Copyright - Brigitte Piniewski, PeaceHealth Labs, 2011

1. 2011Tech Venture Series Manchester Brigitte Piniewski, MD Chief Medical Officer PeaceHealth Laboratories, OregonVice Chair MAWG Continua Health Alliance 2011 PeaceHealth Laboratories 1 Enabling high performance crowds with innovative business models

2. Overview: Problem state: Out dated man-made constructs Centralized Currency, Traditional Medical model, concept of “normal”, Policy and Regulatory model… Transforming Health Value/Cost landscape Modern Health Intelligence Procurement Engines Re-writing history using crowd-based approaches Innovative Business models: Universal Academic Campus use-case and tuition fee lift Global Health Economy 2011 PeaceHealth Laboratories 2

3. 2011 PeaceHealth Laboratories 3 Outdated Man-made constructs: Failure to predict or prevent the human performance gap As modernization advances… Yesterday’s Economic Models Advance Performance Gaps and Social justice Gaps Good Assumptions Crowd Performance erodes Poor Time = 1980’s

4. 1964 Thinking… Medical costs are skyrocketing. Doctors are often scarce. Hospitals are misused. The Medical Profession is in Turmoil. 4 2011 PeaceHealth Laboratories

5. 2011 PeaceHealth Laboratories 5 Low expectations for American students. America’s top math students rank 25thout of 30 countries when compared with top students elsewhere in the world. [1] By the end of 8th grade, U.S. students are two years behind in the math being studied by peers in other countries. [2] Seventy percent of 8th graders can’t read at their grade level, and most will never catch up. Project at Bristol University shows [3] Kids diet affects IQ perhaps permanently [1] Strong American Schools analysis of data from the Organization for Economic Cooperation and Development. Based on data from Volume 2, table 6.2a (p. 227). Rank is based on students performing at Level 6 in each country on the 2006 PISA math assessment. [2] Schmidt, W. (2003, February 4). “Presentation to Mathematics and Science Initiative.” [3] http://www.dailymail.co.uk/health/article-1354683/Junk-food-diet-hits-childs-IQ-reveals-major-UK-study.html

6. Fall from freedom… 6 5-6 Million Years 30-40 Years The Economist 2003 One billion adults overweight world wide 2011 PeaceHealth Laboratories

7. Key Problem: Ignoring biologically-mediated constraints is not without consequence Our pure pursuit of profit violates interdependencies crippling system performance Mankind is limited through our man-made structures; our medium of exchange, policy, medical model, concept of normal and others These old models fail to advance at the pace of change As a result, we remain blind to high yield performance intelligence Marketplaces are limited in capacity to exchange and build wealth due to an under-performing transactional tool 2011 PeaceHealth Laboratories 7 Arthur Brock, Founder, Software designer, Systems Architect at the Geek Gene http://wiki.thetransitioner.org/English/Free_currencies/Free_Currencies:_the_next_global_currency_system

8. Wayne Gretzky 2011 PeaceHealth Laboratories 8 “You miss 100% of the shots you don’t take.” “You miss 100% of the health intelligence you fail to monetize.” Brigitte Piniewski

9. Out dated Medical model “Traditional acute care model is a relic of a by-gone era.” “Normal is of low utility in a world where we are no longer accidentally well” 2011 PeaceHealth Laboratories 9

10. 10 Actual Goal Non-modifiable Contributors to Disease (Age, Gender, Genes) Modifiable Contributors to Disease (Lifestyle) Hu et al. Diet, lifestyle and the risk of type 2 Diabetes in women. NEJM 2001 Sep 13;345(11):790-7. Opportunity:60-80% Adverse Health is Modifiable Non-modifiable contributors Age, gender and genes Modifiable contributors Lifestyle choices Today, poor lifestyle choices increasingly are the largest contributors to common adverse health outcomes 83% Heart Disease 91% Diabetes 69% Cancer 2011 PeaceHealth Laboratories

