Total Exposure Health - A Bold Approach to Transform the Delivery of Healthcare through Primary Prevention

Total Exposure Health – A Bold Approach to Transform the Delivery of Healthcare through

Primary Prevention

06 Nov 2017American Public Health Association

Annual Meeting 2017

Col Kirk PhillipsUnited State Air Force Medical Service

1Cleared for Public Release, SAF/PA Case Number:2016-0444

Disclosure

Col Kirk Philips

∎ 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”

Vision: What if we could…

Such a capability would

Enhance individual human performance

Help providers understand the effects of exposures on a patients health now

and throughout their life “True Comprehensive Health Surveillance”

Enable rapid intervention and supportive medical care, with more confidence

Reduce disability by truly preventing disease

Lead to significant savings in total health care costs

. . . tell if a person has unacceptable exposure-related health risks in near real-time?

Servicemember working in a burn pit in Balad, Iraq. (Public Domain)

We are the sum of our experiences (and exposures)....

Factory emission (Public Domain)

Cleared for Public Release, SAF/PA Case Number:2016-0444 4

Total Exposure Health

Description: Solution to capture workplace, env & lifestyle exposures to theind (i.e., N=1, genome) using advances in science, technology & informaticsto prevent disease; improve health and well-being: Healthiest PerformingPopulation 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


Total Exposure Health- VisualizedE

FF

EC

T

DOSE

11/4/2017

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

Cleared for Public Release, SAF/PA Case Number:2016-0444

* SEG – Similar Exposure Group

Current State - Prev Med Future State – Prev Med

Work exposure only Work, environment, lifestyle (home, rec, etc) exposures

Animal models of exposures are applied to population and (SEG)* with safety factors for Airmen protection and clinical intervention

Individual exposure applied to each Airman’s genome with tailored interventions to include prevention, protection, career, placement and clinical

Limited sensors (time, sensitivity, analytes)

Individual and area sensors with full analytecomplement, real time/all-the-time, sensitive to human based exposure levels

Clinical intervention based on organ function disruption/damage

Clinical intervention based on molecular biology changes brought by exposure

Paper-based exposure summarysomewhere in the clinical record

Expert system (EHR) matching billions of bits of information (DNA, sensor, etc) relevant to exposure with clinical recommendation

Prevention concerns applied post-occupational/lifestyle choice

Prevention of key health outcomes part of the care decision for career/life from recruitment to separation/retirement

TEH

Total Exposure Health: Where it takes us


Reimagining Healthcare w/TEH


TEH PROOF OF CONCEPT


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

Cleared for Public Release, SAF/PA Case Number:2016-0444 11/4/2017 10

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


Turn Data into

Insight

Multiple Gene variants associated w/NIHL


Gene x Environment Interactions & Prevention

*Data Derived from Air Force Coriell study

Multiple genetic variants in multiple genes associated with NIHL or related phenotypesOdds Ratios range from 5.2 to 22.36


Technology - Highlights

∎Noise monitoring sensor measures

External (ambient/audio)

“Digital”

24/7

∎ Bluetooth

∎Agnostic app for individual's device

∎ Low- Profile low cost

14

On duty Off duty


Our Clinical Disposition

Total Exposure Health – Exposure Indices

15

Our Unique Genetic Proclivity

IEHRP:Individual

Exposure IndicesOur Exposures

11/4/2017 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

11/4/2017 16

Visualizing the IEHRP – Individual

11/4/2017

IEHRP will aid in visualizing an individual’s

unique exposure susceptibilities

Kirk

NOISE BENZENELEAD RADIATION GLUTEN

SU

SC

EP

TA

BIL

ITY

HIGH

LOW


Visualizing the IEHRP – Population

Cleared for Public Release, SAF/PA Case Number:2016-0444 11/4/2017

Yr 1 Baseline IEHRPIntervention/Changes

Y2 IEHRPSee Unique PatternsAnn

Al

Lily

Kirk

Rich

YEAR 1

BENZENE

LEAD

RADIATION

GLUTEN

NOISE

YEAR 2

TEH WRAP-UP


∎ Retain health and increase human performance for people

∎ Comply with regulatory standards and Congressional mandates regarding comprehensive health surveillance

∎ Better understand current and emerging exposure trends and their impacts on health

∎ Advance true primary prevention to address health risk before the onset of disease

∎ Develop rapid intervention and supportive medical care with more confidence

∎ Create significant savings in total health care costs and reduced disability by preventing disease

Collectively we can:


QUESTIONS?
