Internet Health Monitors: Distributed Infrastructure for Measuring Population Health - PowerPoint PPT Presentation


PPT – Internet Health Monitors: Distributed Infrastructure for Measuring Population Health PowerPoint presentation | free to view - id: 520-NjVmZ


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation

Internet Health Monitors: Distributed Infrastructure for Measuring Population Health


Health Systems now for Acute Illness. Hospitals are Profitable Business but ... Patients themselves create population health database via informatics that ... – PowerPoint PPT presentation

Number of Views:90
Avg rating:3.0/5.0
Slides: 27
Provided by: can8


Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Internet Health Monitors: Distributed Infrastructure for Measuring Population Health

Internet Health MonitorsDistributed
Infrastructure for Measuring Population Health
Bruce R. SchatzDepartment of Medical Information
ScienceCollege of Medicine, Institute for
Genomic Biology University of Illinois at
Urbana-Champaign ,
Biomedical Informatics Campus Seminar University
of Illinois at Urbana-Champaign October 7, 2005
Healthcare Infrastructure
  • Infrastructure is the Whole System
  • Hospital, Clinic, Home
  • Doctors, Nurses, Brochures, Internet
  • NO Viable Model for Health System
  • Too much Cost! Too Much Volume!

Health Systems
  • Healthcare is THE Economic Issue
  • BIGGEST item in modern societies
  • Fast growing due to aging population
  • Healthcare will BREAK Every Nation
  • Nations go bankrupt and People die!

The Fundamental Cause 1
  • Medicine versus Health
  • Cure Sick in BIG Hospital
  • Maintain Wellness in small Clinic
  • Recent Rise of Chronic Illness
  • No cure with drugs surgery
  • only manage with diet exercise

The Fundamental Cause 2
  • Health Systems now for Acute Illness
  • Hospitals are Profitable Business but
  • Clinics are supported by Government
  • Systems cannot handle Chronic Illness
  • Chronic Illness now dominates Costs and Systems
    cannot handle Volume

The Viable Solution 1
  • Independent Clinics are Doomed
  • 1990s America -- small Clinics failed
  • when Government support reduced.
  • Health Systems start HMOs
  • Health Maintenance Organizations
  • 2000s America HMOs all failing.
  • 2000s Japan small Clinics will fail
  • when Government support reduced.

The Viable Solution 2
  • Need Complete Provider Pyramids
  • High Level for High Quality at High Cost
  • Low Level for Low Quality at Low Cost
  • Handle Volume by Pushing Cases Down
  • Bottom Levels handle MOST CASES
  • Viable Healthcare Infrastructure
  • Hospitals with Doctors for Surgery, Clinics with
    Nurse for Drugs, Homes with Patients for nearly
    all Health Interactions!

Health Informatics
  • Need New Viable Infrastructure
  • Health Information Technology
  • Provides Support for Patients in Homes
  • Creates Bottom of Pyramid to Offload
  • Informatics can Solve this Problem
  • Patients themselves create population health
    database via informatics that automatically
    routes healthcare

Informatics Technologies
  • Measure Population Health
  • Adaptive Question Asking of Quality of Life
  • Answers for Individuals creates Database for the
  • Manage Population Health
  • Structured Health Vectors from normalized patient
  • Statistical Information Retrieval cluster
    patients into care cohorts

Measure Population Health 1
  • Quality of Life Questionnaires
  • Self-Assessment directly by Patients
  • General Status questions, e.g. SF-36
  • Specific Disease questions, e.g.
  • Arthritis Can you walk without pain?
  • Heart Disease Do your ankles swell?
  • QoL correctly does coarse prediction
  • VA Heart Study SF-12 better than surgeon about
    patient survival

Measure Population Health 2
  • Electronic Records for fine prediction
  • Paper supports 10s of questions
  • Electronic supports 100s or 1000s
  • Adaptive Question Asking
  • Choose questions by weighted treewalk
  • Each session asks 10s of questions customized to
    particular condition
  • Generate Population Database
  • Daily individual records from all homes

Manage Population Health
  • Structured Health Vectors
  • Patient answers Questions daily
  • Average scores generate Health Vector
  • Elements of Vector are Meaningful
  • Cluster Patient Cohorts
  • Normalize Vectors for Similar Clusters
  • Weight Question Groups Medically
  • Route Care into Pyramid using Clusters to
    Determine Cohorts

