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Sri Elaprolu, Sr. Manager, Solutions Architecture, AWSGari Clifford, Interim Chair, Dept. of Biomedical Informatics, Emory University Prad Prasoon, Business Technology Strategist, American Heart AssociationJune 21, 2016Health Solutions at the Edge: Mobile and IoT for Life Sciences

2016, Amazon Web Services, Inc. or its Affiliates. All rights reserved.

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Gari Clifford, Interim Chair, Dept. of Biomedical InformaticsEmory University and Georgia Institute of TechnologyJune 21, 2016Scalable mHealth Using the Amazon CloudThe Health aging Study @ Emory& the eCohort at Morehouse School of Medicine

2016, Amazon Web Services, Inc. or its Affiliates. All rights reserved.

The massive burden of brain disease*Data from CDC, NIH, and NGO

~18.8 million (9.5% of US adult population in a given year) with major depression - #1 cause of disability ages 15 45 at >$160 B costs annually~7.7 million with posttraumatic stress disorder (PTSD) at cost of $42 B annually in US~5.4 million people have Alzheimers disease at cost > $200 B annually in US~13% of those over 60 years of age report confusion or memory loss~4.6 million stroke survivors, with 800,000 new strokes annually at a cost of $43 B in US - #1 cause of long-term disability~2.5 million people with TBI at a cost of $77 B annually in US~2 million people have Epilepsy at a cost of $16 B annually in US~1.5 million have Parkinsons disease at cost of $23 B annually in USBy 2030, the United States population aged 65 years and older will double and the 71 million older Americans will make up approximately 20% of the total population

Background Image: Another area of active PET research is the Pittsburgh compound B (PiB). This marker is believed to bind to the amyloid plaques that are ubiquitous in patients with Alzheimer's disease. These patients exhibit significantly higher levels of uptake of the PiB tracer. Current research is following patients whose brains contain elevated levels of PiB but who do not show any current signs of Alzheimer's disease to determine whether the disease process progresses over time. Research like this could enable clinicians to accurately identify individuals years before dementia becomes apparent. Image courtesy of the University of Pittsburgh, PET Amyloid Imaging Group. Licensed under the Creative Commons Attribution ShareAlike 3.0 License. Taken from: www.medscape.com/features/slideshow/alzheimers/3

Emorys Healthy Aging Study

Alzheimer's biomarkers: The Healthy Aging StudyGoizueta Foundation $25 million transformational giftThe challenge: identify predictive AD biomarker during middle age (who, when)The opportunity: 100,000 patients as partners > the Emory Healthy Aging Study Extensive phenotyping of health from MRI to mHealth

Large scale mHealth

Use physiology patches and actigraphy meters Jawbone, Simband, Pebble, etcECG/activity/EEE/O2 patches

Natural behavioral data scrapingSmartphone (accelerometer, gyro, GPS, SMS) Telecom records

Off body sensorsVideo cameras (e.g. sleep)Exposomes R Pi, Grove sensors, Sensly, Satellite data (sleep)

Sleep, activity, and mental health

Objective identification and analysis of physiological and behavioural signs of schizophrenia

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Social networking, geography, and movement

social network & activity = physical illness social network & activity = mental illness

Location: Context is essential

The Healthy Aging appInitial architecture up forSalesforce integration iOS and Android devicesServer-side communications with sales forceData securityData flow to AWS and other DBsParent app developmentFitbit/Jawbone connectorsLayout and functionality of multiple games

mobile clientEmory data center

1. Phone connects to API on Amazon EC2 within load balanced VPC2. AWS app validates user against Salesforce3. Salesforce returns valid user information4. AWS uses validated user data from Salesforce to lookup and retrieve certificate from Emory5. Emory returns the certificate to the application via AWS to encrypt memory on phoneData flow

6. App uploads continuous data to Amazon S3 project bucket every 3+ hours

virtual private cloud 10.0.0.0/16

Availability Zone #1

SSHJump BoxVPC NAT gateway

Public subnet 10.0.1.0/24

Availability Zone #2

Availability Zone #3

Availability Zone #nElastic Load Balancer

webserver

webserver

security group

Auto Scaling groupRDS DB instance

RDS DB instance standby (multi-AZ)

Private 10.0.5.0/24

Private 10.0.4.0/24

Private 10.0.3.0/24

Availability Zone #n

Public 10.0.2.0/24

AWS Cloud Architecture

Region specific Availability zone separated by about 10 miles and has its own power supply.

US EastIreland (European data)

http://www.n2ws.com/images/how-to-guides/Aws_region_map.png

All requests go through the Load Balancer balances it across different webservers -

Auto Scaling Group analyses inbound requests which intelligently spins up another instance in case there are too many requests

RDS amazons relational database includes summary stats but not raw data, which sits on S3 URL pointer. Multiple AZ availability zones for redundant storage

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The Healthy Aging app

a longitudinal tool for life

Emorys Healthy Aging Study

Prad Prasoon, Business Technology Strategist, American Heart Association 6.21.2016HEALTH TECHNOLOGY INNOVATION NEEDS

2016, Amazon Web Services, Inc. or its Affiliates. All rights reserved.

Prad PrasoonBusiness Technology Strategistwww.HEART.org

HEALTH TECHNOLOGY INNOVATION NEEDS

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SAVING LIVESFOR OVER 90 YEARS!

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TO IMPROVE THE CARDIOVASCULAR HEALTH OF ALL AMERICANS BY WHILE ALSO CONTINUING TO DECREASE DEATHS FROMCARDIOVASCULAR DISEASES AND STROKE20% 202020% BYTHE YEAR

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WHAT REALLY IMPACTS THE HEARTEvery25SECONDSsomeone has aHeart attack

1 3inDEATHSis caused by Cardiovascular diseaseThe US spends2.6TRILLIONon health careEach year82.6 MILLIONAmerican adults are living today with some form of

Cardiovascular disease

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WHAT PEOPLE WANT TO DO

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WHAT PEOPLE HAVE TO DO

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CHANGING THE GAME

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Connected health is changing the relationship between healthcare provider and patient

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MOBILE APPS ARE BECOMING A REGULAR PART OF PATIENT CARESource Pricewaterhouse Coopers :http://blog.doctorbase.com/top-10-health-industry-issues-2015-explained-infographics/

THE WEARABLES MARKET CONTINUES TO GROWSource: Wall Street Journal - http://www.wsj.com/article_email/the-future-of-the-wearables-market-1452736738-lMyQjAxMTA2MDAyODYwMTgxWj

SHARE OF DIGITAL HEALTH APP MARKET AND PATIENT PREFERENCESSource: Deloitte 2015 - http://raconteur.net/healthcare/self-service-healthcare-now-possible-with-mobile-technology

PATIENTPERSPECTIVE

CLINICALPERSPECTIVE

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LEVERAGING THE TECHNOLOGY FOR PATIENT ENGAGEMENT

TRANSFORMING CARE AND RESEARCH

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Life is why

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Thank you.

www.HEART.org

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Thank you!