Aug 2 2012
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Asthmapolis: Public Health Data in Action

Hundreds of people in Louisville, Ky., who regularly use an asthma inhaler will soon be doing much more than just helping themselves whenever they take a puff. Through a demonstration project created by Asthmapolis, an innovative technology firm based in Madison, Wisc., data collected by a sensor in the inhalers of the project participants will help Asthmapolis and city leaders in Louisville better understand when and where people with asthma develop symptoms. The goals of the project are to help identify patients who need more help controlling the disease, and to help identify community-wide asthma triggers that can be improved or eliminated. Enrollment in the project began last month and will last for twelve months for each participant.

Asthmapolis was co-founded two years ago by David Van Sickle, a former Epidemic Intelligence Service Officer with the Centers for Disease Control and Prevention, and a Robert Wood Johnson Foundation (RWJF) Health and Society Scholar at the University of Wisconsin School of Medicine and Public Health. Van Sickle did one of the pilot studies of an earlier version of the technology now in use in Louisville during his years as an RWJF scholar and credits the program with the opportunity to do cross-disciplinary work in order to explore the feasibility of the project and collect the initial data. “I also had access to mentors, such as John Mullahy, Stephanie Robert, and David Kindig, at the School of Medicine and Public Health, to get 360 degree feedback on what I was up to,” says Van Sickle.

In addition to a number of academic trials, Asthamopolis has two key projects underway – the one in Louisville and a similar scale-up in Sacramento where the firm has partnered with Dignity Health and the California Health Care Foundation to see how the technology can specifically benefit the needs of the under-served. Interim results could be available in nine months and published results as soon as next summer.

Van Sickle calls the data being collected in the sensors “a vital sign for asthma,” which is critical he says because we need accurate and reliable information, rather than what doctors and communities must typically rely on, which is self-reported information that Van Sickle says is known to be unreliable. “We want to use technology as a fulcrum to make self-management and monitoring more effective, using a bottom up approach” says Van Sickle.

Significant signals the firm will be looking for include inhaler use at night, an indication of more serious asthma, and symptoms both at home and at work and at all times of day and night—signs of uncontrolled or worsening disease.

Why sensors? “Sensors make the absence of data meaningful, where before it was ambiguous,” said Van Sickle.

While the immediate benefit will be for the hundreds enrolled, the value to entire communities is also a key focus of the company, and of the demonstration project underway in Louisville. NewPublicHealth spoke with Ted Smith, the city’s director of innovation and economic development, who is the spearheading the Asthmapolis project.

NewPublicHealth: You are the Director of Economic Development and Innovation for the City of Louisville, and you have responsibility for a demonstration project to capture the city’s asthma triggers. Tell us about that.

Ted Smith: I joined Mayor Fisher’s administration in July of 2011 as his first director of innovation. That title, director of innovation, is a new job title for the city of Louisville. And while some larger cities, including Chicago, Boston and San Francisco have innovation officers, there’s not another city of our size with a similar position.

I was charged by the mayor with bringing an innovation agenda to the city. I had just come from an appointment at the Department of Health and Human Services working in the office of the National Coordinator for Health IT in Washington, and I am deeply familiar with the kinds of personal health technologies that were becoming available on the market. Several months ago, the mayor made me the head of economic development, and we renamed it the department economic growth and innovation, so I’m both. I’m interested in health issues because I can draw a straight line to our regional competitiveness. When employers come into town, they want to know how healthy the workforce is. Most of them are self-insured. They don’t want to pick up a whole population of health hazards, and so this has become an economic competitiveness issue, and you’ll see over the next five or six years that the issue will become a selection criteria that businesses use as they move into communities.

NPH: Why is asthma a key issue for Louisville?

Ted Smith: Louisville has some of the most challenging air quality in the United States, in particular, ozone and small particulate pollution, and so there are many days, especially in the summer, when it is unsafe to be outdoors if you are very young or very old or have breathing disorders.

As a city, we are challenged with air quality issues, and so as the director of innovation, I was very focused on how we might start to tackle that. I knew that David Van Sickle had been with CDC and as a Robert Wood Johnson Foundation fellow had been doing work on the connection between ambient air quality and the burden of asthma. We had a conversation about whether a city would be a logical vehicle to start addressing this as a community—not as an employer, not as a pharmaceutical company, but in the context of geography as a city adopting a program to try to understand this potential intersection between these two things. So we came up with the demonstration project, and I raised money from the private sector to pay for the project.

