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Hacking	
  Health
Designing	
  for	
  and	
  understanding	
  my	
  health

Juhan	
  Sonin
March	
  2011
Your	
  health	
  data	
  is	
  going	
  digital.
Your	
  pets’	
  health	
  data	
  is	
  digital.
How	
  did	
  I	
  get	
  into	
  the	
  Design	
  of	
  Health?




I	
  didn’t	
  have	
  a	
  pulse	
  on	
  my	
  
health,	
  let	
  alone	
  the	
  data.

Cholesterol	
  Check	
  at	
  MITRE	
  in	
  2006
370	
  
Total	
  Cholesterol	
  ,	
  2006




                                    Cheese	
  and	
  salami	
  was	
  coursing	
  
                                    through	
  my	
  blood	
  stream	
  (based	
  on	
  
                                    a	
  meal	
  the	
  night	
  before	
  the	
  
                                    cholesterol	
  test…)
I	
  had	
  no	
  clue	
  what	
  my	
  health	
  metrics	
  were.
I	
  had	
  a	
  beLer	
  pulse	
  on	
  the	
  health	
  of	
  my	
  car.
and	
  the	
  Problem	
  is…
Increasingly	
  complex	
  systems
    – Tool	
  and	
  Methodology	
  gap
Decision	
  makers	
  are	
  swamped	
  with	
  conflicDng	
  data
    – Our	
  work	
  is	
  increasingly	
  mulD-­‐dimensional	
  (not	
  a	
  flat-­‐
      decision	
  space)
ArDfacts	
  driving	
  decisions	
  need	
  to	
  be	
  coordinated,	
  
  presented
Minimal	
  transparency	
  into	
  key	
  health	
  metrics
How	
  do	
  I	
  (as	
  a	
  pa7ent,	
  nurse,	
  
doctor,	
  proxy)	
  make	
  quicker,	
  
more	
  accurate	
  decisions?
Started	
  collecOng	
  and	
  
designing	
  the	
  basics…

Weight,
Waist	
  circumference,
Cholesterol,
Exercise,
Food	
  intake…
From	
  sketch	
  to	
  digital
Early	
  health	
  card	
  designs
Got	
  a	
  checkup.
First	
  Ome	
  in	
  6	
  years.

But…
The	
  doctor’s	
  back	
  was	
  to	
  me	
  while	
  he	
  asked	
  me	
  
ques7ons	
  (and	
  then	
  he	
  typed	
  the	
  answers	
  into	
  
the	
  computer),	
  

zero	
  ques7ons	
  about	
  Life	
  outside	
  of	
  tradi7onal	
  
health	
  info,

no	
  physical	
  or	
  emailed	
  takeaways	
  of	
  next	
  steps	
  
from	
  the	
  exam…
How	
  do	
  I	
  become	
  an	
  informed	
  
and	
  empowered	
  paOent?
HealthCard	
  was	
  
born

Prototyped	
  with	
  
doctors,	
  nurses,	
  
emergency	
  
responders…	
  and	
  
oh	
  yea,	
  paOents.
Used	
  real	
  data…	
  my	
  own	
  data


Design	
  with	
  fake	
  data	
  =	
  
fake	
  design
Real	
  data:
•needs	
  to	
  be	
  grokked	
  by	
  you
•has	
  min/max	
  values,	
  outliers
•needs	
  amplificaOon,	
  cleanup
•begets	
  real	
  feedback	
  +	
  forces	
  people	
  to	
  make	
  real	
  decisions
System	
  view	
  of	
  my	
  family’s	
  health
Followed	
  doctors	
  and	
  nurses	
  at	
  several	
  Boston	
  
hospitals	
  to	
  SEE	
  Healthcare	
  in	
  acOon.




Partner	
  in	
  crime,	
  Rob	
  McCready	
  watching	
  surgery.
Our	
  forecast
Designing	
  a	
  beauOful	
  and	
  
clinically	
  relevant	
  
experience	
  without	
  
beauOful	
  data	
  =

recipe	
  for	
  disaster.	
  
