Health Advisor Project

1. Carlo Mazoleny Ravi Shankar, Ph.D. Florida Atlantic UniversityMay 2009 Health Advisor Project

2. Health Advisor Project BACKGROUND OVERVIEW CASE BACKGROUND THE GAIA METHODOLOGY CASE ANALYSIS PHASE CASE DESIGN PHASE FUTURE DEVELOPMENTS QUESTIONS

3. BACKGROUNDThe Healthcare System • Health Care Statistics • Healthcare is one of the top social and economic problems facing Americans today. • Healthcare expenditures in the United States exceed $2 trillion a year. In comparison, the federal budget is $3 trillion a year. • The amount people pay for health insurance increased 30 percent from 2001 to 2005, while income for the same period of time only increased 3 percent, as reported by the Robert Wood Johnson Foundation. • Nearly 50 million Americans do not have health insurance, while another 25 million are underinsured. • The typical family health insurance plan costs $12,000 a year or more. • In a study completed by the Commonwealth Fund, 45 percent of the adults in the survey reported that they had a hard time paying their bills, even with health insurance, and had been contacted by a collection agency or had to change their way of life in an effort to pay their medical bills. • Approximately 50 percent of personal bankruptcies are due to medical expenses. • According to a Kaiser Family Foundation poll, 28 percent of middle income families (annual family income between $30,000 and $75,000) stated that they were currently having a serious problem paying for healthcare or health insurance • http://www.healthcareproblems.org/

4. BACKGROUNDThe Healthcare System • Health Care Statistics (Continue..) • Most Americans would agree that health care reform needs to happen. • The United States is fast becoming one of the worst health care systems in the world even though they have one of the highest rates for health care expenditures. • One of the biggest and most costly aspects of health care is the treatment of chronic diseases. It will be hard to make insurance affordable without changing how chronic disease is treated. • Many of the problems with health care that are affecting Americans today, come from lack of access to preventative care. • http://www.healthcareproblems.org/

5. The Health Advisor Overview

6. CASE BACKGROUND PARKINSON’S DISEASE Parkinson's disease occurs when certain nerve cells, or neurons, in an area of the brain known as the substantia nigra die or become impaired. Normally, these neurons produce an important brain chemical known as dopamine. Dopamine is a chemical messenger responsible for transmitting signals between the substantia nigra and the next "relay station" of the brain, the corpus striatum, to produce smooth, purposeful muscle activity. Loss of dopamine causes the nerve cells of the striatum to fire out of control, leaving patients unable to direct or control their movements in a normal manner.

7. CASE BACKGROUND PARKINSON’S DISEASE Possible Causes One theory holds that free radicals - unstable and potentially damaging molecules generated by normal chemical reactions in the body - may contribute to nerve cell death thereby leading to Parkinson's disease. Free radicals are unstable because they lack one electron; in an attempt to replace this missing electron, free radicals react with neighboring molecules (especially metals such as iron), in a process called oxidation. Oxidation is thought to cause damage to tissues, including neurons. Normally, free radical damage is kept under control by antioxidants, chemicals that protect cells from this damage. Evidence that oxidative mechanisms may cause or contribute to Parkinson's disease includes the finding that patients with the disease have increased brain levels of iron, especially in the substantia nigra, and decreased levels of ferritin, which serves as a protective mechanism by forming a ring around the iron, and isolating it. Some scientists have suggested that Parkinson's disease may occur when either an external or an internal toxin selectively destroys dopaminergic neurons. An environmental risk factor such as exposure to pesticides or a toxin in the food supply is an example of the kind of external trigger that could hypothetically cause Parkinson's disease. The theory is based on the fact that there are a number of toxins, such as 1-methyl-4-phenyl-1,2,3,6,-tetrahydropyridine (MPTP) and neuroleptic drugs, known to induce parkinsonian symptoms in humans. So far, however, no research has provided conclusive proof that a toxin is the cause of the disease. A relatively new theory explores the role of genetic factors in the development of Parkinson's disease. Fifteen to twenty percent of Parkinson's patients have a close relative who has experienced parkinsonian symptoms (such as a tremor).

8. CASE BACKGROUND PARKINSON’S DISEASE (continued..)CLINICAL MOTOR AND NONMOTOR FEATURES Motor Features

9. CASE BACKGROUND PARKINSON’S DISEASE (continued..)CLINICAL MOTOR AND NONMOTOR FEATURES Nonmotor Features

10. CASE BACKGROUND PARKINSON’S DISEASE (continued..)CLINICAL MOTOR AND NONMOTOR RATING SCALES PD Rating Scales: Motor Symptoms

