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© 2019, Amazon Web Services, Inc. or its affiliates. All rights reserved.
Digital therapeutics and patient personalization
L F S 2 0 2
Greg Tracy
CTO
Propeller Health
Shaun Qualheim
Senior Solution Architect
Amazon Web Services
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Agenda
What are digital therapeutics?
Digital therapeutics on AWS: Architecture overview
Propeller Health’s digital solution
Propeller Health’s architecture
Questions
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© 2019, Amazon Web Services, Inc. or its affiliates. All rights reserved.
“Digital therapeutics (DTx) deliver evidence-based therapeutic interventions to patients that are driven by high quality software programs to prevent, manage, or treat a broad spectrum of physical, mental, and behavioral conditions.”
Digital Therapeutics Alliance
https://dtxalliance.org/dtx-solutions/
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Why digital therapeutics?• Enhance, support, and extend current
treatments
• Extend and differentiate existing therapies, increasing their lifespan and efficacy
• Patient-centered care
• Meet patients where they are (versus at the clinician’s office)
• Data can be used to enhance adherence and influence patient behavior
• Broad impact across many therapy areas
• Asthma, hypertension, smoking cessation, substance abuse, insomnia, ADHD, diabetes management, pediatric behavioral health
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Digital therapeutics in the value chain
Early-phase research Clinical trials Manufacturing Commercialization
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Quantified self
Digital therapeutics “success triangle”Healthcare provider
engagement
Personalized goals
and insights
Group support
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6
4
3
2
1
Digital therapeutics and precision medicine
AWS Cloud
Data sources
Users
Smart sensor
Smart sensor
Mobile client
Users
Clinical
applications
Commercial
Applications
Databases
Endpoints
Real-time ingest
Amazon
Pinpoint
Ingest
Batch data ingest
AWS
DataSync
DB Replication
AWS DMS
Managed ETL
AWS Glue
Amazon S3
AWS Batch
Consume APIs
Storage and archival
Archive:
Amazon S3 Glacier
Lifecycle
policies
Storage:
Amazon S3 IA
5
Data preparation
Source crawlers
ETL and data prep
Data catalog
Security settings
Access control
8
Event driven tasks/alerts
User engagement
Feedback Email, SMS, and mobile push
Amazon Pinpoint
Metadata and rules
AWS Lambda
stream processorAmazon
DynamoDB
AWS Lake Formation
7 Data analytics and
visualization
Data warehouse:
Amazon Redshift
Data Analysis
Ad hoc query:
Amazon Athena
Semistructured/
unstructured:
Amazon EMR
Visualization:
Amazon
QuickSight
Legacy/third-party
apps
Predictive analytics:
Amazon SageMaker
Business
users
Researchers/
data scientists
Care
coordinators
Endpoint-driven predictions
Graphical
interface
Healthcare facility
AWS reference architecture
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© 2019, Amazon Web Services, Inc. or its affiliates. All rights reserved.
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Respiratory medications are very effective
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But our treatment approach has not evolved
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More
accessible
More
personalMore
powerful
More
convenient
People deserve a better
approach to respiratory care
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Jane Doe is at risk of asthma
exacerbation today.
FEB 21
Connected medicinesPatient/caregiver experience Clinical reports
Care team dashboards
Clinical alerts
Data science and analytics
Propeller is a complete solution for respiratory disease
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Our commercial model is built on a 2-sided network
Payers
PBMs
Health
systems
PharmaciesData
Patients
Data
Patients
Upstream Downstream
Respiratory
Pharma
Customers include
Anthem
Express Scripts
Dignity Health
Walgreens
GlaxoSmithKline
Boehringer Ingelheim
Orion
Novartis
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Clinical outcomes (asthma): Decreased ED + hospitalStudy overviewDignity Health patients were enrolled from
2014 to 2017 during routine asthma care
and monitored for at least 1 year. Providers
monitored SABA use and adherence to
inhaled controller medications, and
provided follow-up as needed.
Population● Patients with asthma who were prescribed a
SABA and who had no comorbidities
● N = 224; mean age: 33 years; 43% male;
53% used ICS only and 17% used ICS/LABA,
30% used another controller medication
Reference: Merchant, R., et al. Impact of a digital health intervention on asthma resource utilization. World Allergy Organ J. 2018;11, article 28.
https://waojournal.biomedcentral.com/articles/10.1186/s40413-018-0209-0
Results
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Clinical outcomes (COPD): Decreased ED + hospitalStudy overviewCleveland Clinic enrolled people into
Propeller part of their routine clinical care
and monitored for at least 1 year. Providers
monitored SABA use and adherence to
inhaled controller medications, and
provided follow-up as needed.
