Tuesday, April 22, 2008

Personal Health Profiler™: Part 3

An article last week in ZDNet Healthcare, titled Creating personal health record value from the bottom up, focused on my recent posts about our Personal Health Profiler™ (PHPro) system. It describes the PHPro as a spreadsheet-based system in which “data is nested so you can drill into the detail. Links and databases can be added automatically so that when someone clicks on a condition the data says they have, they get real advice on what to do. … The goal [is] to link personal data to actionable information so you become a better-informed health consumer.” That’s true.

The article then goes on to say that a major difference between the PHPro and current day personal health records (PHRs) is that we build the PHPro “from the bottom-up, rather than the top-down” and, historically, “…top-down solutions usually get built-out first, because there’s motivation to build them. And bottom-up solutions challenge them later.” While one could argue that the PHPro came first (since its development began over two decades ago), this notion of a top-down/bottom-distinction caught my attention.

Top-Down / Bottom-Up

According to Wikipedia: “Top-down and bottom-up are strategies of information processing and knowledge ordering, mostly involving software … A top-down approach is essentially breaking down a system to gain insight into its compositional sub-systems…[that are] then refined in yet greater detail…until the entire specification is reduced to base elements. … A bottom-up approach is essentially piecing together systems to give rise to grander systems. … In a bottom-up approach the individual base elements of the system are first specified in great detail. These elements are then linked together to form larger subsystems, which then in turn are linked, sometimes in many levels, until a complete top-level system is formed. This strategy often resembles a ‘seed’ model, whereby the beginnings are small but eventually grow in complexity and completeness.”

Based on these definitions, a top-down approach to PHR development focuses on defining the main components of the overall system and then defining the smaller parts needed to make it work. A convenient way to do this is by examining existing top-down PHRs (and even electronic medical records) to determine what data are typically collected, what user interfaces are typically used, what types of reports are typically generated, what technology standards are typically followed, etc. Differentiating one PHR from another can be done by making modifications to certain parts. The result is that all top-down PHRs closely resemble each other and evolve gradually over time through series of relatively minor changes. In other words, they are “continuous” (“non-disruptive”) technologies offering small incremental improvements to the status quo.

A bottom-up approach to PHR development, in contrast, is a process focusing on defining the fine details first, and then building up from those details to create the complete system. For me, the bottom-up process went something like this:
  • The first thing we did was to research, define, organize (categorize), and compile lists of data likely to be necessary for understanding understanding the whole person fully. I reasoned this would be an ongoing process since these lists would have to evolve considerably over time as health science generated new knowledge and healthcare professionals across all healthcare disciplines provided their input. That is, before architecting the PHPro’s technology, I wanted to be sure that whatever the technology would ultimately be, it must be able to:
    • Collect every possible piece of information that could help gain deeper knowledge and understanding of how a person’s mind (psychology), body (physiology), and environment (both social and physical surroundings) interact and affect one’s physical and mental/emotional health and wellbeing. The biggest challenge here, by the way, was in the defining the information required for comprehending a person’s psychosocial and mind-body functioning, since understanding a person’s thoughts, emotions, behaviors, social interactions, and environmental influences--and how this all relates to one’s biology and physical health--requires a great deal more information than focusing solely on understanding a particular medical condition.
    • Enable people to gain and use this knowledge and understanding to help prevent and treat biomedical, psychological, and mind-body problems.

