Using healthcare data - context & considerations for collecting, cleansing, analyzing, and displaying geospatial and temporal data, with a focus on Propeller Health's program in Louisville, KY.
2. Propeller Health
• Founded in 2010
• Located in Madison, WI
and San Francisco, CA
• FDA 510(k) cleared
• 25+ commercial programs
• Validated in 12 clinical studies
totaling over 1,200 patients
4. Cost of asthma & COPD
Asthma & COPD are the 5th and 6th most expensive diseases in the US
5. Disease management has not changed in decades
Daily diaries and paper-based action plans add burden &
complexity and are rarely used by patients.
6. Real-time data can help detect exacerbations
• Half of patients who go to ED have had symptoms for > 4
days
• With real-time data, we can intervene early while outpatient
treatment is still an option
8. Digital interventions improve adherence
Significant literature supports the use of SMS and audiovisual
reminders to improve adherence to inhaled controller
medications
10. Sensors measure symptoms & track symptoms
Rescue
Used to address symptoms
when they occur unexpectedly –
among the most important
markers of impairment & risk
Controller / maintenance
Should be used regularly to
minimize or eliminate symptoms
by addressing underlying
pathophysiology
12. 1:38:08
PM PST
Pollen Count 5.2
AQI 102
N47o 34.4452. W110o77.8257
2 inhalations of ProAir (120mcg)
20 seconds apart
Winds from SW, 13mph
And attaches meta
data to each
actuation
13. Multi-faceted approach to improving adherence
• Non-adherence is complex and multi-dimensional
• Improving adherence requires an equally multi-dimensional solution
14. Rules driven notifications & alerts
Goal is to give users small bits of actionable, personalized
feedback to foster self-management, without increasing the effort
required of users
• Passive
• Feed of personalized insights
• Personalized encouragement
• Triggered questions & surveys
• Messaging from Care Team
16. Retain Users
Enroll Users● Intercept during
normal clinical care
● Telephone to schedule visit
● Email marketing
● Direct mail
● Online targeted marketing
● Incentives
● Partnership
● In person (face-to-face)
● On telephone
● Online self-enrollment
● Hardware
● Software
● CSS Team
Experiments every step of the way
30. Data are the backbone of value-based care
Better data are needed to
understand what happens to
patients in between physician
visits
• to effectively manage care
• to improve outcomes
• to prove effectiveness
36. • Enacted August 21, 1996
• 4 key components, including: administrative simplification
• Administrative simplification, including: privacy & security
standards
Health Insurance Portability and Accountability Act
Privacy standards
• Protected Health
Information (PHI)
• Covered entities
• Routine purposes
Security standards
• Administrative: Policies, training, etc.
• Physical: unauthorized intrusion, etc.
• Technical: encryption, etc.
37. Once information is de-identified, it is no longer subject to the
privacy regulation restrictions.
De-identification
Statistical de-identification
• Statistical expert confirms
that data could not
reasonably be re-identified
• Documentation & results of
all statistical tests &
analyses
Safe Harbor Guidelines
Removal of 18 personal
identifiers that constitute
Personally identifiable
information (PII).
1. Names
2. Geo-specificity < than state
3. All dates (birth, death, doc visits, etc.)
4. Telephone numbers
5. Fax numbers
6. Email addresses
7. Social security #s
8. Medical record #s
9. Health plan #s
10. Account #s
11. License #s
12. Vehicle identifiers
13. Device identifiers
14. URLs
15. IP addresses
16. Biometric identifiers
17. Full face photography
18. Any other uniquely identifying #
40. Clinical trials
Series of statistically instrumented experiments to prove safety
& efficacy of treatments, devices, and medical strategies
Development process – medical devices
41. Propeller clinical trials design
500-1,000 enrolled
Intervention
Control
6-12 month study period,
with quarterly assessments of control
Randomization
Sensor +
intervention
Sensor + no
intervention
Primary outcomes
Asthma control
Poorly controlled
Not well controlled
Well controlled
Inhaler use
Rescue inhaler
Controller inhaler
44. Case study: Propeller Health in Louisville, Kentucky
“One of the top 20 “most challenging
places to live with asthma in the US.”