11. CASE BACKGROUND PARKINSON’S DISEASE (continued..)CLINICAL MOTOR AND NONMOTOR RATING SCALES PD Rating Scales: HRQOL

12. CASE BACKGROUND PARKINSON’S DISEASE (continued..)EFFECTIVE TREATMENT STRATEGY • The primary goal of current pharmacologic therapy for PD is to replenish depleted stores of dopamine. • levodopa with dopa-decarboxylase inhibitors (DDIs) (eg, carbidopa, benserazide) and catechol-O-methyltransferase (COMT) (eg, entacapone, tolcapone) inhibitors. • dopamine agonists. • MAO-B inhibitors. • L-DOPA (3,4-dihydroxy-L-phenylalanine) is a naturally occurring amino acid found in food and made from L-Tyrosine in the human body • Dopamine receptor agonists were originally developed as adjunct therapy to levodopa to treat motor fluctuations, but the more recently introduced nonergot agonists are approved for initial monotherapy as well and are often administered as part of a treatment strategy designed to delay initiation of levodopa therapy. • Monoamine oxidase-B inhibitors (eg, selegiline, rasagiline) block the breakdown of dopamine to dihydroxyphenylacetic acid in the brain, resulting in an increased supply of dopamine. As a result, inhibition of MAO-B can increase the dopaminergic response without requiring an increase in levodopa dosage. Treatment with MAO-B inhibitors has also been employed by some neurologists as a potential disease-modifying strategy. In prospective, double-blind, controlled trials, treatment with first-generation MAO-B inhibitor selegiline delayed the progression of disability in patients who had not received previous treatment for PD. However, selegiline is metabolized to amphetamine and methamphetamine metabolites, which may induce sleep disturbances and hallucinations in susceptible patients.

13. CASE BACKGROUND PARKINSON’S DISEASE (continued..) Treatment Summary • Early Diagnosing of PD is challenging • Recognition of subtle, nonmotor signs crucial • Effective management of PD • should involve individualized, patient-focused perspective • Minimize disability • Improve HRQOL • Achieve treatment success

14. THE GAIA METHODOLOGY ANALYSIS AND DESIGN FOR AN AGENT-BASED SYSTEM

15. THE GAIA METHODOLOGY ANALYSIS AND DESIGN FOR AN AGENT-BASED SYSTEM

16. CASE ANALYSIS PHASE THE PARKINSON’S DISEASE CASE • THE ORGANIZATION (The Health Advisor does not have to be divided into Sub-organizations) • THE ENVIRONMENT (All the entities and resources that the MAS can exploit, control or consume) • Diagnosis Information (Illness) • Patient Personal Information (Name, Age, Ethnic, Health Insurance) • Patient’s answers to Rating Scale and Health Related quality of Life (HRQOL) questionnaire • Web database of illness information • Web database of Treatment information for all illnesses • Web database of Health Insurance • Web database of Health Care Providers (Hospitals, Clinics, Doctors, Locations, and cost/treatment) • Web database of Health Care Providers’ History and Statistical Records • Knowledge of particular illness (Parkinson’s) features • Knowledge of particular illness (Parkinson’s) development rating scales • Patient’s History Database

17. CASE ANALYSIS PHASE THE PARKINSON’S DISEASE CASE ROLES MODEL (What is each entity expected to do in the organization)

18. CASE ANALYSIS PHASE THE PARKINSON’S DISEASE CASE ROLES MODEL (Continued..)

19. CASE ANALYSIS PHASE THE PARKINSON’S DISEASE CASE ROLES MODEL (Continued..)

20. CASE ANALYSIS PHASE THE PARKINSON’S DISEASE CASE ROLES MODEL (Continued..) • Similar schemas will be created for the following Roles: • Treatment Finder • Health Care Provider Finder • Cost per Health Care Provider Finder • Risk per Health Care Provider Finder • Report Generator • Patient Monitor

21. CASE ANALYSIS PHASE THE PARKINSON’S DISEASE CASE INTERACTIONS MODEL (Message Interchanges)

22. CASE ANALYSIS PHASE THE PARKINSON’S DISEASE CASE INTERACTIONS MODEL (Continued..) • Similar schemas will be created for the following Interactions: • Send diagnosis description to Treatment finder • Store Patient’s info in patient’s history database • Send diagnosis description to Treatment finder • Send progress assessment to Treatment finder • Store progress assessment in Patient’s History Database • Send progress assessment to Report Generator • Send list of treatments to Health Care Provider finder • Send Health Care Providers list to Cost finder • Send Health Care Providers list to Risk finder • Send Health Care Providers list in location order to the Report Generator • Send Health Care Providers list in cost order to the Report Generator • Send answers of questionnaire to Monitor

23. CASE ANALYSIS PHASE THE PARKINSON’S DISEASE CASE INTERACTIONS MODEL (Continued..) ORGANIZATIONAL STRUCTURE Peer to Peer ?

24. CASE DESIGN PHASE THE PARKINSON’S DISEASE CASE AGENT MODEL

25. CASE DESIGN PHASE THE PARKINSON’S DISEASE CASE AGENT MODEL (Continued..)

26. CASE DESIGN PHASE THE PARKINSON’S DISEASE CASE AGENT MODEL (Continued..)

27. CASE DESIGN PHASE THE PARKINSON’S DISEASE CASE SERVICES MODEL

28. CASE DESIGN PHASE THE PARKINSON’S DISEASE CASE SERVICES MODEL (Continued..)

29. FUTURE DEVELOPMENTS THE HEALTH ADVISOR A FEW MORE REVISIONS NEEDED TO MAKE SURE IT IS A COHERENT SYSTEM IMPLEMENTATION (Possibly in Java)

30. QUESTIONS THE HEALTH ADVISOR