open mhealth-mhealth summit presentation-vfinal

8/3/2019 Open mHealth-mHealth Summit Presentation-VFinal

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Thank you very much for coming to our session. HASHTAG forthe session is #OPENMHEALTH


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I'm sure most of you have seen this Gartner Hype Cycle graphbefore. Where would you say mHealth is right now? Raise your

hand. Here (just before or at the peak)? Here (after the peak)? Orhere (in the trough)?

Yes, we will go through the Trough of Disillusionament, but thereal question is where this will all end up. What will bemHealth's plateau of productivity?


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Let's start with a very high level view of mHealth.

mHealth applications are sources of passive and activelycollected data, which must be visualized and interpreted, andintegrated into daily life and clinical care.

It is the mHealth data that are the nuggets of value here...


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...data to drive what we have identified as three essentialfeedback loops to improve health outcomes.


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First is data to provide feedback on self-care. How is thismedication working for me? Is my stress better now that I'm

sleeping more?

A second feedback loop is to clinical care. For clinicians like me,I want to know how my patients are doing: Is Mrs. Lee'sdepression improving? Perhaps I might want to intervene in herown feedback loop with advice, a dosage change, or some otheraction.

Finally, data can act as research evidence, driving a loop ofknowledge to tell us what works and what doesn't in differentcontexts, which in turn will propagate back to these otherfeedback loops


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...and without better sensemaking to drive the 3 essentialfeedback loops


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we are likely to end up not at the fabled plateau of productivity,but rather at a plateau of diminished promise.

This opportunity gap is what OpenmHealth is about. We seekto tip the mHealth ecosystem to this trajectory, rather than thisone. How are we going to do that?


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Today, mHealth apps are being built independently, with littlesharing of data, methods, or learning. We believe that this

siloed mHealth ecosystem is a barrier to the promise ofmHealth. We believe that what is needed is to borrow theInternets approach of open modular sharing and learning.

The Internet has what is called an hourglass architecture, fromwhich it derived much of its success. There is a commonprotocol that acts as a simple point of commonality at thenarrow waist. This allows innovation to flourish through openinterfaces, or APIs, both above and below the waist.

Open mHealth aims to catalyze the mHealth ecosystem from asiloed architecture to an hourglass architecture, by developingshared components and open APIs at the narrow waist. This


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I will now hand the floor over to Deborah to introduce ourarchitecture, and talk about our InfoVis components for

sensemaking.

I will come back to describe our plans for a personal evidencearchitecture to tie sensemaking to generating researchevidence.and David will finish up describing our project activitiesand how you can get involved.


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Infovis shorthand for sensemaking software modules--data analysis andpresentation techniques--reusable, combinable, across mhealth apps

Decentralized innovative community needs architecture so independentlydeveloped software modules can be mixed and matched--and minimalinterface definitions that all can depend on

Architecture : small set of common principles/practices by which thesemodules are described and interfaced to one another.

Architecture is why we have the internet we do

Need to drive architecture development w/ real use case of patient-facingmHealth--PTSD w/ VA


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Photo: VA and DOD. Adapted from Julia Hoffman (VA), et al.

Julia Hoffman et al. PTSD Coach, personal tool to manage and mitigatesymptoms.

Stigma and logistical challenges of seeking help. Full week between sessions toself-manage.

Skills for between-session and independent self-management: self-assessvariations in condition; develop portable skills to address acute symptoms

Developed 2010 and on app store mid 2011


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PTSD Coach implemented as a stand alone application for patient self-care.PTSD explorer brings data to clinician to support treatment process

PTSD explorer plumbs application to capture data on tool participation,symptom self reports, support types, coping and medications---data arebyproducts of use

Building Infovis data processing modules that extract features from datafor clinician -- trends, correlations over time, across parameters, with noisygappy data

Enable iterative innovation for clinician. Not data exploration during yourpatients all too short session but facilitated flexible config of dataviews forclinician cohort condition


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same process, arch, tools for many patient facing mhealth applications

overall architecture elements:

The third party data applications and stores -- mHealth applications storeand manage data, -- this is where ptsd coach and explorer sit

data processing units (DPUs) building blocks for extracting relevantfeatures from data streams,

Data Visualization building blocks for creating presentations of data,

Infographics that might be created specially to tailor the look of the userinterface, and a local cache for performance.


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data visualization can be modularized and reused across applications

combine to create specific interactive, configurable data views -- zoomabletimelines, maps

not trying to be mhealth service or portalDVUs embeddable in third partymhealth applications

Modules that you can integrate into your platform...use to build yourrepository...

monetized innovation happening above these reusablecomponentsresulting volume of visible innovation much greater.


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Sensemaking, finemodularity, fine.why is it so important that we dothis open?

Goal -- vibrant decentralized community of users...benefit from openarchitecture...therefore contribute to it.

Openmhealth allows individual innovators to avoid wasting resourcesreinventing the wheel; spend resources on innovations above (new apps,biomarkers, treatments, interventions) and below (wireless health devices)-- net innovation of market enhanced.