12. Tuomilehto, 2001 NEJM 344(18): 1343-50

13. 60% Less Cancer

14. De Lorgeril, Arch Int Med 1998;158:1181-87

15. 83%less Heart Disease

16. 91%less Diabetes

17. Nurses Health Study, NEJM 2000;343:16-22, NEJM 2001;345:790-97

18. 73% less CHD

19. 69% less Cancer

20. HALE Project. Knoops JAMA 2004;292:1433-1439

21. 60% Fewer Cardiac Events

22. Hambrecht Circulation 2004;109:1371-78

23. 44% Reduction in total mortality (NNT=16)

24. Lyon Heart Study, Circulation 1999;99:779-85

25. 45% Reduction in total mortality (NNT=2.4)

26. Indian Heart Study, BMJ 1992;304:1015-19

27. 40% Mortality Reduction

28. GISSI-Prevenzione, Med.Diet AHA11/01: Marchioli

29. 67% Mortality Reduction

31. “Normal” means prevalent not “Optimal” Age 0 25 65 Illness Pre-Illness Wellness Death 2008 13 13 2011 PeaceHealth Laboratories

32. Transforming Health Cost Landscape “Is there a reciprocal relationship between Health value efficiency and health dollars spent?” “The crowd, not the medical community, controls the card game” 2011 PeaceHealth Laboratories 14

33. 2011 PeaceHealth Laboratories 15 Health Cost Landscape Age 0 25 65 $ $ $ 60-80% Lifestyle Illness Pre-Illness Wellness Unpredictable Health Predictable (Rules-based) Health Death 2008 15

34. 2011 PeaceHealth Laboratories 16 Business Model Landscape Age 0 25 65 60-80% Lifestyle Illness Pre-Illness Wellness $ $ $ Unpredictable Health Predictable (Rules-based) Health Death 2008 16

35. 2011 PeaceHealth Laboratories 17 $ $ $ Evidence-based Medicine Age 0 25 65 $ $ $ 60-80% Lifestyle Illness Pre-Illness Wellness Unpredictable Health Predictable (Rules-based) Health Death 2008 17

36. 2011 PeaceHealth Laboratories 18 High definition living Age 0 25 65 Illness Pre-Illness Wellness Unpredictable Health Predictable (Rules-based) Health Death 2008 18

37. New Currency models: 2011 PeaceHealth Laboratories 19 Money is a narrow expression of wealth Gaming expands our currency skill set Reliable unit of Health value efficiency Centralized Currency Frivolous Gaming

38. Modern Health Intelligence Procurement Engines “Household and individual data trumps institutional data” “Communities as co-producers of their own health futures” 2011 PeaceHealth Laboratories 20

39. 2011 PeaceHealth Laboratories 21 Modern Knowledge procurement Age 0 25 65 Crowd-accelerated Strategic Intelligence 60-80% Lifestyle Illness Pre-Illness Wellness Legacy Knowledge Systems Death

40. New Knowledge Paradigm 2011 PeaceHealth Laboratories 22 Historical data “Old stuff” Continua Linked Current per unit co-occurrences Relative Clinical Relevance Lightly-instrumented Crowds Malignant vs. Benign Co-occurrences

42. Crowd sourcing

43. Crowd sharing

44. Modern Knowledge Systems

45. Abundance Models modernization Good Crowd Performance Poor Time = 1980’s

46. Reachability Gap Management Radical transformation in how we create our information environment or knowledge engines Set of shared, accessible community health resources Citizens are not passive recipients of goods but co-creators of health value Ultra large scale systems continuously evolving and providing sufficient correctness Encourage community custodianship and crowd co-management “One cannot conceive of a crowdsourced systems functionality in terms of “releases” and more than a city has a release. Metropolis Model , A New logic for development of Crowdsourced systems by Rick Kazman and Hong-meiChen, 2010 2011 PeaceHealth Laboratories 24

47. 2011 PeaceHealth Laboratories 25 Data Aggregation & AnalyticsNew knowledge engines: University of Oregon, Kent State, UNCC Yellow Node = Obesity (i.e BMI) Social Network = Behavior Changes Per-unit Co-Occurrences Personally Relevant Health Knowledge Predictive Individual trend from Crowd trends

