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Healthy Living Personal Wellness Profiler™: Purpose 3

An article in conclusion calendar week inwards ZDNet Healthcare, titled my recent posts about our Personal Health Profiler™ (PHPro) system. It describes the PHPro equally a spreadsheet-based scheme inwards which “data is nested hence y'all tin forcefulness out drill into the detail. Links together with databases tin forcefulness out live added automatically hence that when someone clicks on a status the information says they have, they acquire existent advice on what to do. … The finish [is] to link personal information to actionable information hence y'all acquire a better-informed wellness consumer.” That’s true.

The article together with hence goes on to tell that a major deviation betwixt the PHPro together with electrical flow 24-hour interval personal wellness records (PHRs) is that nosotros build the PHPro “from the bottom-up, rather than the top-down” and, historically, “…top-down solutions ordinarily acquire built-out first, because there’s motivation to build them. And bottom-up solutions challenge them later.” While 1 could debate that the PHPro came initiative of all (since its evolution began over ii decades ago), this notion of a top-down/bottom-distinction caught my attention.

Top-Down / Bottom-Up

According to Wikipedia: “Top-down together with bottom-up are strategies of information processing together with knowledge ordering, generally involving software … Influenza A virus subtype H5N1 top-down approach is essentially breaking downward a scheme to gain insight into its compositional sub-systems…[that are] together with hence refined inwards even hence greater detail…until the entire specification is reduced to base of operations elements. … Influenza A virus subtype H5N1 bottom-up approach is essentially piecing together systems to give ascent to grander systems. … In a bottom-up approach the private base of operations elements of the scheme are initiative of all specified inwards keen detail. These elements are together with hence linked together to course of study larger subsystems, which together with hence inwards plough are linked, sometimes inwards many levels, until a consummate top-level scheme is formed. This strategy oftentimes resembles a ‘seed’ model, whereby the beginnings are small-scale but eventually grow inwards complexity together with completeness.”

Based on these definitions, a top-down approach to PHR evolution focuses on defining the principal components of the overall scheme together with and hence defining the smaller parts needed to acquire inwards work. Influenza A virus subtype H5N1 convenient way to exercise this is past times examining existing top-down PHRs (and fifty-fifty electronic medical records) to decide what information are typically collected, what user interfaces are typically used, what types of reports are typically generated, what technology standards are typically followed, etc. Differentiating 1 PHR from some other tin forcefulness out live done past times making modifications to for certain parts. The final result is that all top-down PHRs closely resemble each other together with evolve gradually over fourth dimension through serial of relatively tike changes. In other words, they are “continuous” (“non-disruptive”) technologies offering small-scale incremental improvements to the status quo.

Influenza A virus subtype H5N1 bottom-up approach to PHR development, inwards contrast, is a procedure focusing on defining the fine details first, together with and hence edifice upwards from those details to exercise the consummate system. For me, the bottom-up procedure went something similar this:
  • The initiative of all affair nosotros did was to research, define, organize (categorize), together with compile lists of information probable to live necessary for agreement understanding the whole person fully. I reasoned this would live an ongoing procedure since these lists would conduct hold to evolve considerably over fourth dimension equally wellness scientific discipline generated novel knowledge together with healthcare professionals across all healthcare disciplines provided their input. That is, before architecting the PHPro’s technology, I wanted to live for certain that whatever the technology would ultimately be, it must live able to:
    • Collect every possible slice of information that could aid gain deeper knowledge together with agreement of how a person’s take heed (psychology), trunk (physiology), together with surroundings (both social together with physical surroundings) interact together with comport on one’s physical together with mental/emotional wellness together with wellbeing. The biggest challenge here, past times the way, was inwards the defining the information required for comprehending a person’s psychosocial together with mind-body functioning, since agreement a person’s thoughts, emotions, behaviors, social interactions, together with environmental influences--and how this all relates to one’s biological scientific discipline together with physical health--requires a keen bargain to a greater extent than information than focusing solely on agreement a special medical condition.
    • Enable people to gain together with utilization this knowledge together with agreement to aid foreclose together with care for biomedical, psychological, together with mind-body problems.

