The presentation will introduce the Individual Exposure Health Risk Profile (IEHRP), a novel approach that integrates occupational, lifestyle, and environmental exposure data from traditional and new personal monitoring exposure assessment technologies with clinical and genomic data to provide a new and novel capability for personalized health. We will demonstrate how IEHRP will create unique opportunities to shift from a healthcare delivery system dependent heavily on infrastructure and staffing to one that allows individuals to take ownership of their health and drive their behaviors and health-related choices by leveraging a Big Data infrastructure and advanced analytics.

1. AFIT Education Excellence:
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Revolutionizing Precision Medicine w/Big Data
The Individual Exposure Health Risk Profile (IEHRP)
INFORMS Healthcare 2019
Richard Hartman, PhD
Mark Oxley, PhD
Professor of Mathematics
Department of Mathematics and Statistics
Graduate School of Engineering and Management
Air Force Institute of Technology (AFIT)
Wright-Patterson AFB, OH
29 Jul 2019

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Disclosures
• Presenter has no interest to disclose.
• No discussion of off-label uses
• The views expressed are those of the author and do not necessarily
reflect the official policy or position of the Air Force, the Department of
Defense, or the U.S. Government.

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Imagine If…
Doctors could understand the effects of
exposures on a patients health throughout
their life
Identify diseases at the molecular
level before the onset of disease
Enable rapid interventions and
supportive medical care
Reduce disability by truly preventing
disease
Demonstrate significant cost savings and
efficiencies
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Total Exposure Health
TEH Overview
TEH aims to capture workplace, environmental & lifestyle exposures to the individual (i.e., N=1, genome) using advances in science,
technology & informatics to prevent disease; improve health and well-being: Healthiest Performing Population by 2025
E
H
Increase use of genomic
research and knowledge
Improve exposure monitoring
through sensors and wearables
Better understanding of monitored
exposure to performance and
individual health outcomes
Advance operational decisions
using advancements in science,
medicine, technology, and
informatics with digital biodata
bank, Big Data analytics, and
expert systems
Total Exposure Health (TEH) represents a paradigm shift in military medicine – from a primary focus on disease and injury treatment to a more
holistic approach that focuses on health and prevention.
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Reimagining Healthcare with TEH
TEH will bring together distinct systems and initiatives into one portfolio: integrating exposure science, information technology, and existing healthcare
programs to develop end-to-end systems.
TEH capabilities will maximize the value of these advances by translating data collection, analysis, management, and visualization into clinically and
personally actionable results.
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INDIVIDUAL EXPOSURE HEALTH RISK
INDEX/PROFILE (IEHRI/P)

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Our Clinical Disposition
Individual Exposure Health Risk Index/Profile (IEHRI/P)
Our Unique Genetic Proclivity
IEHRI/P:
Individual Exposure
Indices/Profile
Our Exposures
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IEHRI/P: Expressed Mathematically
IEHRI
IEHRP
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Individual Exposure Health Risk Profile (IEHRP) = (IEHRI 1, IEHRI 2 ,…, IEHRI i ) = ([v1,1
+ v1,2 + v1,3 ], [v2,1 + v2,2 + v2,3] ,…, [vi,1 + vi,2 + vi,3])

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Visualizing the IEHRP – Individual
IEHRP will aid in visualizing an
individual’s unique exposure
susceptibilities
Lee
NOISE BENZENELEAD RADIATION GLUTEN
SUSCEPTABILITY
HIGH
LOW

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IEHRI with Multiple Variables
• Limitations to the IEHRI became evident,
which only accounted for three variables
to describe an individual exposure.
• This required the IEHRP to be modified
so it could account for multiple
confounding factors
IEHRP = (IEHRI1 , IEHRI2 , … , IEHRIj )
= ([v1,1 + v1,2 + v1,3 +…+ v1,j ] , [v2,1 + v2,2 +
v2,3 +…+ v2,j ] , … , [vi,1 + vi,2 + vi,3 +…+ vi,j ])
Genetics
Diagnostics
Sensors and
Mobile Data
Lifestyle
Occupation
Medical History
Environment
Family History