- Asthma & Allergy Foundation of America, 2014
45. Snapshot of Louisville health
• 1 in 3 adults in Louisville are overweight or obese
- Increased risk for high blood pressure, diabetes, some
cancers, arthritis / joint pain
• 25% of Louisville adults still use tobacco products
- Increased risk for lung disease, cancer, heart attack and stroke,
and poor wound healing
• Louisville’s rate of deaths for heart disease, cancer, diabetes,
stroke are higher than the death rates for Kentucky and the
US
46. Why do this study?
Asthma hospitalizations in Jefferson County, 2011
Data like this has many problems:
• Based on healthcare utilization
• Retrospective, time lags
• Aggregated, low spatial resolution
47. Louisville study design
Enrollment begins
Baseline data collection for 1 month
instrumentation with sensors, but no access to data
Intervention period & data collection for 12 months
5,430 unique rescue inhaler events recorded
27,197 person-days of data
49. Temporal data Air quality index
(Levels of health
concern)
Numerical
value
Meaning
Good 0 to 50 Air quality is considered satisfactory & poses
little or no risk
Moderate 51 to 100 Air quality is acceptable, but for some
pollutants there may be risk for unusually
sensitive groups
Unhealthy for
sensitive groups
101 to 150 Members of sensitive groups may experience
health effects
Unhealthy 151 to 200 Everyone may begin to experience health
effects
Very unhealthy 201 to 300 Health warnings of emergency conditions
Hazardous 301 to 500 Health alerts: everyone may experience serious
health effects
58. Geospatial data
• Usually latitude, longitude
• A shapefile is an vector data storage format for storing
the location, shape, and attributes of geographic features
• Projections matter!
This slide has an
animation.
61. World Geodetic System, 1984 – WGS 84
• Standard for use in cartography and navigation, including GPS
• Coordinate origin at the Earth’s center of mass
• Meridian of zero longitude is ~336 feet east of Greenwich
• Originally developed by the Department of Defense in 1966
• Default projection for Tableau & QGIS
79. Spatial predictors we explored
• Exposures
• Proximity to emission sources, industrial areas, power plants, active mines
• Transportation infrastructure
• High density traffic areas
• Land use
• Impervious surface (%)
• “Greenness” and tree canopy
• Proximity to green spaces & parks
• Neighborhood
• Socioeconomic measures: household income, educational attainment,
property values, property age, crime rates
• Population density
• Study factors
• # of users enrolled per zip
81. Ecological niche modeling
1. Geo-reference inhaler use points
2. GIS of environmental variables
3. Extract environmental data at each point
4. Build model against background sample of
pseudo-absences
5. Model calibration & selection (AUC, cross-
validation with test data, etc.)
6. Probability distribution based on environmental
suitability
7. Assessment of environmental
variable contributions
8. Extrapolate into new
environmental or geographic space
9. Test with additional data
87. Current AIR Louisville emphases
• Improved data & sampling
• More analyses, guided closely by city needs
• More transparency & public awareness with open data portal
105. Louisville is one of the top 20
most difficult places to live
with asthma in the US.
AIR Louisville enrolled 300
residents to track their asthma
rescue inhaler use with
Propeller Health sensors.
AIR Louisville collected data on citizens’ inhaler use for 12 months
Here’s what we learned…
We learned a lot about how
Louisville residents experience
asthma symptoms and use
their inhalers.
Only 31% of asthma attacks
occur in homes.
People use inhalers more
when it is hot outside.
Weed, pollen and mold
significantly increase asthma
risk.
Wind clears the air and
reduces asthma attacks.
When pollution levels are high,
people have more asthma
symptoms.
Strong city partnerships are
key to a successful program.
People use rescue inhalers
more on weekdays than on
weekends.
Trees provide a protective
effect for asthma attacks
(especially evergreens).
A 10% reduction in particulate
matter could mean a 27%
reduction in asthma risk.
Blue dot = inhaler signal
This slide has an
animation.
106. In Mayor Fischer’s own words
This slide has an
animation.
https://youtu.be/iiaTPV09vBE?t=6m27s