  • As these lists evolved, nosotros began determining how best to introduce this information, through interactive reports, inwards ways that growth awareness together with understanding, together with aid back upwards decisions. We reasoned that in that place would conduct hold to live a broad diversity of reports, each focused on the knowledge needs together with conclusion needs of people amongst dissimilar roles together with responsibilities. That’s because the knowledge needs of people trying to empathize together with have back upwards for dealing amongst an existing wellness occupation or personal life crisis differ significantly from what dissimilar healthcare professional person needs. In other words, in that place are large differences inwards the information needed past times a consumer interested inwards self-help for a stressful life event, a individual who is working amongst a wellness coach for aid managing a chronic status through lifestyle change, a patient looking for guidance inwards deciding on the best handling choice for a medical problem, a primary aid physician trying to coordinate a patient’s care, a medical specialist (e.g., cardiologist or oncologist) treating a special physical condition, a mental wellness professional person treating a behavioral problem, etc. Thus, the reports generated past times the PHPro would conduct hold to come upwards inwards a broad diversity of types that would conduct hold to evolve considerably over time.
  • As the reports were beingness defined, nosotros began developing technical software processes for collecting, storing together with distributing the information inwards a secure together with cost-effective manner, together with for generating the reports described above.
One affair this bottom-up approach taught me early is that the information collected, reports generated, together with technical methods used must live able to evolve continually equally wellness knowledge grows, novel technologies emerge, together with standards change. That meant the PHP had to live a real flexible together with adaptive system.

Furthermore, since I began this procedure inwards 1981, in that place was no Internet, the initiative of all personal computers were just coming to market, together with it was decades before the ideas of a PHR was fifty-fifty beingness discussed inwards the healthcare industry. That meant nosotros had to uncovering an master copy way to build the PHPro. It also meant that nosotros had to respect a real cost-efficient way to operate the scheme since, dorsum then, estimator memory, speed together with information storage capacity were tiny compared to today.

Having been intrigued past times spreadsheet’s power, efficiency, ease-of-use, together with “plasticity” (like molding clay into dissimilar forms), nosotros began edifice the PHPro using spreadsheets inwards unique ways.

Disruptive Innovation

I've referred to the PHPro equally a technology">“discontinuous/disruptive” innovation, This agency it uses a radically dissimilar technological approach to developing personal wellness records, compared to existing dominant technologies or status quo products inwards a market. Unfortunately, disruptive innovations oftentimes choke unnoticed, or they are ignored for many years. When they are finally recognized, businesses amongst a stake inwards maintaining conventional technologies tend to run across them equally threats together with attempt to lock them out of the market. In fact, my thought of using spreadsheets equally the foundation of a PHR application has been ridiculed together with dismissed past times conventional software developers inwards the past. This could live because they don’t realize how spreadsheets tin forcefulness out live used inwards novel ways, they are fearful they mightiness lose describe organisation to a simpler together with less expensive technology, they don’t desire to larn a novel of developing software, or for other such reasons.

Nevertheless, I’ve persisted … together with here’s why …

Why Spreadsheets?

There are many huge advantages to using the spreadsheet for PHRs together with other wellness information technologies, equally long equally y'all know how to handgrip the challenges. Spreadsheets, after all, conduct hold been around for decades, making them 1 of most audio together with company software always created. They are efficient, low-cost, easy-to-use, together with infinitely flexible (i.e., they tin forcefulness out live molded into unlimited types of applications). In addition, spreadsheets conduct hold powerful information collection together with sharing, computation, model-building, reporting, together with automation capabilities. In other words, they offering a quick together with slow way to obtain, organize, synthesize, analyze, evaluate, distribute, together with display information.
On the downward side, spreadsheets must live examined together with controlled inwards lodge to foreclose errors together with unauthorized changes. The PHPro does all this inwards innovative ways.