  • As these lists evolved, we began determining how best to present this information, through interactive reports, in ways that increase awareness and understanding, and help support decisions. We reasoned that there would have to be a wide variety of reports, each focused on the knowledge needs and decision needs of people with different roles and responsibilities. That’s because the knowledge needs of people trying to understand and receive support for dealing with an existing health problem or personal life crisis differ significantly from what different healthcare professional needs. In other words, there are big differences in the information needed by a consumer interested in self-help for a stressful life event, a person who is working with a wellness coach for help managing a chronic condition through lifestyle change, a patient looking for guidance in deciding on the best treatment option for a medical problem, a primary care physician trying to coordinate a patient’s care, a medical specialist (e.g., cardiologist or oncologist) treating a particular physical condition, a mental health professional treating a behavioral problem, etc. Thus, the reports generated by the PHPro would have to come in a wide variety of types that would have to evolve considerably over time.
  • As the reports were being defined, we began developing technical software processes for collecting, storing and distributing the information in a secure and cost-effective manner, and for generating the reports described above.
One thing this bottom-up approach taught me early on is that the data collected, reports generated, and technical methods used must be able to evolve continually as health knowledge grows, new technologies emerge, and standards change. That meant the PHP had to be a very flexible and adaptive system.

Furthermore, since I began this process in 1981, there was no Internet, the first personal computers were just coming to market, and it was decades before the ideas of a PHR was even being discussed in the healthcare industry. That meant we had to discover an original way to build the PHPro. It also meant that we had to find a very cost-efficient way to operate the system since, back then, computer memory, speed and data storage capacity were tiny compared to today.

Having been intrigued by spreadsheet’s power, efficiency, ease-of-use, and “plasticity” (like molding clay into different forms), we began building the PHPro using spreadsheets in unique ways.

Disruptive Innovation

I've referred to the PHPro as a “discontinuous/disruptive” innovation, This means it uses a radically different technological approach to developing personal health records, compared to existing dominant technologies or status quo products in a market. Unfortunately, disruptive innovations often go unnoticed, or they are ignored for many years. When they are finally recognized, businesses with a stake in maintaining conventional technologies tend to see them as threats and try to lock them out of the market. In fact, my idea of using spreadsheets as the foundation of a PHR application has been ridiculed and dismissed by conventional software developers in the past. This could be because they don’t realize how spreadsheets can be used in novel ways, they are fearful they might lose business to a simpler and less expensive technology, they don’t want to learn a new of developing software, or for other such reasons.

Nevertheless, I’ve persisted … and here’s why …

Why Spreadsheets?

There are many huge advantages to using the spreadsheet for PHRs and other health information technologies, as long as you know how to handle the challenges. Spreadsheets, after all, have been around for decades, making them one of most sound and solid software ever created. They are efficient, low-cost, easy-to-use, and infinitely flexible (i.e., they can be molded into unlimited types of applications). In addition, spreadsheets have powerful data collection and sharing, computation, model-building, reporting, and automation capabilities. In other words, they offer a quick and easy way to obtain, organize, synthesize, analyze, evaluate, distribute, and display information.
On the down side, spreadsheets must be examined and controlled in order to prevent errors and unauthorized changes. The PHPro does all this in innovative ways.

One thing most people fail to realize is that a spreadsheet is much more than just a big electronic grid with charts. The truth is, a spreadsheet application has three major components:
  • One component is its electronic user forms that enable a person to input information manually, displaying it, and update it.
  • A second component is its code modules (“macros”), which automate processes for such things as:
    • Obtaining data from databases (i.e., running “queries”) and sending data to databases
    • Extracting data from data streams (transmitted packets of data), from XML documents, and 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 e-mail attachments)
    • Connecting to other software applications
    • and more.
  • The third component is its sheets (grids) of interconnected spreadsheet cells that work in conjunction with the code (macro) modules. A spreadsheet cell is an electronic “container” that stores, uses and displays numbers, text (up to 10 pages worth), pictures, hyperlinks (to documents and the web sites), mathematical and logical formulas, and more. In addition, the contents of any cells can be copied, shared, moved, sorted and filtered, hidden or displayed, and formatted in many different ways (e.g., the color, type and size of the text and numbers in a cell can be set, as can the color and style of a cell’s interior and borders).
These cells and code modules make spreadsheets excellent vehicles for developing robust health information applications from the bottom up, as I describe next.

