revolutionizing precision health with big data - the individual exposure health risk profile (iehrp)

Revolutionizing Precision Health with Big Data –The Individual Exposure Health Risk Profile

(IEHRP)

06 Nov 2017American Public Health Association

Annual Meeting 2017

Richard Hartman, PhDUnited State Air Force Medical Service

1Cleared for Public Release, SAF/PA Case Number:2016-0444

Disclosure

Richard Hartman, PhD

∎ No Relationships to Disclose

Cleared for Public Release, SAF/PA Case Number:2016-0444 11/4/2017 2

Healthcare is Changing…

Healthcare in Changing – Focus on the Individual

11/4/2017 3Cleared for Public Release, SAF/PA Case Number:2016-0444

Policy, technology, marketplace & consumer expectations are

disrupting healthcare & we can position ourselves to better

support

“Personalized Healthcare”

Total Exposure Health

Description: Solution to capture workplace, environment & lifestyleexposures to the individual (i.e., N=1, genome) using advances in science,technology & informatics to prevent disease; improve health and well-being:Healthiest Performing Population by 2025

E

H

Increase use of

genomic research

and knowledge

Improve

exposure

monitoring

through sensors

and wearables

Better understanding of

monitored exposure to

performance and

individual health

outcomes

Advance operational

decisions using

advancements in science,

medicine, technology, and

informatics with digital

biodata bank, Big Data

analytics, and expert

systems


Total Exposure Health- VisualizedE

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DOSE

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When we account for

genetic variance we

find we are all unique!

But we can also use

this information to

protect health and

enhance performance

“Sensitive”Individual

“Resilient”Individual

“Average”Individual

Chemical

Allergen

Radiation

Cleared for Public Release, SAF/PA Case Number:2016-0444

Reimagining Healthcare w/TEH


Total Exposure Health - Big Picture


TEH – Helping to Solve Military Hearing Loss

∎ Common exposure

We all experience noise exposure in workplace, lifestyle and environment

Untreatable hearing loss can negatively affect one’s quality of life

∎ Costly Exposure

$1.5-3B DoD/VA annual bill (Benefits and Medical)

Hearing loss and tinnitus are among the top medical complaints, and most widespread injuries,

Linked to chronic disease, dementia, depression, and anxiety.

∎ Affects the mission

Mission effectiveness directly proportional good communication

Good hearing is prerequisite for peak performance

Cleared for Public Release, SAF/PA Case Number:2016-0444 11/4/2017 8

Noise Demonstration Project

• Noise demonstration project will:

• Demonstrate the ability to collect, store, and utilize unstructured “noise” exposure data to identify the unique health risk associated noise and manage NIHL• Data to include: sensor, survey, clinical, and genetics

• Create intervention strategies to protect beneficiaries (training, medical interventions such as functional hearing tests and customized protection)

• Identify future research questions and research needs

ExposureBig Data

Analytics

Cleared for Public Release, SAF/PA Case Number:2016-0444 9

Turn Data into

Insight

Personnel Exposure Monitor (PEM)

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∎ Initial NEDP device senses noise exposure but is actually a general wearable sensor platform

Air (VOCs, CO, T, RH)

Toxins

Radiation

∎ Anything an individual is exposed to: on-duty and off-duty

∎ Transmits data to cloud (via phone or sensor node) On duty Off duty


∎ 10 published studies

Small to modest sample sizes

Multiple genetic variants in multiple genes associated with NIHL or related phenotypes

Grondin et al 2015. “Genetic Polymorphisms Associated with Hearing Threshold Shift in Subjects during First Encounter with Occupational Impulse Noise.” PLoS ONE 10 (6): e0130827.

