALSO CONTAINS CLASSES REFERRING TO THE NUTRITION
SCHEDULE OF INDIVIDUAL USERS. IT IS BASED ON AN ONTOLOGY CREATED IN THE IST/PIPS PROJECT [13] AND ENRICHED WITH ADDITIONAL
NUTRITION CHARACTERISTICS.
• THE WEIGHT ONTOLOGY DESCRIBES ENTRIES AND GOALS RELATED TO WEIGHT MANAGEMENT. IT IS USED FOR COLLECTING WEIGHT MEASUREMENT
VALUES. IT ALSO CONTAINS CLASSES OF WEIGHT FOR DIFFERENT AGES AND GENDERS, E.G. MALE MIDDLE AGE IDEAL WEIGHT AS A FUNCTION OF
HEIGHT.
• THE SLEEP ONTOLOGY AND THE STRESS ONTOLOGY DESCRIBE PARAMETERS OF SLEEP AND STRESS INCLUDING QUALITY MEASUREMENTS, MEDICAL
CONDITIONS AND DISORDERS.
• THE RISK ONTOLOGY DESCRIBES INFORMATION ABOUT "BAD HABITS", SUCH AS SMOKING AND ALCOHOL CONSUMPTION. IT IS USED FOR
MONITORING AND SETTING GOALS.
• THE PERSONAL ONTOLOGY DESCRIBES THE INFORMATION STORED FOR ONE INDIVIDUAL. IT INCLUDES PERSONAL CHARACTERISTICS (WEIGHT,
HEIGHT, GENDER, WORK, PREFERENCES), THE GOALS SET BY THE INDIVIDUAL CONCERNING HIS/HER HEALTH AND RECOMMENDATIONS SET BY THE
HEALTH SPECIALISTS.
• THE CONTEXT ONTOLOGY DESCRIBES POSSIBLE CONTEXT PARAMETERS OF THE ENVIRONMENT OF THE INDIVIDUALS (HOME, WORK, TRAVEL ETC.).
THIS KIND OF INFORMATION IS IMPORTANT IN THE DATA ANALYSIS PHASE. FOR EXAMPLE, THE INFORMATION ABOUT A TRAVEL CAN EXPLAIN A
PERIOD WITH MISSING ACTIVITY ENTRIES OR A CHANGE IN SLEEPING TIMES.
• THE EVENT ONTOLOGY DEFINES ANY RELEVANT EVENT NOT COVERED BY THE OTHER ONTOLOGIES. THIS COULD BE A VISIT TO THE DOCTOR OR
DISCUSSION WITH PERSONAL TRAINER. THERE MAY ALSO BE A REFERENCE TO RELATED INFORMATION, SUCH AS CLINICAL DOCUMENTS.
• THE SOURCE ONTOLOGY DESCRIBES THE DEVICES USED FOR THE MEASUREMENTS INCLUDING INFORMATION ABOUT THE CAPABILITIES AND
SPECIFICATIONS OF EACH DEVICE. THE SOURCE ONTOLOGY IS REFERRED BY THE OTHER DOMAIN ONTOLOGIES IN CASES WHEN A SPECIFIC DEVICE IS
USED E.G. FOR PROVIDING MONITORING DATAOntology-Based Approach for Managing Personal Health and Wellness Information