Examples of how the PHPro uses Spreadsheets in Novel Ways

To exemplify what I’ve just written about spreadsheets, following are four groups of screen shots showing how the PHPro uses spreadsheet forms, grids and modules in innovative ways that deliver a unique range of capabilities and benefits. They explain these processes:
  1. Data definition and collection
  2. Data organization and analysis
  3. Information storage and sharing
  4. Report generation.
1. First comes data definition and collection. As I said earlier, when I started developing the PHPro, my goal was to create a software application able to manage every piece of relevant information over people’s lifetimes. This information would have the potential to help consumers/patients and their healthcare professionals develop a full and deep understanding of the person’s strengths, weaknesses, risks, problems, health trends (changes over time) and preferences, as well as the suitable options for prevention and treatment. I also wanted the information to be “self-actionable” by providing instruction, insight & guidance and warnings & alerts, which would promote a better quality of life by motivating and enabling the person to help him/herself deal with physical, emotional and behavioral concerns.

To accomplish this monumental task, I spent many years researching the healthcare literature and examining health questionnaires. During this process, I built “evergreen” (continually evolving) spreadsheet grids containing lists of questions to be answered by a consumer/patient, as well as by healthcare professionals. The PHPro was then designed to manage people’s answers to these questions, along with data obtained from databases, web sites, data streams and electronic documents (including XML files). Figure 1 (below) shows a small section of one of the PHPro’s Question Grids.

This bottom-up path led to the invention of my patented CP Split™ technology and other “discontinuous/disruptive” innovations, which became key components of the PHPro.

Figure 1 (click to enlarge)
Referring to Figure 1:
  • Column A contains a unique ID number for each question.
  • Columns B, D and E are used to control the branching logic (when the response to one question determines the subsequent question to be presented).
  • Column C is a symbol that identifies the response scale to use (e.g., Yes-No, Yes-No-Uncertain, select one item from a list, select multiple items from a list, use a 1-9 scale, enter unstructured text, etc.)
  • Column F contains the text for each question.
  • Starting in column G and going to the right are the items a person may select in response to the question.
For example, on row 180, the symbol in column C designates a 9-point scale, with “NOT AT ALL” on one end (as indicated in column G) and “A GREAT DEAL” on one end (as indicated in column H). The “BRL” in column B, the number 4 in column E, and the ID number in column D, all instruct the software to branch (jump to) question “103 01 20 10” if the person 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 in those cells.

Figure 2 (below) shows a series of screen shot depicting a type of user form the PHP system uses for manual data input. Macros automate the process by which the forms read the Question Grid above and present the questions and response options to the person; they also collect and store the person’s responses.

Figure 2 (click to enlarge)

As with all the PHPro components, this patented data collection process is very flexible:
  • New questions are added by simply inserting them as new rows into the Question Grid
  • Questions are modified by typing the changes into the Question Grid (and adjusting the ID number accordingly)
  • Questions are removed by deleting their corresponding rows from the Question Grid.
Note that entirely new Question Grids can be constructed at any time in the same manner. In fact, entire libraries of Question Grids can be developed for use by people with different roles and in different situations.

In any case, as the questions are answered, the PHPro automatically stores person’s responses in a list containing the question ID (in a cell of column A) and the person’s response next to it (in column B)—which comprise the “raw data” —as shown in Figure 3 (below). Note that data not manually entered (e.g., data queried from databases, extracted from documents, or streamed from medical devices) can be added automatically to the manually input data using custom macros.

Figure 3 (click to enlarge)

2. Next comes data organization and analysis. Once the raw data are collected, the PHPro uses another spreadsheet grid—the Publisher Spreadsheet Grid shown in Figure 4 (below)—whose cells contain an assortment of formulas (which are not visible in the screen shot). A portion of the Publisher Spreadsheet Grid is which, along with its macros, automatically transform the raw data into structured information ready for report writing. Most of the rules (algorithms) for analyzing the data are included in this spreadsheet and others to which it is linked. These rules may contain criteria identifying when certain data indicate the existence of a health problem (e.g., when a lab test is abnormal, when someone’s emotional or state or cognitions reflects a serious psychological concern, when a reported symptom may be due to an adverse medication side-effect, etc.).

