Public Health Informatics:

Opportunity in an Era of Change

Public Health Informatics Conference

Atlanta, Georgia
M-J. Sepúlveda, MD FACP
April 29, 2014
IBM Fellow & Vice President

0 © 2009 IBM Corporation

Transformation is accelerating in societies driven by
economic, demographic, technological,
environmental and legislative forces.

Cities Big Data Cognitive Computing

Information Readiness and Analytics

Business and Government Structure Modernization

1 © 2009 IBM Corporation

2005

Photo:
© 2009 IBM Luca Bruno / AP
Corporation
2013

© 2009 Photo: Michael Sohn / AP

IBM Corporation
 2008

4 © 2009 IBM Corporation

 2014

Photo: Reuters
© 2009 IBM Corporation
5 IBM Confidential
1990

© 2009 IBM Corporation

2010

© 2009 IBM Corporation

Urban and rural populations by development
group, 1950-2050

Global Rural to Less Developed

Urban Transition Rural to Urban Transition

Less Developed Rural

More Developed Urban

Less Developed Urban
More Developed Rural

© 2009 IBM Corporation

Cities are focal points of economic activity
Top cities act as economic activity
 48% Global GDP in hubs
2012 from top 300 cities with (Size of the bubble – ratio of city share of national GDP
to its share of national population, 2009)
19% worldwide population.

City share of country population, %

30 Lisbon
Sydney
 Talent Cities contain an %Pop”n = % GDP Mexico

increasingly large share of the 20 Seoul

Paris
world's highly skilled,
Brussels
educated, and entrepreneurial
population 10 Cape Town
Beijing Johannesburg
New
 Innovation Cities support Delhi Shanghai
0
large-scale business networks -5 5 15 25 35 45 55
that absorb and extend Bangalore
Guangzhou
innovation
-10

Source: UN Habitat 2010, and IBM Global Center for Economics Development analysis
City share of country GDP, %
9 © 2009 IBM Corporation
Current programs, agencies & transactions in
health and social services are not sustainable
Government and
CBO’s Agency Administration
Early Government
Intervention Agencies
Adult Child Urban Planning
Protection Care
Law Public Safety
Medical Enforcement
Assistance
Planning and
Food Healthcare
Management
Income
Abuse Assistance Providers
Neglect Financial
Environmental
Foster Care Health
Counseling Child SOCIAL Human
LIFE EVENTS NEEDS Services
FAMILY
ENTERPRISES
Marriage
Loss of Job
Safety
Social Infrastructure
Substance Abuse Education Juvenile Energy
Injury Justice Courts and Health and Water
Shelter

Child
Support Education
Providers
Workers Employme Education Transportation
Comp. nt
Unemployment Managem Advocacy
Insurance ent Groups
Employers

10 © 2009 IBM Corporation

 State and Local
Public Welfare and Health Costs
2012
$721B

Municipal
States
Governments
$541B
$180B

11 © 2009 IBM Corporation

 Local governments debt ridden

DTR
Debt to Revenue
Ratio

Revenue Debt
$1.67 Trillion $1.75 Trillion

DTR = 1.1 DTR >1

All Local Governments All Local Governments

$1.75 Trillion in 19 states
$0.6-$93.6 Billion

12
US 12
Census 2012 Annual Survey State Government © 2010 IBM Corporation
Municipal IT systems to manage, monitor processes,
Analyze, consolidate events and initiate responses!
Traffic & Transportation
 Multi-modal Mobility
 Traffic Prediction
 Smarter Parking
 Bus Arrival Prediction
 Fleet Optimization
 Data Integration
 Planning and Simulation
 Road User Charging
 Connected Car
 Electric Vehicle Mgmt
Analyze
Predictive Systems
Modelling &
Simulation
Archive
Standard-based
Interfaces
Domain specific
Interfaces
13
1 Water & Industrial 2 Public Safety & Fraud
 Water and Wastewater  Fusion Centers
 Flood Management  Fraud Analytics
 Utilities Grid Mgmt  Video Analytics
 Oil Platform Mgmt  Crime Information
 Usage Analytics  Predictive Policing
 Leak Detection  Border Security
 Contamination Mgmt  Emergency Response
 Predictive Maintenance  Terrorism
 Asset Management  Cyber Security
 Smart Metering
Intelligent Operations Center
Event Rules Semantic Models
Alarms KPI’s
Service Bus
Gateway Gateway Gateway Gateway
Public
Traffic Water
Safety
3 Planning & Operations 4 Stadiums & Events
 City Planning
 Airport Cockpit
 Smarter Retail Operation
 Integr Supply Chain Mgmt
 Investment Coordination
 Budget Management
 Business Licensing
 Social Programs
 Outcome Management
Workflows
Guidelines
Gateway
Buildings/
Energy
Stadiums
5
 Fan Experience
 Command Center
 Sales Optimization
 Physical Security
 Emergency Mgmt
 Sentiment Analysis
 Traffic and Crowd Flow
 Parking optimization
 Strategic Planning
Visualize
Dashboards
Alarming
Reports / Analysis
Visualization
Data-Integration
Weather / Citizens /
Taxes / Healthcare /
…
© 2011 IBM Corporation
 Intelligent Operations
Smarter Water
Mobility
Water & Wastewater

 Optimal way to destination

Flood prediction &
 Help citizens to avoid Emergency
incidents
 Awareness &
Water Infrastructure
recognition of critical
situations
Weather & External data
 Traffic and incident
management
 Predictive analytics
 Supervise traffic control Intelligent Transportation TOMOR
ROW

