CHICAGO (360Dx) – Telemedicine, online consultation, professional crowdsourcing of medical information, and diagnostic decision support all took major steps forward this month when the Human Diagnosis Project brought in more than half a dozen partners in an effort to expand specialty care to underserved populations in the US.
The Human Diagnosis Project, or Human Dx, has ambitious plans to, as the San Francisco-based organization has said, create "one open health system for all."
Last week, Human Dx announced an alliance with the American Medical Association, the American Board of Internal Medicine and its foundation; the American Board of Medical Specialties; the Association of American Medical Colleges; the Association of Clinicians for the Underserved; the National Association of Community Health Centers; and the Dartmouth Institute for Health Policy and Clinical Practice.
Over the next five years, the alliance expects to scale the Human Dx system to support "the US medical safety net and help close the specialty-care gap for 30 million patients," according to a statement from the group. In the coming decades, Human Dx will work to expand the alliance globally "as it builds one open health system for all," the alliance added.
As part of that effort, Human Dx seeks to integrate data — including eventually genomic, epigenomic, and proteomic data, along with published medical research and health outcomes data — in order to inform doctors’ diagnoses.
Human Dx previously has said it seeks 100,000 volunteer physicians to provide electronic consultations 3 million underserved patients in the US through 2022. Eventually, the group wants to be able to help all safety-net patients in the country and then set its sights on international markets.
This alliance will build on existing research projects Human Dx has with Harvard Medical School, the Johns Hopkins University School of Medicine, and the University of California, San Francisco, Medical Center.
"Millions in this country and more than a billion people worldwide lack access to the healthcare they need, so they choose between paying for it themselves and being forced into poverty, or not getting it and becoming sicker or dying as a result," Jayanth Komarneni, founder and chair of Human Dx, said in a statement.
"Thousands of doctors from over 70 countries are tired of this and have come together to build a solution. By contributing to Human Dx, doctors will expand access to help people get the care they need, beginning with the underserved: first here in America, and ultimately worldwide," Komarneni continued.
The Human Dx platform facilitates online consultations, clinical decision support from published research and colleagues alike, and continuing education for clinicians.
"Human Dx has the potential to improve the health and well-being of patients in this country, and ultimately across the globe," ABMS President and CEO Lois Margaret Nora added in the same statement.
Neither Human Dx nor the AMA — the primary partner in the alliance — made a representative available for an interview for this story.
The groups will be leaning heavily on the 22,000 clinicians practicing at 10,000 community health centers across the US, as represented by the National Association of Community Health Centers.
In the design and implementation plan of the partnership, Human Dx designated NACHC as the liaison to primary care.
"Our populations are very underserved," said Ron Yee, chief medical officer of NACHC. He noted that about 50 percent of the estimated 25 million patients at community health centers nationwide are on Medicaid and that another 20 percent are uninsured. "It was a very natural fit," Yee said.
Human Dx Director Shantanu Nundy, a practicing primary care physician at a federally qualified health center in Washington, personally invited NACHC to participate, according to Yee, who used to work with the recently hired Human Dx medical director, Seiji Hayashi.
The five-year collaboration project will affect 3 million patients at 8,000 rural and urban community health centers across the US, often including special populations. (Yee noted that he practiced for 20 years in communities that included migrant farm workers.)
"I think it's a reasonable starting point," Yee said of the size of the targeted population. "It's a stretch goal, but I think it's very doable," he said.
NACHC already is implementing 15 different primary care projects on behalf of the US Centers for Disease Control and Prevention, Yee said. "They have great evidence-based guidelines on paper," Yee noted, but those need to be digitized to fit new workflows supporting electronic health records.
NACHC will help incorporate Human Dx technology into primary care in safety-net clinics and to bring so-called social determinants of health into the equation.
"What does this look like when the patient doesn't have refrigeration for insulin?" Yee wondered. What happens when a patient doesn't have transportation to a clinic or is homeless or there are language barriers? "How do we move the dial?"
NACHC and the other partners will be working to overcome longstanding resistance to clinical decision support systems and practice guidelines that long have been derided as "cookbook medicine" by busy, stubborn, or paternalistic physicians.
"You don't want cookbook medicine," Yee said. "But you have to have enough humility … and be willing to be taught and to learn from your colleagues around the globe."
Yee called the Human Dx platform the "right combination" of technology, collaboration, and evidence to produce more accurate diagnoses and improve care in underserved communities.
"You will never replicate the face-to-face encounter and the detailed questions you ask" with computer-generated protocols and questionnaires, Yee said. However, he expects the technology to "round out a collective evidence base and experience."
Human Dx continually adds to the evidence base as new studies are published and as databases are augmented with new records. "You're actually learning from each case," Yee said. This creates what he called a "learning community."
The Dartmouth Institute for Health Policy and Clinical Practice — producer of John Wennberg's Dartmouth Atlas of Health Care — is responsible for developing metrics and measuring outcomes for the Human Dx Alliance.
The Dartmouth Institute researches performance of health systems with an eye on the "triple aim" of better care, improved population health, and lower costs. "We're trying to look at all aspects of the triple aim," said Karen Schifferdecker, director of the Dartmouth Center for Program Design and Evaluation.
As it has done elsewhere, the Dartmouth Institute will be applying publicly available data from Medicare, but it will be expanding its work to suit the nature of targeted populations for Human Dx. "We will be relying more on Medicaid data than we had in the past," Schifferdecker said.
"We also will be looking at populations and longer-term outcomes," according to Schifferdecker. For example, do interventions by primary care physicians for patients with chronic diseases reduce referrals to specialists?
"By having e-consults available to them, they're better able to meet the needs of patients," Schifferdecker suggested.
Since the alliance is brand new, "Many things still need to be worked out," Schifferdecker said. "It's a big project," she noted.
One of the most pressing issues, of course, is funding.
Human Dx has beaten out some 1,900 other proposals to become 1 of 8 semifinalists in 100&Change, a John D. and Catherine T. MacArthur Foundation competition for a single $100 million grant to a project that will create "real and measurable progress in solving a critical problem of our time."
Next month, the MacArthur Foundation will whittle the list of semifinalists down to five finalists, who will then present their final proposals in a live event in December before a winner is chosen.
Human Dx will look for other philanthropic funding if it doesn't win the substantial MacArthur grant, Yee said.