Slides for guest lecture to Stanford CS247 (Interaction Design Studio) class on computer-human interaction

1. User Generated Health Chris Hogg twitter.com/cwhogg citizenmed.wordpress.com

2. 6,836 3.4 127/62 84 3.2

3. We are currently in the era of disconnected health

4. We are disconnected from our health data 50.7% use EMR $44k in stimulus per doc

5. We are disconnected from our physicians

6. We are disconnected from the healthcare system

7. We are disconnected from our own health

8. Being disconnected leads to poor health

9. Obesity Trends* Among U.S. AdultsBRFSS,1990, 1999, 2009 (*BMI 30, or about 30 lbs. overweight for 5’4” person) 1999 1990 2009 1/3 of Americans will have diabetes by 2050 (CDC) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

10. The pace of drug development is slowing

11. How did we lose control of our personal health identity?

12. Technology will disrupt healthcare… (it will just take longer than other industries) 80% search for health 3rd most popular web-based pursuit (Susannah Fox, Pew Internet Project)

13. Cyberchondria “Unfounded escalation of concerns about common symptomatology, based on the review of search results and literature on the Web” 2 in 5 report increase in anxiety from medical search (White and Horvitz, Microsoft Research)

14. The patient is the most underutilized resource in healthcare

16. Measurement facilitates behavioral change 10.5% (Seligman and Darley 1977)

17. Is mHealth adoption following a familiar pattern? % of Age Group Age Data from: Brian Dolan, MobiHealthNews Susannah Fox, Pew Internet Project

18. Apple wants to connect you to your health

20. New data is more powerful than a new drug 39% reduction in hospitalizations over 6 months

21. 50% 73 million have HTN 69% with first MI

22. Know your target audience

23. Even young people have chronic medical conditions % of Patients Age

24. # of chronic conditions for Medicare beneficiaries (65+) 5+conditions But as people age, they get a lot more No conditions 4conditions 1condition 3conditions 2 conditions Presented at the Annual Academy Health Research Meeting, June 2007; CMS (Centers for Medicare and Medicare Services)

25. Medical / clinical is converging with health / wellness

26. What you can learn from a few data points?

27. Mood Seasonality Mood by Day of Week

29. Significant personal information from a single daily data point

30. 30 Crowdsourcing personal health data

31. Xanax(Alprazolam) Exercise B Vitamins 31

32. Can crowdsourced personal health data be used to predict personalized drug responses?

33. Data is beginning to flow from the system to users

34. Access to data – Blue Button Practice Fusion MSHV

35. Prescription data is beginning to flow Surescripts data on Rx histories

36. Rx history + treatment algorithm = understanding

37. You can learn a lot about a person from a few simple data points

38. Beta Blockers Diuretics High Blood Pressure Drug ACE Inhibitors Drug Class Liptor Zocor Lovastatin Pravachol Crestor Lescol Calcium Channel Blockers ARBs Statins 70-80% of CAD patients have high blood pressure High Cholesterol Coronary Artery Disease (CAD) Myocardial Infarction (Heart Attack) Zetia Tricor Vytorin Gemfibrozil Niaspan Medical Conditions Event HDL and Other 20-30% of CAD patients have Type 2 Diabetes TZDs Drug Class Metformin Type 2 Diabetes DPP -4 Inhibitors Drug Sulphonylureas Insulin

39. Hidalgo et al. PLoS Computational Biology 5(4):e1000353 (2009) http://hudine.neu.edu/

40. High Cholesterol High Blood Pressure 1 2 3 4 5 High Blood Pressure High Cholesterol High Blood Pressure High Blood Pressure Type 2 Diabetes High Cholesterol Type 2 Diabetes Osteoporosis

41. Social Health App Social Health App Social Health Layer / Health Graph Google Health Microsoft HealthVault Practice Fusion EMR / PHR AllScripts PHR Other EMR / PHR System APIs Google Apps MSHV Apps PF Apps AS Apps Other PHR Apps

42. We are entering the era of Participatory Medicine

43. A medical record is a punctuated data stream Gaps filled via recollection Personal Health Data

44. Anamnesis (patient recollection) is not accurate

45. EMR data + user generated data = healthstream Personal Health Data

46. Rx of Apps Medications METFORMIN 500MG BID LISINOPRIL 20MG OD Applications

47. I will own my healthstream and health data

48. The market for health data is very large

50. Healthcare systems are the future

51. Data enables us all to become Citizen Scientists

52. Can butter make you smarter?

53. The MTHFR Study

54. Groups of users will come together to run their own clinical trials

55. Genomera: A platform for Citizen Science

56. Future study: meditation and blood pressure

57. Citizen Science has the power to disrupt healthcare Drug A Track common measures of efficacy, potential side effects, events, etc. Drug B

59. For those interested in learning more, the Bay Area is a good place to be…

60. Chris Hogg cwhogg@gmail.com twitter.com/cwhogg linkedin.com/in/cwhogg citizenmed.wordpress.com ? Thank You