Theory Experiment
  • Questionnaire from Merged QoL
  • 120 questions from 20 questionnaires
  • General plus some Specific questions
  • Simple Clusters do coarse prediction
  • Students simulate sick or well patients
  • K-means with random seeds does correct clustering
    from actual health monitor sessions with 100

Practice Experiment
  • Practical Risk Assessment Possible?
  • Need 4 Cohort Clusters correctly predicted
    hospital, clinic, telephone, home
  • Is 120 questions (10more) enough?
  • What Clusters can do fine prediction?
  • Use Historical Database of Real Patients
    answering Paper QoL Questionnaires
  • Agglomerative with complete link always
    consistent but always correct? May need
    appropriate structured vector weighting

Clinical Experiment
  • Real Patients in Real Settings
  • 1000 senior patients with heart disease
  • Use in Medicare Coordinated Care
  • Telephone Interface via voice response
  • Determine Care Levels automatically
  • Demonstrate Feasible Technologies
  • Adaptive Question Asking with Faceted Category
  • Statistical Cohort Clustering with Structured
    Vector Weighting

Current Prototype Status
  • Theory Experiment
  • Completed in LIS Healthcare Infrastructure
  • Health Informatics Information Retrieval
  • Practice Experiment
  • On-going collaboration with Carle Hospital
  • Adaptive Faceted being Developed
  • Historical Databases being Analyzed
  • Clinical Experiment
  • Multi-Year Trial Proposal to US AHRQ
    Agency for Healthcare Research Quality

Sample General Health Questions
Sample Specific Health Questions
  • Heart Condition

  • Arthritis Condition

Health Monitor Session
Beyond Screening
  • Why are Some People Healthy? (R. Evans)
  • Major categories are disease, health care,
    health function, genetic endowment, physical
    environment, social environment, individual
    response, behavior, well-being, prosperity.
  • Healthy People 2010
  • 467 objectives in 28 focus areas
  • Measure Full-Spectrum Health Status
  • Detailed QoL in each detailed category

Computer-based Questionnaires
  • Treat actual disease stage (dynamic)
  • Computer assessment handles full-spectrum
  • Database of all questions (300K)
  • Individual session asks only 30 questions
  • Tree-walking Categories by Breadth-First
  • Treat actual patient status (adaptive)
  • MOS knows this the problem (McHorney)
  • GRE as the paradigm
  • Session answers determine questions
  • Historical answers determine questions

Population Management
  • Possible to Monitor Whole Populations
  • Daily Monitors, Full Spectrum of Features
  • Internet Software handles Questionnaires
  • Cohort Clusters supplement Diagnoses
  • Daily Feature Record for each Individual
  • Detailed Databases for whole Population
  • Analyze Clusters of Similar Patients
  • Cohort Switching drive Treatments
  • Manage Expectations with Actual Cases
  • Improve Health by Switching Cohorts

Getting from Here to There
  • Develop Full-spectrum Questionnaire
  • Merge existing Quality of Life instruments
  • Encode knowledge from Medical Professionals
  • Develop Dynamic Adaptive Administration
  • Software to handle Interactive Sessions
  • Software to build Individual History
  • Software to build Population Database
  • Develop Cohort Similarity Clustering
  • Algorithms for Statistical Feature Matching
  • Lifestyle Coaching via Cohort Switching
  • Deploy Test (10) to Trial (1000) Population

Healthcare Infrastructure
  • Provider Pyramids
  • Scale to Volumes for Chronic Illness
  • Risk Assessment
  • Automatically Determine Level of Care

Further Information
  • Papers
  • See articles on Internet Health Monitors and on
    Monitoring Population Health by R. Berlin, MD,
    and B. Schatz, PhD, at under
    Publications under Papers.
  • Demos
  • Try prototypes and view analysis at under MedSpace at bottom of
    web page.

Further Reading
  • Richard Berlin and Bruce Schatz (2001)
  • Population Monitoring of Quality of Life for
    Congestive Heart Failure, Congestive Heart
    Failure, 7(1)13-21 (Jan/Feb 2001).
  • Colleen McHorney (1997)
  • Generic Health Measurement Past Accomplishments
    and a Measurement Paradigm for the 21st Century,
    Annuals Internal Medicine,127743-750.
  • R. Evans, M. Barer, T. Marmor (eds)
  • Why are some People Healthy and Others Not?
  • The Determinants of Health of Populations
  • (New York Aldine de Gruyter, 1990).
  • G. Rose, The Strategy of Preventive Medicine
  • (Oxford University Press, 1992).