 Collaboration of PREDIC
Anticip
ate
TODA REAL TIVE and
concerned agencies Obse
Y
TIME
+ avoid

rve
MULTIMO +  Water quality
DAL
and
react
INTEGRATION & DATA PROCESSING  Conservation /leakage/flood
 Use and Waste
 Flood Management:
Road Taxis Bus / Tram / train
Electric Bikes Car parking Fret
traffic Coach vehicles
© 2011 IBM Corporation
Rio de Janeiro IOC

15 © 2009 IBM Corporation

Big Data
and Internet of Things

Volume Velocity Variety Veracity

Data at Rest Data in Motion Data in Many Forms Data in Doubt

16 © 2009 IBM Corporation

What can we do with big data for PH?
Surveillance
Response, Mobilization  Social media/
 Smart Grid management  Geospatial analysis
 Multimodal surveillance  Physical, Chemical, Biologic
 Real-time promotions  Climactic , Environmental
 Cyber security  Events, Incidents
 ICU monitoring  Risk Factors, Conditions
 Options trading  Epidemic early warning system
 Click-stream analysis  Video analysis
 CDR processing  Audio analysis
 IT log analysis
 RFID tracking & analysis
Discovery & Experimentation
Assessment ,  Surveillance
 Modeling and Simulation
Prediction, Forecasting  Sentiment analysis
 Transaction analysis to create insight-based  Scientific research
product/service offerings  Ad-hoc analysis
 Fraud modeling & detection  Model development
 Risk modeling & management  Hypothesis testing
 Social media/sentiment analysis  Transaction analysis to create insight-
 Environmental analysis Manage and Plan based product/service offerings
 Operational analytics – BI reporting
 Planning and forecasting analysis
 Predictive analysis

17 © 2009 IBM Corporation

4/6/201
Many Challenges

Leadership
Operations
Product and
Training Budgets
Skills Capacity Services Payment

Work
Pay Organization
Rewards Partnerships
People Process

Ethics
Performance Laws
Assessment Liabilities
Technology Culture Measurement

Supply Chain,
Communication Capital/Equipt.
Learning
Standards Improvement
Interoperability Collaboration
Privacy, Security Transparency

18 © 2009 IBM Corporation

Modified after P. Gabow MD; Ret. CEO Denver Health
Danah Boyd, 2010

“Bigger Data are Not Always Better Data”

“Not All Data are Created Equal”

“ “What and Why are Different Questions”

“Be Careful of Your Interpretations”

“Just Because It is Accessible Doesn’t Mean

Using It is Ethical”
http://www.danah.org/papers/talks/2010/WWW2010.html © 2009 IBM Corporation
PPP: Data for Development Challenge (D4D) 2012
 Sponsors: Orange, University of Leuven, MIT
 Objective: use massive data sets mobile phone to improve well-being populations
 Target: Cote D’Ivoire, 4 months; 4 data sets Orange mobile subscribers;
encouraged use other data sets; public, private research institutions
 Projects
– Tourism and events analysis: better organization, economic impacts.
– Population statistics: poverty maps with poverty/GDP development index
– Health improvement : correlating mobility with data on spread of disease,.
– Economic Indicators: correlating calling/mobility patterns with economic
activities
– Alerting/Preventing violence: violent events to improve population’s security
– Improving privacy: Exploring large data sets, crossing them to help improve the
knowledge on how to make better Safe open Data.

© 2009 IBM Corporation

 PPP: Smart Cities Dubuque Iowa

City in Motion: Making

sense of billions of telco Single & -domain
multi
Citizen Engagement
Spatio
-temporal & Social Analytics & Modeling
events in conjunction with Analytics
(Demand Models,& Modeling
Behavior Models, Platform: Coupling social
Information Management Insights)
transportation data profiles (Lotus Connections)
with Spatial data (IOC) in a 2-
Dynamic &
Static Data
Models way city-citizen
communication platform
Sensing Impacting
Impacting Supply
(Active & Passive Sensing) & Influencing
(Inform, Demand
Actuate, Respond, Control,
Influence)
(Inform, Actuate, Respond, Control,
Sensors, Cell Phones, People, Influence via Social Computing)

Smart Water Meter Smart Electric Meter

Analytics: Analyzing smart Analytics: Analyzing
meter data for leaks, smart meter data for
anomalies, and anomalies, and
consumption patterns consumption patterns and
sharing information
© 2009 IBM Corporation
4/6/201
Continuing evolution of computing: new “learning”
systems are required, ushering a new era of
computing
System
intelligence

Cognitive Systems Era

Programmable Computing Era

Search Discovery
Deterministic Probabilistic
Tabulating Systems Era Simple outputs Intelligent options
1

“Enterprise” data Big Data (i.e. 4 “V’s”)

Machine language Natural language

1900 1950 2011

. . . enabling new opportunities and outcomes

1

4V’s = Volume + Variety + Velocity + Voracity © 2009 IBM Corporation

Cognitive computing

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 Watson paths

24 © 2012 International Business Machines Corporation

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 Watson Oncology

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Big data challenges for cognitive computing

Volume:
storage
technologies

Computer Velocity:
architecture: analyzing
CPU centric data in motion

Veracity:
uncertainty,
data in doubt

© 2009 IBM Corporation

  Speed of change & data create great PH/PHI opportunities

 Culture of partnership outside PH/PHI needed, make it happen

 Multi-sectoral data literacy is essential for multi-sectoral collaboration

27 © 2010 IBM Corporation

Transformation is a journey

Digitize View and Exchange Derive value Healthy citizens in

information for exchange of population and intelligence healthy communities
relevant sectors multi-sectoral health-related to improve Smarter
Impacting health and health data within population Health Systems
related and between health outcomes
data via enterprises and curb costs
customizable
user interface
Population health value

Pop. health optimization

Population health systems analytics

Population health information exchange

Population health practitioner portal

Single view of the problem/case

IT optimization

Maturity over time

28 © 2009 IBM Corporation