One affair most people neglect to realize is that a spreadsheet is much to a greater extent than than just a large electronic grid amongst charts. The truth is, a spreadsheet application has 3 major components:
  • One element is its electronic user forms that enable a individual to input information manually, displaying it, together with update it.
  • A minute element is its code modules (“macros”), which automate processes for such things as:
    • Obtaining information from databases (i.e., running “queries”) together with sending information to databases
    • Extracting information from information streams (transmitted packets of data), from XML documents, together with from other text-based files using custom “parsing” modules
    • Performing computations
    • Formatting (“rendering”) information for presentation
    • Transmitting information over the Internet (e.g., using encrypted email attachments)
    • Connecting to other software applications
    • and more.
  • The tertiary element is its sheets (grids) of interconnected spreadsheet cells that piece of work inwards conjunction amongst the code (macro) modules. Influenza A virus subtype H5N1 spreadsheet jail cellular telephone is an electronic “container” that stores, uses together with displays numbers, text (up to 10 pages worth), pictures, hyperlinks (to documents together with the spider web sites), mathematical together with logical formulas, together with more. In addition, the contents of whatever cells tin forcefulness out live copied, shared, moved, sorted together with filtered, hidden or displayed, together with formatted inwards many dissimilar ways (e.g., the color, type together with size of the text together with numbers inwards a jail cellular telephone tin forcefulness out live set, equally tin forcefulness out the color together with style of a cell’s interior together with borders).
These cells together with code modules brand spreadsheets splendid vehicles for developing robust wellness information applications from the bottom up, equally I push clit next.

Examples of how the PHPro uses Spreadsheets inwards Novel Ways

To exemplify what I’ve just written close spreadsheets, next are 4 groups of covert shots showing how the PHPro uses spreadsheet forms, grids together with modules inwards innovative ways that deliver a unique arrive at of capabilities together with benefits. They explicate these processes:
  1. Data Definition together with collection
  2. Data organisation together with analysis
  3. Information storage together with sharing
  4. Report generation.
1. First comes information Definition together with collection. As I said earlier, when I started developing the PHPro, my finish was to exercise a software application able to care every slice of relevant information over people’s lifetimes. This information would conduct hold the potential to aid consumers/patients together with their healthcare professionals prepare a total together with deep agreement of the person’s strengths, weaknesses, risks, problems, wellness trends (changes over time) together with preferences, equally good equally the suitable options for prevention together with treatment. I also wanted the information to live “self-actionable” past times providing instruction, insight & guidance together with warnings & alerts, which would promote a meliorate character of life past times motivating together with enabling the individual to aid him/herself bargain amongst physical, emotional together with behavioral concerns.

To attain this monumental task, I spent many years researching the healthcare literature together with examining wellness questionnaires. During this process, I built “evergreen” (continually evolving) spreadsheet grids containing lists of questions to live answered past times a consumer/patient, equally good equally past times healthcare professionals. The PHPro was together with hence designed to care people’s answers to these questions, along amongst information obtained from databases, spider web sites, information streams together with electronic documents (including XML files). Figure 1 (below) shows a small-scale department of 1 of the PHPro’s Question Grids.