Since this involves technical spreadsheet model-building, I’m not going to take the time to explain what exactly is in this spreadsheet. Suffice to say that the data in this publisher spreadsheet are organized and calculated in a predefined manner that corresponds to the PHP reports.

Figure 4 (click to enlarge)

3. Then the contents of the Publisher Spreadsheet Grid are stored and shared. The contents of the Publisher Spreadsheet Grid are now stored in another file, without any macros, formulas or formats. A section of the stored grid, which is called a “Content File,” is shown in Figure 5 (below). The Content File (which can be converted easily to a delimited text file) is encrypted to protect the data inside. It can retrieved at any time the data needs to be updated, and whenever the person wants to view their information. And if they want, people can share any portions of of their Content File with individuals they authorize.
Note that the Content File can be saved in any location the person wants and its security is compliant with HIPPA regulations. This addresses a concern raised in a recent NY Times article, titled “Warning on Storage of Health Records”. The article discusses how the benefits of personal health records stored in Web-based databases is offset by concerns about risk to privacy. One way to diminish this risk is by putting health records directly in hands of the individual to whom they belong; that way individuals have complete control over who (if anyone) gets to see their personal information. The PHPro Content Files enable such protection.

Figure 5 (click to enlarge)

4. Now comes report generation. Figure 6 (below) portrays a piece of the PHPro report, which I discussed in my initial post on the topic. Only this time I’m showing columns B through F, which are hidden in the actual report.

Figure 6 (click to enlarge)

The cells in these columns contain numeric data that have been extracted from the PHPro Content File (described above). Other cells use these data to determine what rows should be visible and how the data should be displayed. For example, the series of blue boxes in cells K352 and K380, which indicate the amount of distress the person experiences in two situations, are created by a formula in those cells that use data in column E to determine the number of boxes to display.
A few other things about using spreadsheets for the PHPro reports:
  • In addition to numbers, text and symbols, a PHPro report can contain multiple images (including pictures and charts).
  • A report can contain buttons and links that automatically retrieve and display external information from the Web, as well as from electronic documents stored in a person’s own computer or in other computers via networks.
  • Changing a report is similar to modifying the Questions Spreadsheet Grid: Add rows, delete rows, and change the words, formulas and formats of any cells in any rows. A wide variety of charts (graphs) can also be easily added and removed.
Web-Enabling the PHPro

The PHPro was originally built as a stand-alone desktop application. We are now in the process of making in web-enabled as well, so anyone with a browser and Internet connection can use it. I will have more to say about this in future posts.

Fertilizing the Seed

The quote from the ZDNet article at the beginning of this post included the statement that the bottom-up strategy often resembles a “seed” model in which an application’s small beginning eventually grows in complexity and completeness. This requires that the “seed” be nourished (fertilized). The PHPro is designed to grow and evolve continually through a collaborative process in which consumers/patients, sick-care and well-care professionals, research scientists, educators, software developers and others provide ideas and content that are incorporated into the system. Because it is built with highly efficient and flexible spreadsheets, uses a library of categorized data definitions (similar to a book libraries Dewey Decimal system), has a modular structure, and can interoperate with most (all?) other software system, the PHPro is able to molded and expanded into ever-more-powerful knowledge tools that are tailored to the needs of just about anyone. And best of all, this can be done for little cost and with little hassle, which is an important consideration in today’s difficult economic climate.

My hope is that these posts will help motivate people from all groups to join our team of collaborators and grow the seed we’ve been nourishing into a complete, diversified personal health knowledge system that has a positive impact on the health and wellbeing of all people.

Tuesday, April 15, 2008

Personal Health Profiler™: Part 2

In my last post, I introduced our Personal Health Profiler™ (PHPro™) software application, a personal health knowledge system giving self-help (problem-solving) guidance and decision-support. I discussed how the PHPro offers a model of where personal health records (PHRs) ought to be heading.

