Revolutionizing Precision Health with Big Data

The Individual Exposure Health Risk Profile

(IEHRP)

06 Nov 2017
American Public Health Association
Annual Meeting 2017

Richard Hartman, PhD

United State Air Force Medical Service
Cleared for Public Release, SAF/PA Case Number:2016-0444 1
Disclosure

Richard Hartman, PhD

No Relationships to Disclose

11/4/2017 Cleared for Public Release, SAF/PA Case Number:2016-0444 2

Healthcare is Changing

Healthcare in Changing Focus on the Individual

Policy, technology, marketplace

& consumer expectations are
disrupting healthcare & we can
position ourselves to better
support
Personalized Healthcare

11/4/2017 Cleared for Public Release, SAF/PA Case Number:2016-0444 3

Total Exposure Health

Description: Solution to capture workplace, environment & lifestyle

exposures 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

Increase use of Improve Better understanding of Advance operational

genomic research exposure monitored exposure to decisions using
and knowledge monitoring performance and advancements in science,
through sensors individual health medicine, technology, and
and wearables outcomes informatics with digital
biodata bank, Big Data
analytics, and expert
systems

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

 Total Exposure Health- Visualized
Chemical

Radiation

Allergen

When we account for

genetic variance we
EFFECT

find we are all unique!

Sensitive Resilient But we can also use

Average
this information to
Individual Individual Individual
protect health and
enhance performance

DOSE
11/4/2017 Cleared for Public Release, SAF/PA Case Number:2016-0444
Reimagining Healthcare w/TEH

Cleared for Public Release, SAF/PA Case Number:2016-0444 6

Total Exposure Health - Big Picture

Cleared for Public Release, SAF/PA Case Number:2016-0444 7

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 ones 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

11/4/2017 Cleared for Public Release, SAF/PA Case Number:2016-0444 8

Noise Demonstration Project

Big Data Turn Data into

Exposure
Analytics Insight

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

Cleared for Public Release, SAF/PA Case Number:2016-0444 9

Personnel Exposure Monitor (PEM)

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

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

Genetics - Noise Induced Hearing Loss

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

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

Identified Gene variants associated w/NIHL

11/4/2017 Cleared for Public Release, SAF/PA Case Number:2016-0444 12

Individual Exposure Health Risk Profile (IEHRP)

IEHRP:
Individual
Exposure Indices
Our Exposures

Our Unique Genetic Proclivity

Our Clinical Disposition

13
11/4/2017 Cleared for Public Release, SAF/PA Case Number:2016-0444
IEHRP Example Noise

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

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

11/4/2017 Cleared for Public Release, SAF/PA Case Number:2016-0444 14

Exposure Index can have many variables

Medical History

Genetics Faimly History

Diagnostics Occupation

Environment Lifestyle

Sensors and
Mobile Data

11/4/2017 Cleared for Public Release, SAF/PA Case Number:2016-0444 15

IEHRP Exposure Index Data Sources

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Repsentencing IEHRP Mathematically

h Exposure Clinical Genetic propensity

measurements measurements

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)

:
.

11/4/2017 Cleared for Public Release, SAF/PA Case Number:2016-0444 17

 Rethinking Exposure.
Ann Lily
Ann
Lily Al

TOTAL
TYPICAL Kirk Kirk Rich
EXPOSURE
EXPOSURE
GLUTEN
RADIATION
NOISE
LEAD
BENZENE
Rich
CURVE Lily
Al
Al
EFFECT

Kirk
Al Kirk When we layer these
Al exposures we find
Ann Kirk Rich we are all unique
Ann
Al Ann
Kirk
Kirk
Rich Rich
Rich
Lily Lily
Rich Al Ann Lily
Lily Ann

DOSE
11/4/2017 Cleared for Public Release, SAF/PA Case Number:2016-0444
 Visualizing the IEHRP Individual

HIGH

Kirk
SUSCEPTABILITY

IEHRP will aid in

visualizing an individuals
unique exposure
susceptibilities
LOW

NOISE LEAD BENZENE RADIATION GLUTEN

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

Visualizing the IEHRP Population
YEAR 1 YEAR 2

Lily
Yr 1 Baseline IEHRP
Intervention/Changes
Y2 IEHRP
Ann
See Unique Patterns

Rich

Al

NOISE
LEAD
Kirk BENZENE
RADIATION
GLUTEN

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

Rethinking the Similar Exposure Group (SEG)
By Exposure? By Profile?

Lily
How will
Similar Exposure Groups
(SEGs) be determined?
Ann

By Exposure?
or
Rich By Profile?

Al

NOISE
LEAD
Kirk BENZENE
RADIATION
GLUTEN

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

Rethinking Exposure Limits
EXPOSURE
OSHA PEL
CURVE
No-Effect Increasing Effect with
Kirk
Maximum Effect
Range Increasing Dose Range
INCREASING EFFECT

Rich

Exposure limits Pop Based

Protects based on Economic
Feasibility
Were all Respond Differently
Ann Super humans?

Lily
Al

SUPER

INCREASING DOSE

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

TEH Full Implementation

ILER
VBA
Vet
Benefits
Sensor Data

PHA Surveys
SADA
&
T T
DoD/VA
E E (IEHRP) Researchers
Genomic /
H Biodata bank H
MHS Genesis

sharing

DOEHRS analytics
VHA/EHR
ingest Clinical
Provider
Decision
Support
Other databases
System

DOD
Provider

Cleared for Public Release, SAF/PA Case Number:2016-0444 23

THE/IEHRP Brings these things together:

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

Cleared for Public Release, SAF/PA Case Number:2016-0444 24

 Questions

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