48. Re-writing history using crowd-based approaches “Light instrumentation of the crowd tracking high yield health adjustment and delivering high definition living” 2011 PeaceHealth Laboratories 26

50. Activity change

51. Response to nutrition 27

53. Pediatrics

54. Adult care

55. Wellness

56. Chronic disease

57. Elder care

58. End of life careYoung Modifiable Health 60-80% Old Un-modifiable health (Everything else) 2011 PeaceHealth Laboratories

59. 29 DNA DNA DNA DNA DNA DNA IR as a common metabolic portal Obesity Diabetes T2 Hypertension Cardiovascular Disease Liver Disease Some Cancers Alzheimer's Other adverse health outcomes Insulin Resistance Jerald Reaven MD, 1988 Banting lecture: Insulin Resistance 2011 PeaceHealth Laboratories

60. n = 1 vs. n = many Larger group of people Sally Insulin resistance= X Insulin resistance= X + 2 Insulin resistance= X Insulin resistance= X + 2 Medical view Average quality of outcome for this group Quality of outcome for Sally Average healthcare costs for this group Healthcare costs for Sally Policy view 30 2011 PeaceHealth Laboratories

61. 2011 PeaceHealth Laboratories 31 Crowd Data Lowering the barriers to participate Device Interface XHR Interface Community Data Commons Wireless Pulse Oximeter PHR Weighing Scale Secure PHR Wireless Ultra Low Power Ultra low cost Blood Pressure Monitor

62. Crowd SharingiWell Study at PeaceHealth Laboratories Web sensors Activity Employers Personalized motivational Interventions Weight Health Coach Cloud Informatics H-Pod Events, User Content, Measured KPIs Pulse rate & Blood pressure Health Payer (Insurance) + Lab Draws DM program provider Consumers Other device Medical Lab Other device Analytic Engine Recommendation Trainer / Nutritionist / Physicians Other device 2011 PeaceHealth Laboratories 32

63. iMPak; Meridian and Cypak JV 33

64. Activity and Progress Tracking 34 9/29/2011

65. Social Network Impact 9/29/2011 35 SPD vs. SN size SPD The larger your social network, the more active you are. SN size

66. 9/29/2011 36

67. 9/29/2011 37

68. CVD Risk Reduction of 12.3% in 3 months 38 9/29/2011 0 mo 3 mos Reduced CVD risk

69. Diabetes Risk Reduction of 15.8% in 3 months 39 9/29/2011

70. Innovative Business models:The Universal Academic Campus use-case creates infectious action “Gone are the passively prematurely unwell… “Leveraging connectivity to co-produce your own performance futures” 2011 PeaceHealth Laboratories 40

72. Already connected to large numbers

73. Have influence over each other’s behavior

74. Used to uniting to get things done

75. Are early in their health journey

76. Share information

77. Comfortable with alternative currencies (gaming)

79. Global Health Economy 2011 PeaceHealth Laboratories 43 Crowd-relevant Benchmarking Cloud Health Intelligence To leapfrog Sub-Optimal Outcomes Disruptive Innovation

80. Who is Connecting? C. Codagnone, Institute for Prospective Technology Studies, EU Commission Spain D. Osimo, Tech4i2,Pursuasive Technologies, Brussels Belgium Trevor Cooper,Connected Embedded Cloud Solutions, Intel US David Kil, SKT Americas, CSO Informatics, Sunnyvale, CA USA Dejing Dou, Associate Professor in the Department of Computer and Information Science, University of Oregon, USA Jessica Greene,Associate Professor in the Department of Planning, Public Policy & Management , U of Oregon, USA Xintao Wu PhD, Associate professor of Computing and Informatics at the University of N Carolina at Charlotte RuomingJin PhD, Assistant professor of Computer Science at Kent State University Prof. Iain E. BuchanDirector NIBHI & NWeH Science, University of Manchester Others… 2011 PeaceHealth Laboratories 44