So	
  we	
  got	
  into	
  the	
  data	
  +	
  standards	
  game:




                                                                               hData
projectlaika.org                                                             projecthdata.org
Open	
  source	
  so^ware	
  has	
  become	
  part	
  of	
  the	
  CCHIT	
   hData	
  is	
  a	
  method	
  of	
  storing	
  and	
  exchanging	
  health	
  
cerOficaOon                                                                   informaOon

Laika	
  is	
  responsible	
  for	
  automaOng	
  data	
                       Goal:	
  Influence/create	
  Health	
  IT	
  standards	
  to	
  ease	
  
interoperability	
  tesOng	
  of	
  Electronic	
  Health	
  Record	
           implementaOon	
  and	
  speed	
  adopOon
systems
                                                                               Why?	
  Complexity	
  and	
  design	
  of	
  current	
  standards	
  are	
  
HITSP	
  Specs	
  on	
  ConOnuity	
  of	
  Care                                a	
  huge	
  barrier	
  to	
  adopOon	
  and	
  effecOve	
  usage
IHE	
  specs	
  on	
  Document	
  Exchange
US	
  Healthcard




Smartcard	
  to	
  standardize	
  the	
  healthcare	
  “entry	
  point”	
  
transacOon

Prototype	
  US	
  Healthcard	
  data	
  model,	
  design,	
  and	
  explore	
  HHS	
  
adopOon
Why	
  not	
  a	
  1040-­‐HC?
Health	
  devices	
  are	
  gehng	
  cheaper…
Costs	
  approaching	
  zero.

The	
  cost	
  of	
  data	
  is	
  also	
  approaching	
  zero.
Body	
  Probes




Torn	
  bicep
Daily	
  acOvity	
  
dashboard

Using	
  2+	
  years	
  
(0.999	
  human	
  
“upOme”)
Wireless,	
  self-­‐syncing	
  devices
Part	
  of	
  my	
  daily	
  rouOne
At	
  work…
Monthly
Cholesterol	
  
and	
  glucose	
  
self	
  tesOng
Jumped	
  into	
  personal	
  genomics
23andMe	
  (for	
  all	
  my	
  family	
  members),	
  
Personal	
  Genome	
  Project	
  ParOcipant
23andme.com
Medical	
  home

                       IMPLANT
               PULSE
                OX
     BLOOD-
    PRESSURE
      CUFF
                                 Cell Phone

PEDOMETER                                     Digital
                                              Home
   WEIGHT
   SCALE                                      PC

                                                        Internet   Family     Disease    Healthcare   Personal
    FITNESS                                                         care    management                 Health
   EQUIPMENT                                                                             providers
                                                                   givers    services                 Records

        MEDICATION        Personal Health System
         TRACKING
Telemedicine




Intel	
  Health	
  Guide:	
  It	
  integrates	
  personal	
  
communicaDon	
  with	
  the	
  doctor,	
  medicaDon	
  
reminders,	
  educaDonal	
  informaDon,	
  and	
  
videoconferencing	
  for	
  the	
  home.
Assisted	
  living

                                                                                                                                   I	
  opened	
  the	
  door…




                                                                                                                                      I’m	
  watching	
  TV…




                                                                                                                                      I’m	
  going	
  to	
  bed…




Sensors:	
  Mo7on,	
  Fire/Smoke/CO2,	
  Occupancy	
  (Bed/Chair),	
  Use	
  (Door,	
  Stove,	
  Fridge,	
  Tub),	
  Loca7on	
  (Alzheimer's),	
  Fall	
  Alarms,	
  Water	
  flow…	
  
Sensors	
  throughout

Spare	
  Bedroom   Master	
  Bedroom




                                       Bathroom


                                              Living	
  Room
        Kitchen
Enable	
  online	
  clinic	
  for	
  the	
  “pracOce	
  of	
  medicine”

Evolve	
  the	
  FOSS	
  “Healthcare	
  as	
  a	
  so^ware	
  service”	
  
model

School	
  nurse	
  at	
  first;
evolve	
  to	
  state-­‐of-­‐the-­‐art	
  ambulatory	
  screen	
  clinic	
  
(diabetes,	
  obesity,	
  cardiovascular,	
  asthma,	
  allergies)	
  in	
  
2	
  years
So	
  we	
  prototyped	
  a	
  
health	
  staOon.
Self-­‐service	
  health	
  kiosk
   Brief	
  engagement	
  to	
  assess	
  current	
  health
   Simple	
  and	
  minimally	
  invasive
   Get	
  a	
  health	
  snapshot	
  or	
  monitor	
  changes	
  over	
  Ome



Open	
  planorm
   Can	
  add	
  addiOonal	
  measurement	
  devices
   Bluetooth,	
  Wifi,	
  and	
  web	
  accessible
   Accessible	
  API	
  for	
  building	
  home	
  grown	
  apps



Measurements
   Blood	
  pressure
   Weight
   Body	
  composiOon
   HydraOon
   Pulse
   Temperature
   Eyesight
   Hearing
   RespiraOon
Evolve	
  from	
  nurse-­‐aLended	
  to
self-­‐service	
  health	
  experience
How	
  do	
  you	
  get	
  a	
  pulse	
  on	
  key	
  health	
  
metrics	
  without	
  a	
  single	
  tear?

