Total Exposure Health A Bold Approach to

Transform the Delivery of Healthcare through

Primary Prevention

06 Nov 2017
American Public Health Association
Annual Meeting 2017

Col Kirk Phillips

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

Col Kirk Philips

No Relationships to Disclose

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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

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Vision: What if we could
. . . tell if a person has unacceptable exposure-
Such a capability would related health risks in near real-time?
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
We are the sum of our experiences (and exposures)....

Factory emission (Public Domain) Servicemember working in a burn pit in

Balad, Iraq. (Public Domain)

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 Total Exposure Health

Description: Solution to capture workplace, env & lifestyle exposures to the

ind (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

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 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
Total Exposure Health: Where it takes us

Current State - Prev Med Future State Prev Med

Work exposure only
Animal models of exposures are applied
to population and (SEG)* with safety
factors for Airmen protection and clinical
intervention
Limited sensors (time, sensitivity,
analytes)
Work, environment, lifestyle (home, rec, etc)
exposures
Individual exposure applied to each Airmans
genome with tailored interventions to include
prevention, protection, career, placement and
clinical
Individual and area sensors with full analyte
complement, real time/all-the-time, sensitive to

Clinical intervention based on organ

TEH human based exposure levels
Clinical intervention based on molecular biology
function disruption/damage changes brought by exposure
Paper-based exposure summary Expert system (EHR) matching billions of bits of
somewhere in the clinical record information (DNA, sensor, etc) relevant to
exposure with clinical recommendation
Prevention concerns applied post- Prevention of key health outcomes part of the
occupational/lifestyle choice care decision for career/life from recruitment to
separation/retirement

* SEG Similar Exposure Group

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Reimagining Healthcare w/TEH

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TEH PROOF OF CONCEPT

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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

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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

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Multiple Gene variants associated w/NIHL

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Gene x Environment Interactions & Prevention

Multiple genetic variants in multiple genes associated with NIHL or related phenotypes
Odds Ratios range from 5.2 to 22.36
*Data Derived from Air Force Coriell study

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Technology - Highlights

Noise monitoring
sensor measures
External
(ambient/audio)
Digital
24/7
Bluetooth
Agnostic app for
individual's device
Low- Profile low cost
On duty Off duty

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14 Case Number:2016-0444
Total Exposure Health Exposure Indices

IEHRP:
Individual
Exposure Indices
Our Exposures

Our Unique Genetic Proclivity

Our Clinical Disposition

15
11/4/2017 Cleared for Public Release, SAF/PA Case Number:2016-0444
Exposure Index can have many variables

Medical History

Genetics Faimly History

Diagnostics Occupation

Environment Lifestyle

Sensors and
Mobile Data

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 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

 TEH WRAP-UP

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Collectively we can:

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

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 QUESTIONS?

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