ONTOLOGY CREATION FOR A WELLNESS PARADIGM

BYDR. MOLLY MALOOF MD

WHAT IS AN ONTOLOGY?

• EXPLICIT, FORMAL SPECIFICATION OF A SHARED CONCEPTUALIZATION OF A PARTICULAR DOMAIN OF DISCOURSE.

• A THESAURUS OF WORDS AND INFERENCE RULES THAT OPERATE ON THE RELATIONSHIPS OF WORDS

• WE HAVE ROBUST ILLNESS ONTOLOGIES• SNOMED, MESH, OBO FOUNDRY, GENE ONTOLOGY, UMLS, ICD, ICPC, ICF

WHY DO WE NEED ONTOLOGIES?

• THEY LIMIT COMPLEXITY• THE ORGANIZE INFORMATION• THEY HELP WITH INFORMATION RETRIEVAL • THEY ALLOW DOMAIN KNOWLEDGE SHARING• THEY ALLOW KNOWLEDGE INTEGRATION• THEY CAN BE APPLIED TO PROBLEM SOLVING…

OUR GREATEST PROBLEM: DIETARY RISKS

US Burden of Disease Collaborators, JAMA 2013

HEALTH CARE IS BASED ON THE PATHOGENIC PARADIGM

• ILLNESS ONTOLOGIES ARE USED TO SATISFY THE NEEDS OF ORGANIZATION-CENTRIC HEALTHCARE.

• THEY SERVE THE HEALTH CARE PROVIDERS AND INSURANCE COMPANIES• TRAINING IS FOCUSED ON DISEASE• PAYMENTS ARE FOCUSED ON DISEASE CODING • TREATMENTS ARE FOCUSED ON DRUGS AND SURGICAL PROCEDURES CODING

• DISEASE IS WHAT THE SYSTEM PAYS FOR.• THE SYSTEM IS DESIGNED TO PERPETUATE THE SYSTEM, NOT TO BRING INDIVIDUALS TO A GREATER

STATE OF HEALTH.• THE SYSTEM DOES NOT PAY FOR HEALTHY, NOURISHING FOOD (YET).

YET WHEN YOU LOOK UP “WELLNESS” IN MESH

• YOU GET THE WORD “HEALTH” AND, IF YOU LOOK UP THE WHO DEFINITION OF HEALTH, IT SAYS, “HEALTH IS A STATE OF COMPLETE PHYSICAL, MENTAL AND SOCIAL WELL-BEING, AND NOT MERELY THE ABSENCE OF DISEASE AND INFIRMARY.”

LET’S GO BACK 200 YEARS

• HISTORICALLY, THE ROOTS OF WELLNESS MAY BE TRACED BACK TO THE EARLY TEACHINGS OF THE TWO DAUGHTERS OF AESCULAPIAS, THE ANCIENT GREEK GOD OF HEALING. • THE FIRST, PANACEA, BELIEVED THAT TREATING EXISTING ILLNESS WAS THE WAY

TO PROMOTE HEALING. • HYGEIA, ON THE OTHER HAND, BELIEVED THAT WE SHOULD TEACH POSITIVE

WAYS OF LIVING TO HELP PREVENT ILLNESS.

Meyers, J and Sweeney T. “Wellness in Counseling: An Overview” (2007)

WHY IS THERE SUCH A FOCUS ON DISEASE?

• EMPIRICISM AND SCIENCE: MEDICINE IS ORIENTED TOWARD BIOLOGICAL APPROACH AND AWAY FROM SUPERSTITION (ROHMAN 2002:180).1

• “WHY IS IT THAT DOCTOR’S AND NURSES AND HEALTH WORKERS SO FREQUENTLY FORGET THE MEANING OF THIS DEFINITION? FOR, EVEN WHILE THEY QUOTE THE WORDS, THEY TEND TO FOCUS UPON DISEASE, DISABILITY, AND DEATH, TO EXCLUSION OF THESE OTHER FACTORS. PERHAPS IT IS BECAUSE THEIR TRAINING HAS BEEN ORIENTED TOWARDS DISEASE RATHER THAN TOWARD POSITIVE WELLNESS; AND THEREFORE FIND DISEASE MORE INTERESTING THAN WELLNESS. ALSO, IT’S EASIER TO FIGHT AGAINST SICKNESS THAN TO FIGHT FOR A CONDITION OF GREATER WELLNESS. AFTER ALL, PEOPLE—THEIR PATIENTS—WANT TO GET WELL; THAT IS, THEY WANT TO BE FREE FROM SICKNESS. YET WHEN THEY ARE FREE FROM SICKNESS, THESE SAME PEOPLE ARE RARELY INTERESTED IN BECOMING MORE WELL.”

