Headquarters U.S.

Air Force
Integrity - Service - Excellence

Enhancing Health Risk Assessment:

The Individual Exposure Health
Risk Profile (IEHRP)

Richard Hartman, PhD

Chief Strategist
Air Force Medical Support Agency
23 August 2018

Cleared for Public Release, SAF/PA Case Number: 2018-0490

 Disclosure

 No conflicts of interest

 No discussion of off-label uses

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 Reimagining Healthcare with
Total Exposure Health (TEH)

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 IEHRP: Introduction
IEHRP
 Support TEH to enhance the electronic health record (MHS-GENESIS)
 Identify and integrate “Big Data” (DOEHRS, DMSS), genomics, sensors...
 GOAL: build a mathematical model defining individual’s exposure profile
 $1.7M in Joint Program Committee (JPC-1) funding

Individual Exposure Health Risk Indices (IEHRI) = (v1,1) + (v1,2) + (v1,3)

IEHRInoise = (vnoise, measure) + (vnoise, genes) + (vnoise, history)

Individual Exposure Health Risk Profile (IEHRP) =

[(v1,1) + (v1,2) + (v1,3)], [(v2,1) + (v2,2) + (v2,3)], … , (vn,j)
IEHRP = [(vnoise, mea.) + (vnoise, gen.) + (vnoise, his.)] , [(vradon, mea.) + (vradon, gen.) + (vradon, his.)], … ,(vi,j)

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 IEHRI Example: Noise

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 IEHRI Example: Noise
 Basic linear equation for noise:

Individual Exposure Health Risk Index (Noise) = Personal Monitored Exposure (Noise) +
Medical/Clinical Disposition (Noise) + Genetic Proclivity (Noise)

 Adding chemical exposure the equation changes to:

Individual Exposure Health Risk Index (Noise) = Personal Monitored Exposure (Noise) +
Medical/Clinical Disposition (Noise) + Genetic Proclivity (Noise) + Ototoxins (Noise)

 The Individual Exposure Risk Index becomes more refined as we identify

confounding factors that affect the risk of NIHL:

Individual Exposure Risk Index (Noise) = Personal Monitored Exposure (Noise) +

Medical/Clinical Disposition (Noise) + Genetic Proclivity (Noise) + Ototoxins (Noise)
– Protective factors (Noise) – Protective Interventions (Noise)

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 IEHRP Visualization &
Normalization
Graphing the raw data we get the
3 following IERP. However, to address
censored data requires - Normalization

X 2 2 = censored data

MEASURED
EXPOSURE

Genetics

Medical Record

NOISE RADON BENZENE GLUTEN

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 IEHRP Visualization &
Normalization
Normalization = all indices will have
values between 0 and 1. Accounting for
the censored data we get the following
IEHRP

X 1 1 1 1

MEASURED
EXPOSURE

Genetics

Medical Record

NOISE RADON BENZENE GLUTEN

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 IEHRI & IEHRP: Expanded
IEHRP
 IEHRI – Which vi,j value is more important?
 WFi,j = weighting factor– importance of each variable (vi,j) when
compared with all the variables with in the IEHRI (e.g. are genes more
important than exposure measure?-
 CFi,j = correction factor – variability (confidence) in the (vi,j) based on
the process, procedures, methods, device, etc. for each (vi,j)

Individual Exposure Health Risk Index (IEHRI) (exposure) =

[(v1,1)(CF1,1)(WF1,1) + (v1,2)(CF1,2)(WF1,2) + … (vi,j)(CFi,j)(WFi,j)
Individual Exposure Health Risk Profile (IEHRP) =
[(v1,1)(CF1,1)(WF1,1) + (v1,2)(CF1,2)(WF1,2) + (v1,3)(CF1,3)(WF1,3)] , [(v2,1)(CF2,1)(WF2,1) +
(v2,2)(CF2,2)(WF2,2) + (v2,3)(CF2,3)(WF2,3)] , … ,
[(vi,1)(CFi,1)(WFi,1) + (vi,2)(CFi,2)(WFi,2) +…+ (vi,j)(CFi,j)(WFi,j)]

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 IEHRP: Future
Plan Ahead

 Phase I: IEHRI basic equation: 3 variables, 1 exposure each (v1,1) + (v1,2) + (v1,3)

 Phase II: Introduce correction (CFi,j) & weighted factors (WFi,j) for IEHRI
(v1,1)(CF1,1)(WF1,1) + (v1,2)(CF1,2)(WF1,2) + (v1,3)(CF1,3)(WF1,3) + … (v1,j)(CF1,j)(WF1,j)

 Phase III: Multiple variables and exposures

[(v1,1)(CF1,1)(WF1,1) + (v1,2)(CF1,2)(WF1,2) + (v1,3)(CF1,3)(WF1,3)] , [(v2,1)(CF2,1)(WF2,1) + (v2,2)(CF2,2)(WF2,2) + (v2,3)(CF2,3)(WF2,3)] , … ,
[(vi,1)(CFi,1)(WFi,1) + (vi,2)(CFi,2)(WFi,2) +…+ (vi,j)(CFi,j)(WFi,j)]

 Phase IV: Build IEHRP array w/ censored data* - - (v1,3) (v1,4)

(v2,1) (v2,2) - (v2,4)
*variables may be missing or not measured - (v3,2) - -

Future
 Leverage noise demo to expand into physical, chemical, biological exposures
 Implementation into Clinical Decision Support System (CDSS)
 Full integration into individual EHR: Individual Longitudinal Exposure Record (ILER)

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 IEHRP Benefits: Tailorability

NOISE GLUTEN RADON BENZENE NOISE BENZENE GLUTEN RADON

RADON NOISE BENZENE GLUTEN NOISE BENZENE GLUTEN RADON

“Healthcare Provider” “Policymaker”

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Headquarters U.S. Air Force
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QUESTIONS?

Richard Hartman
Richard.t.hartman3.ctr@mail.mil
Comm: (703)-681-7626
DSN: 761-7626

Cleared for Public Release, SAF/PA Case Number: 2018-0490