Before I delve more into the particulars of the healthcare consumer and provider versions of our PHPro, I'd like to clarify a main premise I'm making: An abundance of relevant, personalized information about your physical, mental, and mind-body health problems and risks gives you greater understanding of how best to deal with them.

This may sound logical—the more you know and understand, the more effective your decisions and actions—but I've been debating this issue for many years with healthcare professionals who are more concerned about time constraints and information overload, than on comprehensive knowledge and understanding. As I wrote in a series of three posts about information overload and how to avoid it, accumulating massive amounts of health information over a person's lifetime need not cause overload if we deliver it in reports that save time and reduce confusion by:
  • Filtering out irrelevant information, so a person stays focused on what's important
  • "Serving up" the information as needed, rather than requiring a person to search for it
  • Personalizing the presentation, so that the information is tailored to a person's preferences (i.e., it is presented in a personalized manner to minimize confusion, increase clarity, and maximize ease-of-use)
  • Organizing and summarizing the information in a way that enables people to examine the data from different perspectives, as well as to "drill down" from the general to the underlying details
  • Tailoring instruction (education materials) to a person's ability to learn and particular information needs.
The PHPro incorporates all these capabilities.

Nevertheless, this still begs the question: Why do we need so much data? After all, there are health assessment instruments that ask as few as five or six questions (EQ-5D and SF-6D), behavioral health instruments that have as few as 24 or 32 questions (BASIS-24 and 32), and personal health records (including data storage web sites) that are limited to asking a few dozen questions and track a dozen or so types of information (i.e., a person's vital signs, diagnoses, medications, basic lab results, treatment procedures, allergies, inoculations, diet, sleep, activity levels, stress/mood and emergency contact information).

The PHPro, on the other hand, contains thousands of questions (using sophisticated branching logic, so only the questions pertinent to a person are asked), and manages hundreds of different data types (not to mention adding decision support and self-help tools). But why bother being so comprehensive? Isn't it true that "less is more?"

Having written extensively about this issue here and here, let me know say that when it comes to healthcare, the adage "more is less" not only doesn't apply, but less knowledge is dangerous! Healthcare providers and consumers often lack the knowledge needed for making consistently good, well-informed decisions. In fact, a knowledge gap is a key reason we have a healthcare crisis, and why consumers rarely get high-value care. That's because better health-related decisions come from having "deeper" (more complete) understanding of a person's body, mind, spirituality, and environment, which can only come from having an abundance of relevant knowledge. Why? Because the accuracy and dependability of your understandings depend directly on how much you know about a wide variety of important things.

So, when it comes to making decisions about preventing, diagnosing, self-managing, and treating health problems, more complete knowledge results in better decisions and outcomes.