Early	
  detecOon	
  of	
  chronic	
  diseases	
  will	
  be	
  as	
  
easy	
  as	
  carrying	
  your	
  cell	
  phone	
  in	
  your	
  
pocket.

Engaged	
  paOents	
  will	
  increasingly	
  self-­‐check	
  
and	
  self-­‐monitor	
  using	
  bloodless,	
  self-­‐
administered	
  medical	
  tests.
5	
  million	
  doctors




6.7	
  billion	
  pa,ents
4.7	
  billion	
  cell	
  phones




6.8	
  billion	
  paOents
paOents


SCALE
mHealth	
  Axioms

Bring	
  the	
  examinaDon	
  room	
  to	
  the	
  paDent

Bring	
  the	
  collecDve	
  experDse	
  of	
  the	
  pracDce,	
  the	
  standard	
  
of	
  care,	
  to	
  the	
  paDent’s	
  bedside	
  or	
  home

Migrate	
  from	
  a	
  system	
  of	
  episodic	
  evaluaDon	
  to	
  a	
  system	
  
of	
  conDnuous	
  assessment

Expect	
  paDents	
  and	
  their	
  families	
  to	
  be	
  their	
  own	
  primary	
  
care	
  provider	
  (key	
  member	
  of	
  the	
  care	
  team)
hGraph
      Compelling,	
  standardized	
  visual	
  representa7ons	
  of	
  a	
  pa7ent’s	
  health	
  status…on	
  the	
  celltop
      Designed	
  to	
  increase	
  awareness	
  of	
  the	
  individual’s	
  factors	
  that	
  can	
  affect	
  one’s	
  health
      Open	
  source	
  healthcare	
  applica7on	
  
      Created	
  for	
  mobile	
  devices,	
  star7ng	
  with	
  the	
  iPhone	
  and	
  iPad
Your	
  health	
  in	
  one	
  picture
      Users	
  provide,	
  view,	
  share,	
  and	
  understand	
  a	
  holis7c	
  view	
  of	
  their	
  health	
  	
  
      Based	
  on	
  an	
  individual’s	
  health	
  data,	
  iden7fies	
  where	
  an	
  individual’s	
  health	
  numbers	
  are,	
  
         and	
  where	
  they	
  should	
  be
      Pa7ent	
  focused,	
  with	
  professional	
  clinical	
  relevance	
  
hScore
      Single	
  aggregated	
  number	
  ranging	
  from	
  1-­‐100	
  that	
  represents	
  best	
  knowledge	
  status	
  of	
  an	
  
          individual’s	
  health
      Experimental	
  measure	
  correlated	
  with	
  sta7s7cal	
  data	
  from	
  open	
  sources
hGraph
Used	
  as	
  status	
  	
  
indicator	
  for	
  current	
  
plan	
  of	
  care

Recent	
  updates	
  can	
  
trigger	
  “just	
  in	
  Dme”	
  
healthcare	
  consults

AddiDonal	
  mHealth	
  
monitors	
  augment	
  
hGraph	
  scope	
  and	
  
real-­‐Dme	
  nature

Live	
  consults	
  with	
  
healthcare	
  
professionals
85%	
  of	
  adults	
  have	
  a	
  
cellphone	
  today…
The	
  Future:	
  Stage	
  zero	
  detecOon



           90%	
  Survive                            10%	
  Survive




    Early	
  stage	
  detecDon   Late	
  stage	
  detecDon
Special	
  thanks	
  to:
Rob	
  Dingwell
Andrew	
  Gregorowicz
Dirk	
  Knemeyer
Rob	
  McCready
Harry	
  Sleeper
Brian	
  Staats
Hacking	
  Health
Designing	
  for	
  and	
  understanding	
  my	
  health

Juhan	
  Sonin

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"Hacking Health" by Juhan Sonin