NPH: Who are your partners?

Ted Smith: The total amount needed is $150,000. The Foundation for a Healthy Kentucky provided half the funding and had a match requirement and the Norton Healthcare Foundation came in and matched part of that, and a private philanthropist provided the rest.

NPH: What do you think got the interest of the partners?

Ted Smith: The Foundation for a Healthy Kentucky knows there is a mandate at the state level to monitor the burden of asthma. The state several years ago sent a charge out to all the communities in Kentucky and said we really need to understand this at a more granular level than a county-wide survey every two years. We already had a roadmap and there has been a tremendous year over year growth in asthma in Kentucky’s counties. But the recommendations of the commission were to get a little bit lower than that in detail. Is it parts of communities? Is it demographics? Is it irritants? A countywide multiple-choice survey just can’t tell you what’s going on.

I’m an unlikely champion of the project, and the reason I am that champion is because this is a great example of breaking down data silos in the public sector. We monitor for the Environmental Protection Agency every few milliseconds what the air quality is in our county, but we didn’t really have a good handle on what was going on with asthma. Once we had the Asthmapolis citizen-centered technology, we have data strains that we could mash up together and take a look at. And there are lots of other data streams that we could be looking at. We could be looking at surface traffic. We could be looking at vegetation patterns. And this to me is a model project for how the public sector and communities should start working with informatics.

Once we shift from simply monitoring and reporting to “data science” or hypothesis-driven data collection and combination, we can begin to inform public debate and policy creation. All of this technology—especially sensor technology—gives us a new and robust vista on the issues in our built environment. For example, we could be looking at traffic patterns and public park utilization to better understand where “nudging” opportunities are to help citizens make active lifestyle choices.

NPH: How comfortable do you think other cities are in accumulating and assessing critical data in new ways in order to improve community health?

Ted Smith: They’re not very comfortable. That is the honest answer. This is a transition going on—the entire open government movement, open data, open government, open access to data streams. Some communities and sectors are very uncomfortable with the idea that we’re supposed to be releasing all of the data to the private sector, and to the public generally who may work with it and discover things, theoretically, to improve the quality of our communities, to improve the quality of government and the services that are delivered. There’s not a high level of comfort, though there is commitment to getting it done. If you’re a larger city, you probably have stepped up to the plate and you’ve created an innovation office. You have a chief technology officer in addition to a chief information officer, and that CTO or innovation person or team is really trying to break down those silos.

NPH: What’s the goal with the asthma demonstration project?

Ted Smith: It’s a milestone-based goal. We essentially raised enough money for 500 units to be deployed in our community. I imagine there will be a second round of fundraising to get that number up to 1,000 or 2,000 inhalers. At 1,000 inhalers I’d feel better about what we can learn and what we can act on in this project. The critical goal of the project, in addition to raising visibility about data, personal health technologies and the role of our community, is to get enough data to something that we can do something about it such as enact policy and deploy interventions.

NPH: What’s the next topic you might collect data on?

Ted Smith: I don’t know that the lens that I’m using is disease specific. This is about our quality of place, our community. I think the most useful way to look is at what really are the burdens that are getting in the way of us being a competitive, vibrant community. And so, for example, obesity and diabetes, if you had to put a disease filter on it, I can draw a straight line between those things and our quality of workforce and our overall well-being in our community. But then, there are lots of things that are outside of health that would also be next on the list that have to do with just improving our quality of place.

Activity is a good example. Physical activity in our population is an issue, in part because we don’t have a mountain range or a beach anywhere nearby. And so, in the Midwest, you’ll see bigger issues with obesity than you’ll see in places where there are more active populations. We need to ask, those citizens who are active, what do they do? And, what as a community should we be building toward in our built environment so that we’re increasing and improving the level of activity of our citizens?

>>Read more in an interview with David Van Sickle, an alumnus of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program and founder and CEO of Asthmapolis, on the RWJF Human Capital Blog.

Tags: Asthma, Public Health Informatics, Q&A