For example, only after analyzing a considerable amount and diversity of information can we gain the knowledge we need to all the following:
  • Determine relationships between the medications a person is taking and how their side-effects (or drug-drug interactions) may be causing or exacerbating the person's symptoms and abnormal lab test results
  • Determine relationships between a person's medical conditions, stress levels, diet, metabolic functioning, and environmental influences, and the person's symptoms and abnormal lab test results
  • Predict if one's health is improving or being maintained, or if risk factors are likely to become illnesses due to aging or deteriorating health
  • Discover what types of treatments and preventive interventions work best for particular types of individuals with particular health conditions.
And when it comes to diagnosing complex or multifaceted medical conditions, and problems with a psychological component, a substantial amount of information is also often necessary. For example, it is important to assess the nature, severity, and etiology (causes) of the depressive symptoms in light of a person's current life-events, past experiences, and personal demographics. This means using a vast data pool that measures such things as:
  • The intensity, frequency, duration, and cyclical time occurrences of the depression
  • The etiology of the depression, including family history, current psychosocial and biomedical problems, medication side-effects, and psychoactive substance abuse
  • The nature and degree of dysfunctional cognition associated with the depression such as thoughts of helplessness, hopelessness, suicidal ideation, self-deprecation, and existential/spiritual dilemmas, as well as cognitive slowing, rigidity, and focusing problems
  • The nature and degree of concomitant (co-occurring) physiological symptoms such as lethargy versus agitation, changes in sleeping and eating patterns, and physical complaints
  • The nature and degree of behavioral disruptions such as social alienation versus clinging dependence, and occupation or education dysfunction
  • The nature and degree of coexisting emotional problems such as anger toward self, anxiety, guilt, and shame
  • Demographics, such as age, sex, ethnicity, and socioeconomic status.
Even health status and risk appraisals used by wellness coaches often require extensive data for establishing, implementing, and evaluating well-care plans. This data pool includes such things as a person's:
  • Background information (demographics)
  • Health exams and interventions
  • General health status
  • Attitudes about health
  • Symptoms
  • Existing health problems/conditions
  • Biometrics (weight, blood pressure, cholesterol levels, vital signs)
  • Health risk factors
  • Psychological/emotional quality of life
  • Distressing life events
  • Personal achievement & success, personal power & influence
  • Self-esteem, self-competence & confidence
  • Life purpose & meaning , goodness of life. life satisfaction
  • Interest, involvement, and enjoyment of your daily activities
  • Stress and trauma
  • Work-related issues
  • Caregiver responsibilities
  • Social relationships
  • Emotional state, mood
  • Coping strategies
  • Physical activity & exercise
  • Nutrition
  • Sleep
  • Energy levels
  • Wellness coaching preferences
  • Areas to address with coach.
Here, too, the PHPro manages all this information, and much more.

Up to this point, I've been focused on the importance of comprehensive knowledge to an individual's health & quality of life. This issue, however, extends to the quality of our entire healthcare system. Here, for example, is a link to an explanation of Sir Muir Gray, Chief Knowledge Office of Britain's National Health Services, about how the lack of adequate healthcare knowledge is preventing us from solving the following "magnificent 8 problems:
  • Errors and mistakes
  • Poor quality healthcare
  • Waste
  • Unknowing variations in policy & practice
  • Poor patient experience
  • Overenthusiastic adoption of interventions of low value
  • Failure to get new evidence into practice
  • Failure to manage uncertainty.
He continues:
[We are currently in a] third industrial (and therefore, healthcare) revolution [that] is driven by citizens, IT and knowledge. Professionals are by and large two decades off the zeitgeist and this is not restricted to healthcare, it's seen across all professions.
Knowledge is the enemy of disease, the application of what we know will have a bigger impact than any drug or technology likely to be introduced in the next decade. I'm talking about three types of knowledge here Statistics, Evidence and Mistakes [italics added] we need to be able to deliver these as simply and abundantly as we deliver clean water… What we're introducing in NHS bodies is a Chief Knowledge Officer--because you need energy to make knowledge appear everywhere….We should be thinking systems rather than structures, recognizing the network that runs alongside every bureaucracy is responsible for innovation.
While I would argue that his three types of knowledge don't cover all bases, I fully agree that we need to do a much better job in generating, sharing, and using a great diversity of knowledge focused on fixing our healthcare system and improving outcomes all each patients/consumers.

While current day personal health records do little, if anything, to address these global, systemic problems, the PHPro is designed to do support the kind of research that generates the knowledge needed to solve the magnificent 8 problems.

So, the vision I'm espousing—which focuses on improving people's health and wellbeing through the development, sharing and use of wide-ranging knowledge—spans from the individual patient/consumer, sick-care provider and wellness coach to the entire healthcare system. My sincere desire to help turn this vision into a reality has kept me motivated for over 25 years in evolving the PHPro.

Click here for the last post in this series.

Monday, April 07, 2008

Personal Health Profiler™: Part 1

In these next series of posts, I’m going to delve into the details of a truly next-generation personal health record (PHR); well, it's actually, more like a personal health knowledge system. As I discussed in my last post, one key component of a better healthcare system is a very cost-efficient and easy-to-use way to gain and use valid knowledge to improve outcomes and control costs. This is where I've been focusing much of my professional life for almost three decades. I'm now going to write about a paradigm-busting software technology I've been developing over this period. Some may see this as self-serving, but my deepest hope is to develop good collaborative relationships and help bring social good. First, some background.

