Knowledge-driven Personalized Contextual mHealthService for Asthma Management in Children

Pramod Anantharam, Tanvi Banerjee, Amit Sheth, Krishnaprasad Thirunarayan, Surendra Marupudi, Vaikunth Sridharan

Ohio Center of Excellence in Knowledge-enabled Computing(Kno.e.sis),Wright State University, USA

Presentation for: IEEE 4th International Conference on Mobile Services, June 27 – July 2, 2015, NY, USA

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http://www.technologyreview.com/featuredstory/426968/the-patient-of-the-future/

MIT Technology Review, 2012

The Patient of the Future

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Through analysis of physical, physiological, and environmental observations, our cellphones could act as an early warning system to detect serious health conditions, and provide actionable information

canary in a coal mine

Empowering Individuals (who are not Larry Smarr!) for their own health

kHealth: knowledge-enabled healthcare

Asthma Dementia Heart Failure Liver Cirrhosis

kHealth Application Areas

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1http://www.nhlbi.nih.gov/health/health-topics/topics/asthma/2http://www.lung.org/lung-disease/asthma/resources/facts-and-figures/asthma-in-adults.html 3Akinbami et al. (2009). Status of childhood asthma in the United States, 1980–2007. Pediatrics,123(Supplement 3), S131-S145.

25 million

300 million

$50 billion

155,000

593,000

People in the U.S. are diagnosed with asthma (7 million are children)1.

People suffering from asthma worldwide2.

Spent on asthma alone in a year2

Hospital admissions in 20063

Emergency department visits in 20063

Asthma: Severity of the problem

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Asthma: A Multi-faceted and Symptomatically Variable Health Issue

Personal level Signals

Public level Signals

Population level Signals

1Marcus, Philip, Kevin R. Murphy, Abid Rahman, and Christopher D. O’Brien. "Intrapatient symptom variability in adults and children with asthma: Results of a survey." Advances in therapy 22, no. 5 (2005): 488-497.

“ … survey indicates that adult patients and caregivers of pediatric patients report variability in asthma symptoms over time, even when asthma medications are taken.”1

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Asthma: Actionable Information

How is my Asthma control?

Should I take additional medication today?

How can I reduce my asthma attacks at home?

“… Far better an approximate answer to the right question, which is often vague, than the exact answer to the wrong question, which can always be made precise.”

-- John Tukey, Ann. Math. Stat. 33 (1962)

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Personal level Signals

Public level Signals

Population level Signals

Domain Knowledge

Asthma: Challenges in Heterogeneity, Variability, and Personalization

http://www.tuberktoraks.org/managete/fu_folder/2011-03/html/2011-3-291-311.html

Contextual Personalized Actionable

OR

Sensordrone

(Carbon monoxide,

temperature, humidity)

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Sensor PlatformsAndroid Device

(w/ kHealth App)

Total cost: ~ $550

kHealth Kit for the application for Asthma management

Along with sensor platforms in the kit, the application uses a variety of population level signals from the web:

Pollen level Air Quality Temperature & Humidity

Node Sensor

(exhaled Nitric Oxide)Fitbit ChargeHR

(Activity, sleep quality)

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kHealth Kit: Sensor Platforms

Sensordrone• Precision gas sensor• Reducing gas sensor • Oxidizing gas sensor• Non-contact thermometer• Humidity sensor• Temperature sensor• Light sensor• Color sensors• Pressure• Proximity• Expansion connector

Node Sensor• Exhaled Nitric Oxide

Fitbit ChargeHR• Heart Rate• All-Day Activity• Sleep Monitoring

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kHealth Kit: Android Application

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For collecting observations from both machine sensors and from patients in the form of a questionnaire

kHealth: Health Signal Processing Architecture

Personal level Signals

Public level Signals

Population level Signals

Domain Knowledge

Risk Model

Events from Textual Streams

Take Medication before going to work

Avoid going out in the evening due to high pollen levels

Contact doctor

AnalysisPersonalized Actionable

Information

Data Acquisition & Aggregation

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Patient Health Score (diagnostic)

Risk assessment model

Semantic Perception

Personal level Signals

Public level Signals

Domain Knowledge

Population level Signals GREEN – Well Controlled

YELLOW – Not well controlledRed – Poor control

How controlled is my asthma?

