Eric Miller

The United States healthcare model has become increasingly reductive with components of a patient’s health profile dissected between isolated specialized fields. A declining primary care sector has exacerbated this compartmentalization as knowledge within these specialties becomes siloed, forcing treatment to become reactionary and sequential in the absence of a holistic perspective. This can lead to overlooked component interactions such as conflicting treatment plans or compounding illness. However, recent advancements in digital technologies may provide a solution through the facilitation of open communication between specialties. Intelligent Wellness, for instance, refers to a simultaneous optimization model of patient care which identifies and responds to imbalances in a person’s measurable stress through reference to their entire health profile. This model holistically examines three pillars of an individual’s mental, physical, and financial wellbeing. Taking inspiration from naturally and mechanically occurring negative feedback loop systems, such Intelligent Wellness would collect comprehensive, real-time data on a participant’s internal functioning state and their relevant environmental factors. Such data would then be analyzed and delivered back to the participant in the form of personalized behavioral recommendations for effectively improving baseline health. This collection, analysis, and delivery would occur through a digital twin medium that acts to accurately simulate and predict a participant’s dynamic wellbeing.

The Coronavirus crisis has forced hospitals globally to develop new virtual service portals and systems to: 1) triage, diagnose, and manage new patients virtually for every clinical specialty at home as their symptoms emerge, avoiding COVID-19 exposure to patient or physicians, and hospitalization, as much as possible, and 2) discharge, track, and support recovered patients via homecare and virtual visits to free as many critical care beds as possible. This paper focuses on simulating and modeling an episode of care with innovative initial patient contact and triage processes using the Colored Petri Net (CPN) formalism to help optimize workflow, patient throughput, and overall system efficacy. The two patient triage programs under consideration are a health system in Australia and an orthopedic surgical program in the US. We describe our model for the US program. Our presented results establish a desired stratification of patients through a virtual musculoskeletal triage.

For most people, decisions about “wellness” are made by default. Without specific evidence-based guidance, most find it difficult to make specific long-term commitment to achieving and maintaining wellness. Proposed here is an approach to filling the information gap through “Informed spectatoring” using appropriate instrumentation and advice: a type of “feedback control”.

Human beings are complex systems having many interoperable subsystems. Neither these subsystems nor their interactions are completely understood. Further, while there are broad principles describing these subsystems and their interactions, the specifics are personal. Taken together, these factors make optimization of the human being by achieving and maintaining Wellness a challenging problem.

We describe a cloud-based system intended to provide actionable recommendations to users for improving their wellness. The recommendations are personalized for the user demographic and history. This is accomplished in three steps:

1)
Assessment: a knowledge-based expert system ingests data from the user, and positions them on an objective, numeric multi-dimensional wellness scale in the general areas of Psychology, Physiology, and Finanaces. This assessment of wellness is informed by the user demographic, history, and a wearable monitoring device.

2)
Projection: A bank of feedback controllers (pid controllers) is used to estimate user future wellness states by projecting the user wellness state forward in time. This is a prospective, rather than merely retrospective analysis. It is focused on where the user will be rather than merely where the user has been.

3)
Recommendation: Based upon the assessment of user wellness, and the forward projection of the user wellness, a knowledge-based expert system selects a few areas of wellness that can be addressed in a unified way by simple user actions. An innovation is that the expert system makes these recommendations by automatically crafting a report in colloquial prose that reads like it was written by a human.

An operational, cloud-based prototype has been built and tested on simulated data. We describe an upcoming human trial using members of the U.S. Olympic Team as subjects.