Twenty-seven years ago, I began a career as a licensed clinical psychologist. That same year, 1981, was also the time that the personal computer (PC) became available and I was intrigued. As I began learning about computers, the power of spreadsheet software caught my attention. I wondered if there was a way to use spreadsheet technology to manage patient information in a way that would:

  • Help clinicians/practitioners of any type develop better treatment plans, deliver better care, and develop professionally through ongoing feedback about the progress and results (outcomes) of the care rendered.
  • Help consumers (i.e., patients, clients and others utilizing well-care and sick-care services) to make better decisions and take more responsible actions--when dealing with health problems and other difficult life situations--through increased their self-understanding, knowledge of options, and structured guidance.
  • Help researchers and policy-makers develop, validate, and disseminate best-practice guidelines.

A key question that came to my mind was this: How can a computer help an individual and his/her healthcare professionals understand how the person’s health, wellbeing and quality of life are affected by his/her:

  • Thinking processes (one’s beliefs, attitudes, perceptions, etc.);

  • Emotional processes (how one feels in different situations and why);

  • Behavioral tendencies (including how and a person act in self-defeating ways);

  • Coping strategies (how one tends to deal with life problems and the benefits one receives) ; and

  • Mind-body interactions?

My quest to find an answer resulted in a two and a half decade journey of creative discovery.

Before I present and discuss the details of my radical innovation, I’d like to reiterate my full-disclosure: The software to which I’m referring is the Personal Health Profiler™ (PHPro™) application, which is owned by my company (National Health Data Systems, Inc.) and incorporates processes I patented in 1998. My intention here is to gain exposure for my invention with the goal of stimulating dialogue about new directions for personal health records, as well as sparking creative collaboration projects aimed at transforming our current healthcare system.

Now that the brief background and disclosure are out of the way, this post will focus on one of the many unique abilities of the PHPro: Its comprehensiveness and personalized navigation. In other words, the PHPro software handles a much greater depth and breadth of health data than any other PHPro. It presents this useful information--via web-based or desktop (stand-alone) applications--in interactive reports for consumers and health professionals. A simple mouse-click process enables an individual to “drill-down” from high level views (showing only the data category headings) to increasingly detailed views and self-help modules that are tailored to a person’s particular needs.

The image below (which can be expanded by clicking it) shows the least detailed ("highest" level) view of the PHPro’s Whole-Person Health & Wellness Profile (note that clinical profiles for healthcare and wellness professionals are also available). Included in a personal health profile is information derived from:

  • Data entered manually by an individual via an intelligent "branching logic" process that I will demonstrate in a future post. Depending on the situation and type of profile being generated, the data may be entered the consumer/patient, a caregiver, and/or an authorized health professional.
  • Data obtained from external databases, such as healthcare provider's electronic medical records (EMRs).
  • Documents and other sources, including sick-care (treatment) and well-care (preventive & self-maintenance) guidelines, links to pertinent web sites, etc.

As you can see by the data category headings, the PHPro data are divided into five major (“first-level”) categories of data (in red). Within these main categories are 29 "second-level" categories (in yellow). Also notice that there are grey buttons in the right column with a down-pointing arrow.
click to enlarge image

Although the PHPro application does not look like it's a spreadsheet grid (see below), it is one, and it takes advantage of a spreadsheet's powerful, flexible computational and automation (macro) capabilities. In the screenshot above, for example, each data category heading "resides" on its own row of spreadsheet cells.
click to enlarge image

What you don't yet see (but will shortly) are the many additional rows beneath each heading row, which contain the person's actual health data. In the following image, I enabled the spreadsheet's column letters (top) and row numbers (left) to be visible temporarily, so you can see how many of the rows are hidden from view. For example, 77 rows of data related to possible symptoms are hidden between rows 139 and 216. This report, in fact, has about 1,400 rows of headings and data, of which only 34 rows are currently visible.

