Download - Stanford cs247 lecture 2 21-11 final v ss
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User Generated Health
Chris Hoggtwitter.com/cwhogg
citizenmed.wordpress.com
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6,8363.4
127/62843.2
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We are currently in the era of disconnected health
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We are disconnected from our health data
50.7% use EMR$44k in stimulus per doc
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We are disconnected from our physicians
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We are disconnected from the healthcare
system
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We are disconnected from our own health
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Being disconnected leads to poor health
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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)
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The pace of drug development is slowing
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How did we lose control of our personal health identity?
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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)
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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)
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The patient is the most underutilized resource in healthcare
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Measurement facilitates behavioral change
(Seligman and Darley 1977)
10.5%
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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
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Apple wants to connect you to your health
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New data is more powerfulthan a new drug
39% reduction in hospitalizations over 6 months
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73 million have HTN69% with first MI50%
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Know your target audience
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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
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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+)
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Medical / clinical is converging with health / wellness
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What you can learn from a few
data points?
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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
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Significant personal information from a single
daily data point
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30
Crowdsourcing personal health data
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31
Exercise
B Vitamins
Xanax(Alprazolam)
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Can crowdsourced personal health data be used to
predict personalized drug responses?
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Data is beginning to flow from the system to users
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Access to data – Blue ButtonPractice FusionMSHV
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Surescripts data on Rx histories
Prescription data is beginning to flow
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Rx history + treatment algorithm =
understanding
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You can learn a lot about a person from a few simple
data points
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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
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Hidalgo et al. PLoS Computational Biology 5(4):e1000353 (2009)http://hudine.neu.edu/
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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
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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
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We are entering the era of Participatory Medicine
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A medical record is a punctuated data stream
Pers
onal
Hea
lth D
ata Gaps filled via recollection
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Anamnesis(patient recollection)
is not accurate
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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
3/21/0
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
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Rx of AppsMETFORMIN 500MG BIDLISINOPRIL 20MG OD
Medications
Applications
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I will own my healthstream and health data
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The market for health data is
very large
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Healthcare systems are the future
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Data enables us all to become Citizen Scientists
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Can butter make you smarter?
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The MTHFR Study
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Groups of users will come together to run their own clinical trials
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Genomera: A platform for
Citizen Science
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Future study:meditation and blood pressure
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Drug A
Drug B
Track common measures of efficacy, potential side effects, events, etc.
Citizen Science has the power to disrupt healthcare
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For those interested in learning more, the Bay Area
is a good place to be…