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Patient Vulnerability Score (prognostic)

Risk assessment model

Semantic Perception

Personal level Signals

Public level Signals

Domain Knowledge

Population level Signals

Patient health Score

How vulnerable* is my control level today?

*considering changing environmental conditions and current control level

GREEN – LowYELLOW – ModerateRed – High

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Sensordrone – for monitoring environmental air quality

Wheezometer – for monitoringwheezing sounds

Can I reduce my asthma attacks at night?

What are the triggers? What is the wheezing level?

What is the propensity toward asthma?

What is the exposure level over a day?

Commute to Work

Decision Support for Doctors and Patients: A Scenario

Luminosity

CO level

CO in gush during day time

Actionable Information

Personal level Signals

Public level Signals

Population level Signals

What is the air quality indoors?

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Usability and decision support trial

Dr. Shalini G. Forbis, MD, MPH

Deployment Details and Data Collection

kHealth kit was deployed with four patients for feasibility study of data collection and preliminary analysis of data to derive value

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6/2/2

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6/3/2

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Did patient take al-buterol last night due to

cough or wheeze?

6/2/2

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Exhaled Nitric Oxide

Medication (Albuterol) related to decreasing Exhaled Nitric Oxide

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6/2/2

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How much did asthma or asthma symptoms limit pa-

tient's activity today?

6/2/2

014

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Exhaled Nitric Oxide

Activity limitation related to high exhaled Nitric Oxide

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6/2/

2014

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/201

46/

11/2

014

6/12

/201

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00.10.20.30.40.50.60.70.80.9

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Has patient had wheeze, chest tightness, or

asthma related cough today?

41792.6000034259

41793.8430565394

41795.8798923843

41796.9000038657

41798.4715425694

41799.6928319907

41802.4572316551

41803.56436067120

0.05

0.1

0.15

0.2

0.25

Exhaled Nitric Oxide

Low exhaled Nitric Oxide observed with absence of coughing

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6/2/2

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1.5

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2.5

Pollen

6/2/2

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How much did asthma or asthma symptoms limit patient's activity today?

Activity limitation observed with high pollen activity

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Conclusion

Unprecedented and Continuous Access to Intimate Patient Data is Possible• Doctors can utilize this information for informed decision making• Require techniques to find promising hypothesis to be vetted by doctors

Personalized Treatment of Asthma is Challenging• Asthma is a multifaceted and symptomatically variable ailment • Patient specific understanding of response to triggers would help in personalization

Contextual Application for Actionable Information is Challenging• Detecting recurring conditions of response to triggers is required for context awareness• Background knowledge from doctors would be crucial for recommending actions

Future Work

Carry out a Large Scale Pilot & Clinical Trial• kHealth kit is prepared to be deployed with over 200 asthma patients

Formulate Patient Vulnerability Score• This score is not formally specified in the asthma diagnosis guidelines from NIH1 • The complexity of asthma makes it hard to define vulnerability score (prognostic)• Personalization is crucial even if such a score can be defined

Add New Sensors for Monitoring Triggers such as Smoke and Indoor Air Quality• We need these sensors for correlating it with the report of asthma attacks• Remedial measures can be suggested by experts based on indoor conditions

1 http://www.nhlbi.nih.gov/files/docs/guidelines/asthgdln.pdf

Acknowledgements

Partial support for this research was provided by Wright State University’s VP ofResearch under a challenge grant.

Thank you

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For more information on kHealth, please visit us at http://knoesis.org/projects/khealth

Link to the paper: http://www.knoesis.org/library/resource.php?id=2153