• ~HALBERT DUNN, HIGH LEVEL WELLNESS (1961)

THOUGHT EXPERIMENTS

• WHAT WOULD THE WORLD LOOK LIKE IF WE INVESTED HALF OF WHAT WE SPEND ON SICK CARE ON OPTIMIZING THE HEALTH OF OUR CITIZENS?

• WHAT WOULD THE WORLD LOOK LIKE IF WE TOOK THE MARKETING BUDGETS OF BIG PHARMA AND INVESTED THEM INTO MARKETING FRUITS AND VEGETABLES?

A PARADIGM SHIFT IS HAPPENING• P4 MEDICINE: PERSONALIZATION, PARTICIPATION, PREDICTION, PREVENTION

c/o: Nathan Price

WEARABLE COMPUTING • PERVASIVE

COMPUTING TECHNOLOGIES ARE ENABLING US TO COLLECT A LOT OF DATA – ANYTIME, ANYWHERE.

• BUT, THERE IS STILL A LOT WE DO NOT KNOW ABOUT HOW TO GET TO OPTIMAL HEALTH.

• DECENTRALIZATION: MOVING HEALTHCARE OUTSIDE THE HOSPITAL ENVIRONMENT

• PEOPLE MANAGING THEIR PERSONAL HEALTH AND WELLNESS OUTSIDE OF THE PROVIDER NETWORK.

WHY WE NEED A WELLNESS ONTOLOGY:

• TO CLASSIFY AN INDIVIDUAL’S LEVEL OF VITALITY, THRIVING AND WELLBEING, SKILLS ASSOCIATED WITH WELLNESS, AND HIGHER FUNCTIONING.• TO COME TO A CONSENSUS REGARDING WHAT PERSONAL WELLNESS ACTUALLY IS AND ITS COMPONENTS.

• TO IDENTIFY EMPIRICAL CORRELATES OF HEALTH, QUALITY OF LIFE, AND LONGEVITY.• TO CREATE DEVELOP TECHNOLOGY-BASED SOLUTIONS TO IMPORTANT AND RELEVANT HEALTH AND BUSINESS

PROBLEMS.• ON THE SOCIAL LEVEL: FOR POLICY, EDUCATION, OUTCOME EVALUATION, ENVIRONMENTAL

ASSESSMENT, RESOURCE PLANNING & DEVELOPING, FOR ACCOUNTABLE AND VALUE BASED CARE HEALTH CARE MODELS.

• ON THE INDIVIDUAL LEVEL: FOR GOAL SETTING, ASSESSMENT, SELF-EVALUATION, INTERVENTIONS, COMMUNICATION

LET’S DEFINE WHAT WELLNESS IS• THE DEFINITION OF WELLNESS ACCORDING TO MYERS, SWEENEY, AND WITMER (2000):

• “A WAY OF LIFE ORIENTED TOWARD OPTIMAL HEALTH AND WELL-BEING, IN WHICH BODY, MIND, AND SPIRIT ARE INTEGRATED BY THE INDIVIDUAL TO LIVE LIFE MORE FULLY WITHIN THE HUMAN AND NATURAL COMMUNITY. IDEALLY, IT IS THE OPTIMUM STATE OF HEALTH AND WELL-BEING THAT EACH INDIVIDUAL IS CAPABLE OF ACHIEVING. (P. 252)

• PENDER ET AL. (2002) DEFINED HEALTH AND WELL-BEING AS: • “ACTUALIZATION OF INHERENT AND ACQUIRED HUMAN POTENTIAL THROUGH GOAL

DIRECTED BEHAVIOR, COMPETENT SELF-CARE, AND SATISFYING RELATIONSHIPS WITH OTHERS, WHILE ADJUSTMENTS ARE MADE TO MAINTAIN STRUCTURAL INTEGRITY AND HARMONY WITH RELEVANT ENVIRONMENTS.”

• IN SHORT: IT’S BOTH THE JOURNEY AND THE DESTINATION -- IN THE OPPOSITE DIRECTION OF ILLNESS.

WHERE DOES WELLNESS LEAD US?• VITALITY, THRIVING, SELF-ACTUALIZATION• PEOPLE HAVING MORE OF THEIR NEEDS MET (MASLOW’S HIERARCHY OF NEEDS).• DEVELOPING THE POSITIVE ASPECTS AND STRENGTHS OF HUMAN BEHAVIOR.