As shown in the image below, a person simply double-clicks an arrow next to any data category heading to reveal its details by displaying the rows beneath them. In this example, the button next to the Distressing Life Events heading is being clicked ...
click to enlarge

The PHPro then displays the pertinent information as shown below. In this example, the person has reported some degree of distress concerning eight life events (out of a possible 19 in the current assessment), with health problems being the most upsetting and stressful.

Note that the other 11 life events, which are not problematic for the person, remain hidden since they are not distressing. Also note that there are buttons in the left column on every data row showing an open lock symbol. If the person wants to share his/her information with certain healthcare professionals, clicking those buttons enables him/her to authorize access to certain individuals, while preventing access from others. This gives the person complete control over the privacy of his/her personal health information. click to enlarge

As per the image below, let's say the person double-clicks the down arrow next to “Having serious medical problems."
click to enlarge

This next image shows some of the details about the way the person thinks and feels about his/her medical problems. It also has an orange button labeled: “Manage this Problem.”
click to enlarge

Clicking that button launches the Coping & Problem Solving module, which starts with a brief interpretation of the person’s thoughts and feelings about the medical problem, as shown in the screen shot below. [Note that the screen shots below, unlike the ones above, are built with spreadsheet program's "user forms" instead of spreadsheet grids.]

No matter which distressing life event is selected, the person can then click the green “Solve It” button to be guided through a comprehensive “transactional problem solving” process that helps him/her deal with the problem.
click to enlarge

After clicking the Solve It button, the Introduction window appears, as shown below.
click to enlarge

Clicking “Next” brings up the first Coping & Problems Solving screen, as shown below. Note that this window has a yellow “See More” button.
click to enlarge

Clicking the “See More” button displays an analysis and interpretation of the person’s coping strategies.
click to enlarge

I’m going to stop here, but the Coping & Problems Solving process continues through a series of instructional and action steps that guides the person in:

  • Changing maladaptive thinking and reducing self-defeating emotions (from a Cognitive-Behavioral and Rational-Emotive therapeutic framework),

  • Building and evaluating possible plans of action to solve (or at least control) the problem,

  • Implementing the best plans,

  • Assessing the results, and

  • Trying to solve it again, if it is wise to do so, or learning to tolerate it better if it cannot be solved.

Note that a person can discuss his/her problem-solving plans with others and even share the details of his/her Coping & Problems Solving steps with a wellness coach, counselor, or therapist.

I’ve barely scratched the surface. In subsequent posts, I will:

  • Show the details of other categories of data
  • Discuss how the information supplied by the PHPro can be used by coaches/counselors/therapists to help break through consumer's inertia and promote positive lifestyle change for better overall health & wellbeing and self-maintenance of chronic conditions
  • Discuss the Coping & Problem-Solving process in more detail, focusing on how it can help consumers help themselves, as well as assisting their coaches/counselors/therapists Demonstrate how a person can authorize different people to view particular pieces of information and prevent other data from being accessed
  • Describe the processes for:
    • Manually inputting data using sophisticated branching logic
    • Modifying, updating, and tracking changes over time
    • Obtaining data automatically from external databases
    • Storing the Profile data in "individual record files"
    • Using computational algorithms (rules) to analyze the data
    • Developing, updating, and modifying reports
    • Sharing a data file securely
    • Accommodating any current and future data standards
    • Expanding, modifying, and validating data sets
    • Working in conjunction with other software technologies
    • Building research knowledge bases
    • Incorporating "information therapy" materials
    • Supporting centralized, decentralized (peer-to-peer), web-enabled, and asynchronous desktop architectures/platforms
  • Explain many of the unique yet simple technical methods that make all this possible.

I plan to have a fully functional version of the PHPro application available sometime this month, so collaborators can obtain their own profile and offer feedback.

I welcome your questions and comments.

My next post focuses on the need for much greater knowledge and the role PHPro can play.