Q&A with Bill Davenhall on Medical Place History, TEDMED, and the Importance of a Story Well Told

11/10/10Follow @bvbigelow

A little more than a year ago, ESRI’s Bill Davenhall delivered a thought-provoking talk at TEDMED about the importance of including a “place history”—a record of the places where a person has lived (and the nearby environmental risks)—as part of that person’s medical history. (Watch a video of Davenhall’s talk here.)

ESRI, based in Redlands, CA, is the world’s largest developer of geographic information system (GIS) software, and at its annual conference in July, ESRI unveiled its first GIS mobile mapping app for the iPhone and iPad, which is free. ESRI also highlighted related “crowdsourcing” initiatives that extend its mapping technology beyond its usual Windows-based market.

Last week, ESRI added a new app to the Apple iStore and to its Web-based offerings that begins to fulfill the vision that Davenhall outlined at the 2009 TEDMED conference in San Diego. (ESRI used its proprietary ArcGIS technology to develop the mapping API for mobile devices running Apple’s operating system.)

The app, which also is available on ESRI’s website, is pretty simple to use. You can enter the address, zip code, or even just a city name for every place you’ve lived, and the system responds with information about public health and environmental hazards for each location. The app draws upon publicly available data concerning the incidence of heart attacks (per 100,000 Medicare enrollees) from the Dartmouth Atlas Project, and lists of chemicals within three miles, according to data drawn from the Environmental Protection Agency’s Toxics Release Inventory and the National Institutes of Health’s known chemical database. ESRI spokesman Bob Ruschman says, “Future versions will include additional databases for water quality, lead contamination, cancer, mortality, and poverty.”

Bill Davenhall

Bill Davenhall

As ESRI’s global marketing manager for health and human services, Davenhall contends that a patient’s place history is just as important in assessing human health risks as genetics and lifestyle. In a medical evaluation, Davenhall says physicians will ask a lot of questions about a patient’s medical history: Any allergies? Taking any medications? How about illicit drugs? Drink alcohol? Smoke tobacco? Any previous hospitalizations? Davenhall says doctors never ask, “Have you ever lived within 120 yards of a major freeway or highway?”—but they should.

“The one thing that never happens in my doctor’s office,” Davenhall said in his TEDMED talk, “They never ask me about my place history.”

In a phone interview yesterday, I talked with Davenhall about ESRI’s medical place history app and the highlights of everything that has happened since his TEDMED talk last year. Here’s our exchange, edited for length and clarity:

Xconomy: What has happened since you gave your TEDMED talk a year ago?

Bill Davenhall: The TEDMED people asked me to prepare an impact statement of sorts. It ended up being much bigger than I had even thought in terms of the event itself because of the energy that an event like that creates for a new idea. It wasn’t really in many ways what I was saying. It was how I was saying it and putting it in perspective. It was sort of back to this notion that I was popularizing this idea that conceptually had been around for some time, but was put in a new wrapper. The thumbnail on this is that many of us underestimate the power of a story well told.

X: Are you still seeing strong interest these days?

BD: The people who came back to TEDMED 2010—I’d say anybody who was there last year picked back up when they saw me, and they re-engaged. The story hadn’t gotten old. In other words, they were still very much interested. Of course, we tried to get the app actually delivered at TEDMED, but it was not possible. The Apple approval gods were just not on our side. We contracted out [the app development], and there were some little glitches that occurred that we weren’t able to be correct in time to get through the process.

X: How would people actually use this?

BD: Before I go there, there’s one other thing I want to tell you. One result of the TEDMED thing was I was invited to go to the national meeting of the TRI (Toxics Release Inventory). Now can you believe this? The EPA has had a conference for like 12 years on the database that I used. There were 250 or 300 people there who had spent their whole lives, since 1987, caring, feeding, worrying about this database. They invited me to put a new face on it. So I showed up and gave them this presentation, which I would have to say that many of them were stunned by it. Basically I was saying here’s a different way to tell your story, and here’s this application that’s going to do it. Even though the EPA does have applications like this, you’d have to exactly know what you’re looking for before you could find it. It’s sort of hidden under bureaucratic-type technology thinking. It’s not that they’re on a different path than I’m on, it’s just that they’ve been so focused on the technology part of it that they have failed to recognize why people engage with technology. We engage because we’re curious, we want to improve our understanding. It’s not just for the sake of having a cool app.

X: So what are you doing with this app?

BD: It’s about your place history. The example is toxic chemicals. But it could just as easily be put to use in a whole wide variety of things. Say you want to look at a lifetime of real estate values of the places where you have lived. Or you want to look at a lifetime of energy consumption where you have lived. When you start to think of all the things that are related to place, you realize there are social things, cultural things, health things, police things, fire things. Now what we want to do is re-aggregate the data in a different fashion. We want to say this is our place, now all you people who have data that is relevant to that place come on, bring it into this application. We wanted something that would transcend any individual marketplace.

X: OK. So then what?

BD: The next phase in this whole thing of my place history is we’re giving people this information in terms of toxic releases and what’s? around them. Now people are asking, “What does it mean? What’s the difference between chromium and copper?” So it’s back to the technology drawing board. Now we have to move to this next phase where people begin to focus on how do we explain this data, and how do we get it so it can be useful to the consumer or useful to the physician.

X: I’ve talked to some doctors who say environmental risks are important, but most chemicals are practically impossible to correlate to specific ailments. They say it makes more sense to understand a patient’s genetic makeup and lifestyle because that can be more directly tied to health.

BD: The EPA says on the front page of their TRI database that the database is to inform consumers about what exists in their community. It’s not to prove that it causes any kind of disease. They’re just providing the information. Medical practice hasn’t incorporated this analytical framework yet, so that’s another thing this app is trying to do. You know, somebody in medicine stopped blood-letting [as a medical treatment], it only took 200 years. I’m not suggesting this will be quick. I’ve got interest at the Institute of Medicine at the National Institutes of Health, where they’re beginning to really seriously think about this, about how they would drive more geo-medicine into their curriculums.

Bruce V. Bigelow is the editor of Xconomy San Diego. You can e-mail him at bbigelow@xconomy.com or call (619) 669-8788 Follow @bvbigelow

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