Effect sizes are surprisingly large

Odds Ratios range from 5.2 to 22.36

Several associated genotypes are already typed in the available genechips

Genetics - Noise Induced Hearing Loss


Identified Gene variants associated w/NIHL

Cleared for Public Release, SAF/PA Case Number:2016-0444 1211/4/2017

Our Clinical Disposition

Individual Exposure Health Risk Profile (IEHRP)

13

Our Unique Genetic Proclivity

IEHRP:Individual

Exposure IndicesOur Exposures

11/4/2017 Cleared for Public Release, SAF/PA Case Number:2016-0444

Basic linear equation for Noise:

Individual Exposure Risk Index (Noise Induced Hearing Loss) = (CF) Personal Monitored Exposure (Noise) + (CF) Medical/Clinical Disposition(Noise) + (CF) Genetic Proclivity(Noise) + n…+n

IEHRP Example – “Noise”

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Adding Chemical Exposure the equation changes to:

Individual Exposure Risk Index (Noise Induced Hearing Loss) = (CF) Personal Monitored Exposure (Noise) + (CF) Medical/Clinical Disposition (Noise) + (CF) Genetic Proclivity (Noise) + (CF) Ototoxins + n…+n

The Individual Exposure Risk Profile becomes more refined as we identify confounding factors that affect the risk of NIHL

Individual Exposure Risk Index (Noise Induced Hearing Loss) = (CF) Personal Monitored Exposure (Noise) + (CF) Medical/Clinical Disposition (Noise) + (CF) Genetic Proclivity (Noise) + (CF) Ototoxins + n…+n – Protective factors – Protective Interventions


Genetics

Diagnostics

Sensors and Mobile Data

Lifestyle

Occupation

Medical History

Environment

Faimly History

Exposure Index can have many variables


IEHRP Exposure Index Data Sources


Repsentencing IEHRP Mathematically…

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h Exposure

measurements

Clinical

measurements

Genetic propensity

……

Exposure element 1 Index(1,1) Index(1,2) Index(1,3)




:

.


NOISE

TYPICAL

EXPOSURE

CURVE

Rethinking Exposure….E

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When we layer these exposures we findwe are all unique

BENZENELEADRADIATIONGLUTEN

Rich

Al

Kirk

Lily

Ann

Rich

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Kirk

LilyAnn

Rich

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Kirk

Lily

Ann

Ann

Rich

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Kirk

Lily

Rich

Ann

AlKirk

Lily

Ann

Rich

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Kirk

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Ann

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Kirk

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TOTAL

EXPOSURE


Visualizing the IEHRP – Individual

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IEHRP will aid in visualizing an individual’s

unique exposure susceptibilities

Kirk

NOISE BENZENELEAD RADIATION GLUTEN

SU

SC

EP

TA

BIL

ITY

HIGH

LOW


Visualizing the IEHRP – Population

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Yr 1 Baseline IEHRPIntervention/Changes

Y2 IEHRPSee Unique PatternsAnn

Al

Lily

Kirk

Rich

YEAR 1

BENZENE

LEAD

RADIATION

GLUTEN

NOISE

YEAR 2


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How will Similar Exposure Groups (SEGs) be determined?

By Exposure?or

By Profile?

Ann

Al

Lily

Kirk

Rich

By Exposure?

BENZENE

LEAD

RADIATION

GLUTEN

NOISE

Rethinking the Similar Exposure Group (SEG)

By Profile?


Rethinking Exposure LimitsIN

CR

EA

SIN

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INCREASING DOSE

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Exposure limits Pop BasedProtects based on Economic

Feasibility We’re all Respond Differently

Super humans?

EXPOSURE

CURVEOSHA PEL

“SUPER”

Rich

Lily

Kirk

Al

“No-Effect”

Range

Maximum Effect

RangeIncreasing Effect with

Increasing Dose

Ann


TEH Full Implementation

SADA&

(IEHRP)

Sensor Data

PHA Surveys

Genomic /

Biodata bank

DOEHRS

Other databases

MHS Genesis

ILER

VBA

Vet

Benefits

DOD

Provider

analytics

ingest

sharing

T

E

H

Clinical

Decision

Support

System

T

E

H

VHA/EHR

Provider

DoD/VA

Researchers

Cleared for Public Release, SAF/PA Case Number:2016-0444 23

THE/IEHRP Brings these things together:

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∎ Area sensors, Personnel/Physiological Sensors, …

∎ Integrated with all genetics, previous exposures, DBs, …

∎ All information integrated about an individual

∎ Advanced analytics and decision support

∎ Situational awareness tools for real-time monitoring/use

∎ Predictive capability for optimized readiness and performance

∎ Open, integrated, advanced system for force health protection, improved care, and operational use

∎ Technologies are real, available, and ready for application/use


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Questions


revolutionizing precision health with big data - the individual exposure health risk profile (iehrp)

Data & Analytics