  • 1. Hacking  Health Designing  for  and  understanding  my  health Juhan  Sonin March  2011
  • 2. Your  health  data  is  going  digital.
  • 3. Your  pets’  health  data  is  digital.
  • 4. How  did  I  get  into  the  Design  of  Health? I  didn’t  have  a  pulse  on  my   health,  let  alone  the  data. Cholesterol  Check  at  MITRE  in  2006
  • 5. 370   Total  Cholesterol  ,  2006 Cheese  and  salami  was  coursing   through  my  blood  stream  (based  on   a  meal  the  night  before  the   cholesterol  test…)
  • 6. I  had  no  clue  what  my  health  metrics  were. I  had  a  beLer  pulse  on  the  health  of  my  car.
  • 7. and  the  Problem  is… Increasingly  complex  systems – Tool  and  Methodology  gap Decision  makers  are  swamped  with  conflicDng  data – Our  work  is  increasingly  mulD-­‐dimensional  (not  a  flat-­‐ decision  space) ArDfacts  driving  decisions  need  to  be  coordinated,   presented Minimal  transparency  into  key  health  metrics
  • 8.
  • 9. How  do  I  (as  a  pa7ent,  nurse,   doctor,  proxy)  make  quicker,   more  accurate  decisions?
  • 10.
  • 11.
  • 12.
  • 13. Started  collecOng  and   designing  the  basics… Weight, Waist  circumference, Cholesterol, Exercise, Food  intake…
  • 14. From  sketch  to  digital
  • 16. Got  a  checkup. First  Ome  in  6  years. But… The  doctor’s  back  was  to  me  while  he  asked  me   ques7ons  (and  then  he  typed  the  answers  into   the  computer),   zero  ques7ons  about  Life  outside  of  tradi7onal   health  info, no  physical  or  emailed  takeaways  of  next  steps   from  the  exam…
  • 17. How  do  I  become  an  informed   and  empowered  paOent?
  • 18. HealthCard  was   born Prototyped  with   doctors,  nurses,   emergency   responders…  and   oh  yea,  paOents.
  • 19. Used  real  data…  my  own  data Design  with  fake  data  =   fake  design Real  data: •needs  to  be  grokked  by  you •has  min/max  values,  outliers •needs  amplificaOon,  cleanup •begets  real  feedback  +  forces  people  to  make  real  decisions
  • 20. System  view  of  my  family’s  health
  • 21. Followed  doctors  and  nurses  at  several  Boston   hospitals  to  SEE  Healthcare  in  acOon. Partner  in  crime,  Rob  McCready  watching  surgery.
  • 23. Designing  a  beauOful  and   clinically  relevant   experience  without   beauOful  data  = recipe  for  disaster.  
  • 24. So  we  got  into  the  data  +  standards  game: hData projectlaika.org projecthdata.org Open  source  so^ware  has  become  part  of  the  CCHIT   hData  is  a  method  of  storing  and  exchanging  health   cerOficaOon informaOon Laika  is  responsible  for  automaOng  data   Goal:  Influence/create  Health  IT  standards  to  ease   interoperability  tesOng  of  Electronic  Health  Record   implementaOon  and  speed  adopOon systems Why?  Complexity  and  design  of  current  standards  are   HITSP  Specs  on  ConOnuity  of  Care a  huge  barrier  to  adopOon  and  effecOve  usage IHE  specs  on  Document  Exchange
  • 25. US  Healthcard Smartcard  to  standardize  the  healthcare  “entry  point”   transacOon Prototype  US  Healthcard  data  model,  design,  and  explore  HHS   adopOon
  • 26. Why  not  a  1040-­‐HC?
  • 27.
  • 28. Health  devices  are  gehng  cheaper… Costs  approaching  zero. The  cost  of  data  is  also  approaching  zero.
  • 30. Daily  acOvity   dashboard Using  2+  years   (0.999  human   “upOme”)
  • 32. Part  of  my  daily  rouOne At  work…
  • 34. Jumped  into  personal  genomics 23andMe  (for  all  my  family  members),   Personal  Genome  Project  ParOcipant
  • 36. Medical  home IMPLANT PULSE OX BLOOD- PRESSURE CUFF Cell Phone PEDOMETER Digital Home WEIGHT SCALE PC Internet Family Disease Healthcare Personal FITNESS care management Health EQUIPMENT providers givers services Records MEDICATION Personal Health System TRACKING