• GREATER ADAPTABILITY, SELF-MANAGEMENT, AND RESILIENCE WHEN FACED WITH LIFE STRESS.• LESS DISEASE, DYSFUNCTION, AND DISABILITY.• OPTIMAL INDIVIDUALIZED FITNESS SO THAT ONE LIVES A FULL, CREATIVE LIFE (GOLDSMITH,

1972).• BEING ABLE TO FEEL GOOD DURING A LIFE OF MOBILITY, ENJOYMENT, AND SOCIAL

RELATIONSHIPS (BRESLOW, 1999)

WHERE DO WE BEGIN IN CREATING A WELLNESS ONTOLOGY?

• LOOK AT EXISTING WELLNESS RESEARCH • LOOK AT EXITING ILLNESS ONTOLOGY SYSTEMS• CREATE A THESAURUS AND MAP THE RELATIONSHIPS• COME UP WITH A NEW META-MODEL

• SOME EXITING WELLNESS ONTOLOGY SYSTEMS & META-MODELS MAPPING THE RELATIONSHIPS

Context-aware and Trust-based Personal Wellness Information Framework for Pervasive Health

WE WILL HAVE TO BUILD MANY ONTOLOGIES

• THE ACTIVITY ONTOLOGY CONTAIN INFORMATION ABOUT THE EXERCISE TYPE, DURATION, INTENSITY ETC. THE ENTRIES MAY ALSO INCLUDE SETS OF MEASUREMENTS, SUCH AS THE HEART BEAT RATE.

• THE NUTRITION ONTOLOGY DESCRIBES THE NUTRITIONAL VALUES OF MEALS AND FOOD. IT ALSO CONTAINS CLASSES REFERRING TO THE NUTRITION SCHEDULE OF INDIVIDUAL USERS. IT IS BASED ON AN ONTOLOGY CREATED IN THE IST/PIPS PROJECT [13] AND ENRICHED WITH ADDITIONAL NUTRITION CHARACTERISTICS.

• THE WEIGHT ONTOLOGY DESCRIBES ENTRIES AND GOALS RELATED TO WEIGHT MANAGEMENT. IT IS USED FOR COLLECTING WEIGHT MEASUREMENT VALUES. IT ALSO CONTAINS CLASSES OF WEIGHT FOR DIFFERENT AGES AND GENDERS, E.G. MALE MIDDLE AGE IDEAL WEIGHT AS A FUNCTION OF HEIGHT.

• THE SLEEP ONTOLOGY AND THE STRESS ONTOLOGY DESCRIBE PARAMETERS OF SLEEP AND STRESS INCLUDING QUALITY MEASUREMENTS, MEDICAL CONDITIONS AND DISORDERS.

• THE RISK ONTOLOGY DESCRIBES INFORMATION ABOUT "BAD HABITS", SUCH AS SMOKING AND ALCOHOL CONSUMPTION. IT IS USED FOR MONITORING AND SETTING GOALS.

• THE PERSONAL ONTOLOGY DESCRIBES THE INFORMATION STORED FOR ONE INDIVIDUAL. IT INCLUDES PERSONAL CHARACTERISTICS (WEIGHT, HEIGHT, GENDER, WORK, PREFERENCES), THE GOALS SET BY THE INDIVIDUAL CONCERNING HIS/HER HEALTH AND RECOMMENDATIONS SET BY THE HEALTH SPECIALISTS.

• THE CONTEXT ONTOLOGY DESCRIBES POSSIBLE CONTEXT PARAMETERS OF THE ENVIRONMENT OF THE INDIVIDUALS (HOME, WORK, TRAVEL ETC.). THIS KIND OF INFORMATION IS IMPORTANT IN THE DATA ANALYSIS PHASE. FOR EXAMPLE, THE INFORMATION ABOUT A TRAVEL CAN EXPLAIN A PERIOD WITH MISSING ACTIVITY ENTRIES OR A CHANGE IN SLEEPING TIMES.

• THE EVENT ONTOLOGY DEFINES ANY RELEVANT EVENT NOT COVERED BY THE OTHER ONTOLOGIES. THIS COULD BE A VISIT TO THE DOCTOR OR DISCUSSION WITH PERSONAL TRAINER. THERE MAY ALSO BE A REFERENCE TO RELATED INFORMATION, SUCH AS CLINICAL DOCUMENTS.

• THE SOURCE ONTOLOGY DESCRIBES THE DEVICES USED FOR THE MEASUREMENTS INCLUDING INFORMATION ABOUT THE CAPABILITIES AND SPECIFICATIONS OF EACH DEVICE. THE SOURCE ONTOLOGY IS REFERRED BY THE OTHER DOMAIN ONTOLOGIES IN CASES WHEN A SPECIFIC DEVICE IS USED E.G. FOR PROVIDING MONITORING DATA

Ontology-Based Approach for Managing Personal Health and Wellness Information