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IEHRI & IEHRP: Expanded
IEHRP
 IEHRI – Which vi,j value is more important?
 WFi,j = weighting factor– importance of each variable (vi,j) when compared with all the variables
with in the IEHRI (e.g., are genes more important than exposure measure?)
 CFi,j = correction factor – variability (confidence) in the (vi,j) based on the process, procedures,
methods, device, etc. for each (vi,j)
Individual Exposure Health Risk Index (IEHRI) (exposure) =
[(v1,1)(CF1,1)(WF1,1) + (v1,2)(CF1,2)(WF1,2) + … + (v1,j)(CF1,j)(WF1,j)]
Individual Exposure Health Risk Profile (IEHRP) =
[(v1,1)(CF1,1)(WF1,1) + (v1,2)(CF1,2)(WF1,2) + (v1,3)(CF1,3)(WF1,3)] ,
[(v2,1)(CF2,1)(WF2,1) + (v2,2)(CF2,2)(WF2,2) + (v2,3)(CF2,3)(WF2,3)],
…..… ,
[(vi,1)(CFi,1)(WFi,1) + (vi,2)(CFi,2)(WFi,2) +…+ (vi,,j)(CFi,,j)(WFi,,j)]
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2 2
3
1
IEHRP Visualization & Normalization
X
RADONNOISE BENZENE
MEASURED
EXPOSURE
Genetics
Medical Record
GLUTEN
Graphing the raw data we get the following IERHP.
However, to address censored data requires -
Normalization
= censored data
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IEHRP Visualization & Normalization
IEHRP
= (IEHRI1 , IEHRI2 , IEHRI3, IEHRI4 )
= ([v1,1 + v1,2 + v1,3 ] , [v2,1 + v2,2 + v2,3] , [v3,1 + v3,2 + v3,3] , [v4,1 + v4,2 + v4,3 ])
= ([1 + 1 + 1] , [1 + (-) + 1] , [1 + 1+ (-)] , [(-) + (-) + 1])
= (3, 2, 2, 1)
Normalization Factors w.r.t. censored values in each IEHRI
Normalized IEHRI1 = (1/3) IEHRI1 = (1/3) [1 + 1 + 1] = 1
Normalized IEHRI2 = (1/2) IEHRI2 = (1/2) [1 + 0 + 1] = 1
Normalized IEHRI3 = (1/2) IEHRI3 = (1/2) [1 + 1 + 0] = 1
Normalized IEHRI4 = (1/1) IEHRI4 = (1/1) [0 + 0 + 1] = 1

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1 11 1
IEHRP Visualization & Normalization
X
RADONNOISE BENZENE
MEASURED
EXPOSURE
Genetics
Medical Record
GLUTEN
Normalization = all indices will have values between 0
and 1. Accounting for the censored data we get the
following IEHRP
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Values and Factors Matrices
Modified values
Sum row entries
to produce indices =
IEHRI1
IEHRI2
IEHRI3
IEHRI4
Hadamard product is entry-wise multiplication

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Values and Factors Matrices
Modified values
Sum row entries
to produce indices =
IEHRI1
IEHRI2
IEHRI3
IEHRI4
Hadamard product is entry-wise multiplication

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More Values and Indices
=
IEHRI1
…….
……..
IEHRIm

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Matrix Notation
column vector of
indices
matrix multiplication

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IEHRP Benefits: Example
A
B
“Policymaker”“Healthcare Provider”
NOISE BENZENE GLUTEN RADON
NOISE BENZENE GLUTEN RADON
NOISE GLUTEN RADON BENZENE
RADON NOISE BENZENE GLUTEN
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Conclusion…
• Total Exposure Health can:
• Drive the development of medical expert systems, sensors and R&D
• Advance the science and understand the effects of currently undetectable exposures
and what we clinically know about exposure, gene expression, and disease
• Through the IEHRP:
• All information integrated about an individual
• Area sensors, Personnel/Physiological Sensors…integrated with all genetics, previous exposures
• Genomic data will be transparently incorporated into the clinical decision process
• Collectively
• Patients/providers will be afforded data real-time into healthcare enhancing the
Doctor/Patient experience
• Incrementally maximize human performance to not only retain personal health
attributes but enhance them
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QUESTIONS?
Mark Oxley, PhD
Professor of Mathematics
Air Force Institute of Technology (AFIT)
Office: 1-937-255-3636 ext. 4515
Mark.oxley@afit.edu

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Noise Exposure Demonstration Project (NEDP)