stanford cs247 lecture 2 21-11 final v ss

User Generated Health

Chris Hoggtwitter.com/cwhogg

citizenmed.wordpress.com

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We are currently in the era of disconnected health

We are disconnected from our health data

50.7% use EMR$44k in stimulus per doc

We are disconnected from our physicians

We are disconnected from the healthcare

system

We are disconnected from our own health

Being disconnected leads to poor health

1999

Obesity Trends* Among U.S. AdultsBRFSS, 1990, 1999, 2009

(*BMI 30, or about 30 lbs. overweight for 5’4” person)

2009

1990

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

1/3 of Americans will have diabetes by

2050(CDC)

The pace of drug development is slowing

How did we lose control of our personal health identity?

Technology will disrupt healthcare…

(it will just take longer than other industries)

80% search for health3rd most popular web-based pursuit

(Susannah Fox, Pew Internet Project)

Cyberchondria“Unfounded escalation of concerns about common symptomatology,

based on the review of search results and literature on the Web”

2 in 5 report increase in anxiety from medical search

(White and Horvitz, Microsoft Research)

The patient is the most underutilized resource in healthcare

Measurement facilitates behavioral change

(Seligman and Darley 1977)

10.5%

18-29 30-49 50-64 65+0%

5%

10%

15%

20%

15%

8%6% 5%

16%

12%

7%5%

mHealth Adoption (Today)Social Networking Adoption (2005)

Age

% o

f Age

Gro

up

Is mHealth adoption following a familiar

pattern?

Data from:Brian Dolan, MobiHealthNews

Susannah Fox, Pew Internet Project

Apple wants to connect you to your health

New data is more powerfulthan a new drug

39% reduction in hospitalizations over 6 months

73 million have HTN69% with first MI50%

Know your target audience

Even young people have chronic medical

conditions

0-19 20-44 45-64 65+0%

25%

50%

75%

100%

25%

40%

67%

87%

5%15%

40%

67%

One or more chronic conditionsTwo or more chronic conditions

Age

% o

f Pati

ents

Presented at the Annual Academy Health Research Meeting, June 2007; CMS (Centers for Medicare and Medicare Services)

19%

21%

20%

15%

10%

15%But as people age, they get a lot more No conditions

1condition

2 conditions

3conditions

4conditions

5+conditions

# of chronic conditions for Medicare beneficiaries (65+)

Medical / clinical is converging with health / wellness

What you can learn from a few

data points?

1/12/0

6

2/1/0

6

2/21/0

6

3/13/0

6

4/2/0

6

4/22/0

6

5/12/0

6

6/1/0

6

6/21/0

6

7/11/0

6

7/31/0

6

8/20/0

6

9/9/0

6

9/29/0

6

10/19/0

6

11/8/0

6

11/28/0

6

12/18/0

65.5

5.6

5.7

5.8

5.9

6

6.1

6.2

6.3

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

5.7

5.8

5.9

6.0Mood Seasonality Mood by Day of Week

Significant personal information from a single

daily data point

30

Crowdsourcing personal health data

31

Exercise

B Vitamins

Xanax(Alprazolam)

Can crowdsourced personal health data be used to

predict personalized drug responses?

Data is beginning to flow from the system to users

Access to data – Blue ButtonPractice FusionMSHV

Surescripts data on Rx histories

Prescription data is beginning to flow

Rx history + treatment algorithm =

understanding

You can learn a lot about a person from a few simple

data points

LiptorZocor

LovastatinPravachol

CrestorLescol

ZetiaTricor

VytorinGemfibrozil

Niaspan

HDLand

Other

Statins

Drug

Drug Class

High Cholesterol

Coronary Artery

Disease(CAD)

Myocardial Infarction

(Heart Attack)

DrugDrug Class

EventMedical Conditions

High Blood Pressure

Diuretics

Calcium Channel Blockers

ARBs

ACE Inhibitors

Beta Blockers

Type 2 Diabetes

Metformin

Sulphonylureas

Insulin

DPP -4 Inhibitors

TZDs

20-30% of CAD patients have

Type 2 Diabetes

70-80% of CAD patients have high

blood pressure

Hidalgo et al. PLoS Computational Biology 5(4):e1000353 (2009)http://hudine.neu.edu/

High Cholesterol

High Blood Pressure

Type 2 Diabetes

1

2

3

4

5

High Blood Pressure

High Blood Pressure

High Blood Pressure

High Cholesterol

High Cholesterol

Type 2 DiabetesOsteoporosis

Social Health Layer / Health Graph

Google Health

Microsoft HealthVault

Practice Fusion

EMR / PHR

AllScripts PHR

Other EMR / PHR System

APIs

Google Apps MSHV Apps PF Apps AS Apps Other PHR Apps

Social Health App

Social Health App

We are entering the era of Participatory Medicine

A medical record is a punctuated data stream

Pers

onal

Hea

lth D

ata Gaps filled via recollection

Anamnesis(patient recollection)

is not accurate

Pers

onal

Hea

lth D

ata

12/31/05

1/8/06

1/16/0

6

1/24/0

6

2/1/06

2/9/06

2/17/0

6

2/25/06

3/5/06

3/13/0

6

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6

3/29/0

6

4/6/06

4/14/0

6

4/22/0

6

4/30/0

6

5/8/06

5/16/0

6

5/24/06

6/1/06

6/9/06

6/17/0

6

6/25/0

6

7/3/06

7/11/0

6

7/19/0

6

7/27/0

6

8/4/06

8/12/0

6

8/20/0

6

8/28/0

6

9/5/06

9/13/0

6

9/21/06

9/29/0

6

10/7/06

10/15/06

10/23/06

10/31/06

11/8/06

11/16/06

11/24/06

12/2/06

12/10/06

12/18/06

EMR data + user generated data = healthstream

Rx of AppsMETFORMIN 500MG BIDLISINOPRIL 20MG OD

Medications

Applications

I will own my healthstream and health data

The market for health data is

very large

Healthcare systems are the future

Data enables us all to become Citizen Scientists

Can butter make you smarter?

The MTHFR Study

Groups of users will come together to run their own clinical trials

Genomera: A platform for

Citizen Science

Future study:meditation and blood pressure

Drug A

Drug B

Track common measures of efficacy, potential side effects, events, etc.

Citizen Science has the power to disrupt healthcare

For those interested in learning more, the Bay Area

is a good place to be…

Thank You

Chris Hoggcwhogg@gmail.comtwitter.com/cwhogglinkedin.com/in/cwhoggcitizenmed.wordpress.com

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