81. 2011 PeaceHealth Laboratories 45 US EU collaborative technical report, “Nudging lifestyles for better health outcomes: crowdsourced data and persuasive technologies for behavior change” Piniewski et al. EUR 24785 EN - 2011 Brigitte Piniewski, MD Chief Medical Officer PeaceHealth Laboratories 1201 Lloyd Blvd, Suite 200 Portland, OR 97232 503 720 0655 (c) 541-222-7461 (o) 541-431-9152 (f) bpiniewski@peacehealthlabs.org http://www.peacehealth.org/ The END

82. Extra slides: 2011 PeaceHealth Laboratories 46

84. Personalized Goals

85. Virtual Coaching

86. Wellness Games & Competitions

87. Social Network & Nudging47 2011 PeaceHealth Laboratories

89. Wellness meter

90. Level + role model

91. SN messages

92. UGC with social nudging

93. Virtual coaching

94. Competition

95. Games + goals

96. Steps per minute captured

97. Automatic wireless data aggregation from additional sensors

98. Accuracy : SPM to speed, height, weight, and gender

99. Activity-type recognition

100. Activity-pattern clustering

101. Part of recommendation

102. Complex event processing

103. User models with predictive algorithms for intent

104. Adaptive micro intervention

105. Social network computing

106. Causal network-based outcomes analytics

107. Web3 analyticsData Modeling Action Impact 48 2011 PeaceHealth Laboratories

108. Social Network Impact 9/29/2011 49 SPD vs. SN size SPD The larger your social network, the more active you are. Mean CVD risk reduction = 12.3% Mean DMII risk reduction =15.8% …in 3 months !!! SN size

111. Disease specific

112. Narrow therapeutic window

113. High security risk (HIV) status)

114. And so on…2011 PeaceHealth Laboratories 51 Start here………………………………..and learn how to get…………………….here!!

115. 2011 PeaceHealth Laboratories 52 Monetizing a community data commons… Payers sell de-identified claims data to pharmaceutical companies anywhere from $100K to millions of dollars, combining the data with simple research models.Ingenix packages United Healthcare claims data with their analytics components, and charges premium pricing to pharmaceutical companies, Contract Research Organizations (CROs), and other healthcare R&D institutions. Archimedes has an IndiGO engine that basically suggests possible intervention options given claims and lab data. Active Health Management did the same in the Evidenced Medicine Guideline (EBM) space, charging payers PMPM on the order of <$1.00. Large undefined future landscape for much higher yield health information…

116. Using Segmentation 53 2011 PeaceHealth Laboratories

117. Global Health Economy “Developing nations as late arrivals to western modernization have a health asset ready to be monetized; Crowd-relevant bench-marking data to pull modern nations out of their poor health expression” 2011 PeaceHealth Laboratories 54

118. 2011 PeaceHealth Laboratories 55 The future is here. It is just not evenly distributed. At least 80% of humanity lives on less than $10 a day.

119. Blue Zones Longevity Society ~Emphasis on strong family values~Strong community values~Exclusively plant based diets (little to no animal products)~Whole food lifestyles focused on fruits and veggies~Antioxidants and anti-aging herbs are plentiful~Daily benefits of physical exercise~Everyone knows how to deal with stress~All the elders and centenarians still work~Daily consumption of small amounts of alcohol~A sense of purpose in life (Ikigai is the Japanese word for this)~Spirituality is part of life in all of the blue zones~A complete absence of smoking and obesity~Everyone knows the benefits of a positive attitude 2011 PeaceHealth Laboratories 56

120. Making Better Choices?? 57 2011 PeaceHealth Laboratories

121. G-G-G-G-G-G-G-G-G-G-G-G-G-G G-G-G-G-G-G-G-G-G-G-G-G-G-G G-G-G-G-G-G-G-G-G-G-G-G-G-G Sugar G-G 58 2011 PeaceHealth Laboratories

122. Carbs, carbs, and carbs 59 2011 PeaceHealth Laboratories

123. Slow food Fast food Insulin Resistance Sedentary Activity 60 2011 PeaceHealth Laboratories

124. 2011 PeaceHealth Laboratories 61 Insulin Insulin Receptor Mitochondria Fat Cell G G G G G G G G G G G Ectopic Fat