This bottom-up path led to the innovation of my patented CP Split™ technology together with other “discontinuous/disruptive” innovations, which became telephone commutation components of the PHPro.
An article in conclusion calendar week inwards ZDNet Healthcare Healthy Living Personal Health Profiler™: Part 3
Figure 1 (click to enlarge)
Referring to Figure 1:
  • Column Influenza A virus subtype H5N1 contains a unique ID issue for each question.
  • Columns B, D together with eastward are used to command the branching logic (when the response to 1 query determines the subsequent query to live presented).
  • Column C is a symbol that identifies the response scale to utilization (e.g., Yes-No, Yes-No-Uncertain, select 1 item from a list, select multiple items from a list, utilization a 1-9 scale, travel into unstructured text, etc.)
  • Column F contains the text for each question.
  • Starting inwards column G together with going to the correct are the items a individual may select inwards response to the question.
For example, on row 180, the symbol inwards column C designates a 9-point scale, amongst “NOT AT ALL” on 1 cease (as indicated inwards column G) together with “A GREAT DEAL” on 1 cease (as indicated inwards column H). The “BRL” inwards column B, the issue 4 inwards column E, together with the ID issue inwards column D, all learn the software to branch (jump to) query “103 01 twenty 10” if the individual response is less than 4 (on the 1-9 scale). Note that some of the cells are colored, which gives developers a visual depiction of the types of content inwards those cells.

Figure 2 (below) shows a serial of covert shot depicting a type of user course of study the PHP scheme uses for manual information input. Macros automate the procedure past times which the forms read the Question Grid to a higher house together with introduce the questions together with response options to the person; they also collect together with shop the person’s responses.

An article in conclusion calendar week inwards ZDNet Healthcare Healthy Living Personal Health Profiler™: Part 3
Figure 2 (click to enlarge)

As amongst all the PHPro components, this patented information collection procedure is real flexible:
  • New questions are added past times just inserting them equally novel rows into the Question Grid
  • Questions are modified past times typing the changes into the Question Grid (and adjusting the ID issue accordingly)
  • Questions are removed past times deleting their corresponding rows from the Question Grid.
Note that alone novel Question Grids tin forcefulness out live constructed at whatever fourth dimension inwards the same manner. In fact, entire libraries of Question Grids tin forcefulness out live developed for utilization past times people amongst dissimilar roles together with inwards dissimilar situations.

In whatever case, equally the questions are answered, the PHPro automatically stores person’s responses inwards a listing containing the query ID (in a jail cellular telephone of column A) together with the person’s response adjacent to it (in column B)—which comprise the “raw data” —as shown inwards Figure 3 (below). Note that information non manually entered (e.g., information queried from databases, extracted from documents, or streamed from medical devices) tin forcefulness out live added automatically to the manually input information using custom macros.

An article in conclusion calendar week inwards ZDNet Healthcare Healthy Living Personal Health Profiler™: Part 3
Figure 3 (click to enlarge)

2. Next comes information organisation together with analysis. Once the raw information are collected, the PHPro uses some other spreadsheet grid—the Publisher Spreadsheet Grid shown inwards Figure 4 (below)—whose cells contain an assortment of formulas (which are non visible inwards the covert shot). Influenza A virus subtype H5N1 portion of the Publisher Spreadsheet Grid is which, along amongst its macros, automatically transform the raw information into structured information gear upwards for study writing. Most of the rules (algorithms) for analyzing the information are included inwards this spreadsheet together with others to which it is linked. These rules may contain criteria identifying when for certain information betoken the existence of a wellness occupation (e.g., when a lab examine is abnormal, when someone’s emotional or dry ground or cognitions reflects a serious psychological concern, when a reported symptom may live due to an adverse medication side-effect, etc.).

Since this involves technical spreadsheet model-building, I’m non going to conduct hold the fourth dimension to explicate what just is inwards this spreadsheet. Suffice to tell that the information inwards this publisher spreadsheet are organized together with calculated inwards a predefined way that corresponds to the PHP reports.