Pays not to fork--john mattison of kp: discipline makes institution in bettershape to adopt external innovations over time. Weber on opensource....recommended by karl brown and retweeted by me.

componentsreused by community grow in validity robustness efficiency


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To advance science and practice of mHealth, the sensemaking has to bebrought to bear on scientific questions in scientific way-

As science advances the feedback loops will be powered by the resultingevidence and models.

Pass it over to Ida to talk about the Personal evidence architecture that willhelp to close and enhance these loops


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When we say we want to advance the "science and practice" ofmHealth, one of the biggest questions we need to answer is

whether something "works" or not.

For example, does Text4Baby work?


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When we say we want to advance the "science and practice" ofmHealth, one of the biggest questions we need to answer is

whether something "works" or not.

For example, does Text4Baby work? That's an imprecisequestion though. It should be rephrased as a statistical question,about the strength of association between being "exposed" toText4 Baby and some outcome we care about, like increasedbreastfeeding.

We can be interested whether Text4Baby works at thepopulation level (in teen moms) or whether it works for an

individual (does it work for me).


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The only formal method for answering "does it work for me" isthe N-of-1 study design.

In which there's only 1 person, 1 "n" in the study. So I would berandomized first to PTSD Coach, then usual care, and back andforth a few cycles, assessing my PTSD symptoms along the way.

This method is not widely known and is statisticallycomplicated, but offers the kind of personal evidence we need todrive systematic but personalized learning across mHealth


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O Our Personal Evidence Architecture aims to make it easierto answer questions scientifically, starting with individual-

level questions. Patients and clinicians will be able to define aquestion, set up a study using say an n-of-1 study template, runthe study as an app, and on the backend, it will use InfoVis to dothe data analysis and feedback as you heard Deborah describeearlier.


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* And once we have evidence from many individual n-of-1studies, we can essentially flip the traditional direction of

research inference on its head, aggregating individual-levelevidence to get at population-level evidence, rather than theother way around


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We are focusing now on building out N-of-1 scripting andanalysis, and identifying a small library of high-value shared

measures. We're looking at some of the measures in NIH'sPROMIS project, for example, but there will also be a need todevelop and validate measures specifically for the mHealthcontext, in which self-report data can be collected several timesa day rather than once every 3 months like in many traditionalmeasures.

For aggregating evidence, we are exploring a shared set ofcontext meta-data tags, to capture the context about the variable

and about how the data was collected, for example the OS andversion used, the app version, etc. Context meta-data is criticalto ensure that data and evidence can make sense together aswell as separately


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That's a quick tour of our InfoVis and Personal EvidenceArchitecture work. Now David will tell you about our other

project activities and how you can get involved.


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We want to pinch the siloed mHealth applications at the waist to create ascalable, open architecture.


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We have some successful open source predecessors in our midst. that playan important function in advancing health IT.

From OpenMRSs medical record system to ODKs data collection tools,each play an important function and role in this advancement.


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Today OpenmHealth is needed to advance mHealth by increasing thespeed, innovation, exploration, and effectiveness of mHealth sensemaking.


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Open mHealths mission is to tip the current mHealth ecosystem to achievegreater openness, integration and evidence in order to improve individual

and public health.


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Were going to do this by:

1.Catalytically convening an open community to design, develop, test,

generate evidence and share their learnings from using the Open mHealtharchitecture.

2.Allowing innovators and entrepreneurs to focus on their unique marketofferings while increasing the validity, robustness and effeciency of sharedcomponents and methods. We want mHealth to scale by saving themHealth community time and $$.

3.Flipping the direction of research inference on its head by generatingpopulation-level evidence from personal evidence.


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Open mHealth is a 501.3c that just began its work on September 1, 2011.

Were able to achieve our mission through funding from RWJFs PioneerPortfolio and the California Healthcare Foundation.

Were honored to be hosted by the Tides Center.


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In order to achieve our mission, we are using an integrated approach tobring together developers and health innovators to develop code and drive

more use cases along the open mHealth architecture.


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Photo: Tapping the Table Board, Fosdem 09, Free and Open Source SoftwareDevelopers European Software Meeting 2009. Creative Commons License

These developers were referring to include those that work for smallstartups, technical architects, hackers, and those from the open sourcecommunity.


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Photo: UN Foundation, 2011

Health innovators are those health experts that understand the problem.They own the problem.

They might be a clinician, researcher, institution or patient group that hasan app or project and want to use the OMH architecture.


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These user groups do not suppose that other user groups are notimportant.

Focusing on one group will not benefit OMH or the mHealth space. Theresno benefit to health innovators alone if theres no one to build solutions forthem. Likewise, theres no benefit to developers if theres no one to assistin knowledge sharing on specific health subject matters.

The intersection of these user groups is critical for anything meaningful tohappen in mHealth.

We want to break the barriers between developers and health innovatorsby building an active and productive community.


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Technical contributors and users of Infovis modules and other aspects ofarchitecture.

INFOVIS

EVIDENCE

BUSINESS MODEL


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Were going to start monthly Google+ meetups for those interested indiscussing the Open mHealth architecture, projects, etc.

Go to our website, www.openmhealth.org for email updates about this andother related Open mHealth news.


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