Population● Patients with COPD with ≥1 utilization (ED
visit or hospitalization) in prior 12 months
● N = 39; mean age: 69 years; 51% male;
69% African American; mean FEV1
predicted: 47.2%; mean CAT 19
Alshabani K, et al. Electronic inhaler monitoring and healthcare utilization in chronic obstructive pulmonary disease. J Telemed Telecare. 2019.
doi:10.1177/1357633X19850404
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What is Propeller?
Bluetooth-enabled
sensors track rescue
and controller
medication use
Passive syncing +
patient/caregiver
experiences
Objective data on
medication adherence and
clinical status for care teams
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Rescue use tracking and analysis
10:17:08 AM PST
AQI 48
47°34.4452 N,110°77.8257 W
Winds from SW, 13 mph
2 puffs of ProAir
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Improving medication adherencePropeller takes a multifaceted approach to help patients build
sustainable medication-taking behaviors
Game mechanics and
behavior change In-app reminders
Sensor
reminder
sounds
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Using data to create magical user experiences
Using data, we can begin to predict when someone will
have symptoms, and even what might be causing them
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© 2019, Amazon Web Services, Inc. or its affiliates. All rights reserved.
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Propeller’s core architecture
Mongo
Device
API
Workers Workers
ETL Amazon Aurora
Ingress queue
Task queue
pubsub
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Prediction models of large pools of patients
Propeller has developed algorithms and models to determine whether a patient is at increased risk for exacerbation
Increasing risk of
exacerbation/
worsening
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Propeller’s Achilles’ heel
Mongo
Device
API
Workers Workers
ETL Amazon Aurora
Ingress queue
Task queue
pubsub
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Examples of analytics and data science capabilities
Geospatial
modeling
Prediction
models
Product insightsClinical
analytics
Propeller’s data team provides partners with a
wide range of capabilities including geospatial
modeling of location and environment data,
prediction modeling, clinical analytics, and
continuous monitoring of product
performance and user engagement
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Propeller’s applied data infrastructure
Data are extracted,
transformed, and loaded into
unstructured, semi-
structured & structured
data stores
Data science team uses a
combination of tools to
derive insights
Modern machine learning
tools are used to build
models to power
personalized experiences
Data are collected in
proprietary and third-
party systems
Streams of app, web, patient,
device, environmental,
& location data
Amazon Aurora
Amazon S3 Amazon S3
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We’re growing up
ETL
Amazon Aurora
Mongo Amazon Kinesis
AWS Glue Amazon Redshift
Looker reports
Amazon S3
Amazon SageMakerAnalysts
Propeller
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Data lake architecture
Amazon KinesisPropeller
AWS Glue
Clinical
Geo
Ingress stats• 3.3 million symptom
events
• 250 million patient
hours
2 TB of raw data
Analytics
Environmental
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Enrich and transform
Amazon Athena
Amazon Redshift
AWS Glue Data
CatalogAWS Glue curation
Engineers Data
scientists
Analysts
Looker reportsPropeller
Data lake
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Population-level reporting
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Prediction models for individual patients
Providing actionable interventions to patients when we know that the conditions may be difficult
● Mobile push/email○ Conditions are bad○ Early morning
● Connect forecast to IFTTT● Content in patient’s feed
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Our framework personalizes both inputs and outputs
Model
7 historical days +
present-day
conditions
Raw daily SABA puff
countOR binary “symptom-day”
Personalized
user data
“Good”
“Fair”
“Poor”
Model Raw output
Percentile of
user’s past 28
days
Weather
Pollutants
Personal xlinical
Socioeconomic (ZIP)
Built environment
Training
Production
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Enrich, transform, and trainAWS Glue Data
Catalog
AWS Glue curationData lake Amazon SageMaker
Train
Amazon SageMaker
• We’ve generated over 21M asthma forecasts for users
• We’ve predicted over 150k exacerbations
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We’re scaling and expanding
2020
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We’re feeling settled and prepared
Amazon Redshift
AWS Glue Data
CatalogAWS Glue curation
Data lake
Ingress
Amazon SageMaker
Propeller
Analytics
Environmental
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We’re exploring new inputs and models
Inputs and outputs are personalized
The model itself is not
Prototyping, common sense, and evidence from other fields such as predictive maintenance suggest that simple, more personalized tree-based models outperform population-level deep learning models
Pipelines
● New datasets & signals● Near-time predictions● Per-patient automatic
retraining● Improve accuracy of
existing datasets
UX● Less friction● More education/context● Bubble up raw signals
Sensitivity
similarity meta-
model
Training/validation
data from K most
similar patients
Use previous
framework with
tree-based models
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Healthcare & Life Sciences networking lounge
Join us at our networking lounge for post-session speaker meet-and-greets, lightning talks, and informal discussions
Venetian, Level 3
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AWS Healthcare & Life Sciences Happy Hour
Join us at our networking reception for informal discussions with industry colleagues and AWS HCLS Leadership
OTORO Sushi & Grill @ Mirage Hotel
Tuesday: 6:00 – 8:00 PM
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Thank you!
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