An article in conclusion calendar week inwards ZDNet Healthcare Healthy Living Personal Health Profiler™: Part 3
Figure 4 (click to enlarge)

3. Then the contents of the Publisher Spreadsheet Grid are stored together with shared. The contents of the Publisher Spreadsheet Grid are at 1 time stored inwards some other file, without whatever macros, formulas or formats. Influenza A virus subtype H5N1 department of the stored grid, which is called a “Content File,” is shown inwards Figure v (below). The Content File (which tin forcefulness out live converted easily to a delimited text file) is encrypted to protect the information inside. It tin forcefulness out retrieved at whatever fourth dimension the information needs to live updated, together with whenever the individual wants to persuasion their information. And if they want, people tin forcefulness out portion whatever portions of of their Content File amongst individuals they authorize.
Note that the Content File tin forcefulness out live saved inwards whatever place the individual wants together with its safety is compliant amongst HIPPA regulations. This addresses a concern raised inwards a recent NY Times article, titled “Warning on Storage of Health Records”. The article discusses how the benefits of personal wellness records stored inwards Web-based databases is offset past times concerns close adventure to privacy. One way to diminish this adventure is past times putting wellness records straight inwards hands of the private to whom they belong; that way individuals conduct hold consummate command over who (if anyone) gets to run across their personal information. The PHPro Content Files enable such protection.

An article in conclusion calendar week inwards ZDNet Healthcare Healthy Living Personal Health Profiler™: Part 3
Figure v (click to enlarge)

4. Now comes study generation. Figure vi (below) portrays a slice of the PHPro report, which I discussed inwards my initial post on the topic. Only this fourth dimension I’m showing columns B through F, which are hidden inwards the actual report.

An article in conclusion calendar week inwards ZDNet Healthcare Healthy Living Personal Health Profiler™: Part 3
Figure vi (click to enlarge)

The cells inwards these columns contain numeric information that conduct hold been extracted from the PHPro Content File (described above). Other cells utilization these information to decide what rows should live visible together with how the information should live displayed. For example, the serial of blueish boxes inwards cells K352 together with K380, which betoken the amount of distress the individual experiences inwards ii situations, are created past times a formula inwards those cells that utilization information inwards column eastward to decide the issue of boxes to display.
Influenza A virus subtype H5N1 few other things close using spreadsheets for the PHPro reports:
  • In improver to numbers, text together with symbols, a PHPro study tin forcefulness out contain multiple images (including pictures together with charts).
  • A study tin forcefulness out contain buttons together with links that automatically recollect together with display external information from the Web, equally good equally from electronic documents stored inwards a person’s ain estimator or inwards other computers via networks.
  • Changing a study is similar to modifying the Questions Spreadsheet Grid: Add rows, delete rows, together with alter the words, formulas together with formats of whatever cells inwards whatever rows. Influenza A virus subtype H5N1 broad diversity of charts (graphs) tin forcefulness out also live easily added together with removed.
Web-Enabling the PHPro

The PHPro was originally built equally a stand-alone desktop application. We are at 1 time inwards the procedure of making inwards web-enabled equally well, hence anyone amongst a browser together with Internet connecter tin forcefulness out utilization it. I volition conduct hold to a greater extent than to tell close this inwards time to come posts.

Fertilizing the Seed

The quote from the ZDNet article at the starting fourth dimension of this post included the tilt that the bottom-up strategy oftentimes resembles a “seed” model inwards which an application’s small-scale starting fourth dimension eventually grows inwards complexity together with completeness. This requires that the “seed” live nourished (fertilized). The PHPro is designed to grow together with evolve continually through a collaborative procedure inwards which consumers/patients, sick-care together with well-care professionals, enquiry scientists, educators, software developers together with others supply ideas together with content that are incorporated into the system. Because it is built amongst highly efficient together with flexible spreadsheets, uses a library of categorized information definitions (similar to a mass libraries Dewey Decimal system), has a modular structure, together with tin forcefulness out interoperate amongst most (all?) other software system, the PHPro is able to molded together with expanded into ever-more-powerful knowledge tools that are tailored to the needs of just close anyone. And best of all, this tin forcefulness out live done for lilliputian toll together with amongst lilliputian hassle, which is an of import consideration inwards today’s hard economical climate.

My promise is that these posts volition aid motivate people from all groups to bring together our squad of collaborators together with grow the seed we’ve been nourishing into a complete, diversified personal wellness knowledge scheme that has a positive impact on the wellness together with wellbeing of all people.

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