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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
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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
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Reimagining Healthcare w/TEH
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Total Exposure Health - Big Picture
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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
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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
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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
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∎ 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
11/4/2017 11Cleared for Public Release, SAF/PA Case Number:2016-0444
Identified Gene variants associated w/NIHL
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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
Cleared for Public Release, SAF/PA Case Number:2016-0444
Genetics
Diagnostics
Sensors and Mobile Data
Lifestyle
Occupation
Medical History
Environment
Faimly History
Exposure Index can have many variables
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IEHRP Exposure Index Data Sources
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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)
Exposure element 2 Index(2,1) Index(2,2) Index(2,3)
Exposure element 3 Index(3,1) Index(3,2) Index(3,3)
Exposure element 4 Index(4,1) Index(4,2) Index(4,3)
:
.
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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
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Kirk
LilyAnn
Rich
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Kirk
Lily
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AlKirk
Lily
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Lily
TOTAL
EXPOSURE
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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
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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?
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Rethinking Exposure LimitsIN
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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
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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
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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
Cleared for Public Release, SAF/PA Case Number:2016-0444
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