  • 37. Telemedicine Intel  Health  Guide:  It  integrates  personal   communicaDon  with  the  doctor,  medicaDon   reminders,  educaDonal  informaDon,  and   videoconferencing  for  the  home.
  • 38. Assisted  living I  opened  the  door… I’m  watching  TV… I’m  going  to  bed… Sensors:  Mo7on,  Fire/Smoke/CO2,  Occupancy  (Bed/Chair),  Use  (Door,  Stove,  Fridge,  Tub),  Loca7on  (Alzheimer's),  Fall  Alarms,  Water  flow…  
  • 39. Sensors  throughout Spare  Bedroom Master  Bedroom Bathroom Living  Room Kitchen
  • 40.
  • 41.
  • 42.
  • 43.
  • 44.
  • 45. Enable  online  clinic  for  the  “pracOce  of  medicine” Evolve  the  FOSS  “Healthcare  as  a  so^ware  service”   model School  nurse  at  first; evolve  to  state-­‐of-­‐the-­‐art  ambulatory  screen  clinic   (diabetes,  obesity,  cardiovascular,  asthma,  allergies)  in   2  years
  • 46. So  we  prototyped  a   health  staOon.
  • 47.
  • 48. Self-­‐service  health  kiosk Brief  engagement  to  assess  current  health Simple  and  minimally  invasive Get  a  health  snapshot  or  monitor  changes  over  Ome Open  planorm Can  add  addiOonal  measurement  devices Bluetooth,  Wifi,  and  web  accessible Accessible  API  for  building  home  grown  apps Measurements Blood  pressure Weight Body  composiOon HydraOon Pulse Temperature Eyesight Hearing RespiraOon
  • 49. Evolve  from  nurse-­‐aLended  to self-­‐service  health  experience
  • 50.
  • 51.
  • 52. How  do  you  get  a  pulse  on  key  health   metrics  without  a  single  tear? Early  detecOon  of  chronic  diseases  will  be  as   easy  as  carrying  your  cell  phone  in  your   pocket. Engaged  paOents  will  increasingly  self-­‐check   and  self-­‐monitor  using  bloodless,  self-­‐ administered  medical  tests.
  • 53.
  • 54. 5  million  doctors 6.7  billion  pa,ents
  • 55.
  • 56. 4.7  billion  cell  phones 6.8  billion  paOents
  • 57.
  • 59. mHealth  Axioms Bring  the  examinaDon  room  to  the  paDent Bring  the  collecDve  experDse  of  the  pracDce,  the  standard   of  care,  to  the  paDent’s  bedside  or  home Migrate  from  a  system  of  episodic  evaluaDon  to  a  system   of  conDnuous  assessment Expect  paDents  and  their  families  to  be  their  own  primary   care  provider  (key  member  of  the  care  team)
  • 60.
  • 61.
  • 62.
  • 63.
  • 64.
  • 65.
  • 66.
  • 67. hGraph Compelling,  standardized  visual  representa7ons  of  a  pa7ent’s  health  status…on  the  celltop Designed  to  increase  awareness  of  the  individual’s  factors  that  can  affect  one’s  health Open  source  healthcare  applica7on   Created  for  mobile  devices,  star7ng  with  the  iPhone  and  iPad Your  health  in  one  picture Users  provide,  view,  share,  and  understand  a  holis7c  view  of  their  health     Based  on  an  individual’s  health  data,  iden7fies  where  an  individual’s  health  numbers  are,   and  where  they  should  be Pa7ent  focused,  with  professional  clinical  relevance   hScore Single  aggregated  number  ranging  from  1-­‐100  that  represents  best  knowledge  status  of  an   individual’s  health Experimental  measure  correlated  with  sta7s7cal  data  from  open  sources
  • 68.
  • 69.
  • 70.
  • 71.
  • 72.
  • 73. hGraph Used  as  status     indicator  for  current   plan  of  care Recent  updates  can   trigger  “just  in  Dme”   healthcare  consults AddiDonal  mHealth   monitors  augment   hGraph  scope  and   real-­‐Dme  nature Live  consults  with   healthcare   professionals
  • 74.
  • 75. 85%  of  adults  have  a   cellphone  today…
  • 76. The  Future:  Stage  zero  detecOon 90%  Survive 10%  Survive Early  stage  detecDon Late  stage  detecDon
  • 77. Special  thanks  to: Rob  Dingwell Andrew  Gregorowicz Dirk  Knemeyer Rob  McCready Harry  Sleeper Brian  Staats
  • 78. Hacking  Health Designing  for  and  understanding  my  health Juhan  Sonin