The Human Diagnosis Project
Crowdsourcing Patient Cases for Future Diagnoses
Health Tech | Shiv Gaglani
We recently learned about the Human Diagnosis (Human Dx) Project, which is a global initiative that aims to map any health problem to its possible diagnosis. In using their private mobile app that enables clinicians and medical students to share and solve patient cases, I decided to reach out to their chief medical officer, Shantanu Nundy, MD, who has a background in medicine, public health, business, and technology.
What was the impetus for the Human Dx Project?
The Human Dx Project started over 2 years ago. While I only joined the team recently, I have been thinking about the problem Human Dx is trying to solve for a long time.
When I was a medical student, I saw a patient no one could diagnose. She was a 30-year-old marine stationed in South East Asia, who was in an excellent health until a year earlier when she developed recurrent, nightly fevers that left her disabled. Over the next 12 months, she went from hospital to hospital without a diagnosis, starting with the local naval clinic, then the regional base, then Germany, then Walter Reed, and finally Johns Hopkins Hospital where I was a student. On the last day of her hospitalization, just as she was about to be discharged, a retired infectious disease physician barged into her room and diagnosed her in 15 minutes. Within a few months, she was back to her usual health.
The case left me stunned. Somebody, somewhere knew how to help this patient. Yet, despite access to many of the world’s top medical institutions, it was only by luck and happenstance that she finally got better.
This patient’s dilemma is not unique. To nearly every person on Earth, the well-being of oneself and one’s loved ones is the most important concern. And, yet, the most essential question of human well-being is still very difficult to answer: when someone has a health problem, what steps should he or she take to get better? The Human Dx Project intends to answer that question for current and future generations.
What are your goals for the initiative within 1 year? Five years?
Today, Human Dx is being pilot-tested with physicians and medical students at some of the world’s leading academic medical institutions including Harvard, Hopkins, UCSF, Stanford, and Penn. The Project is supported by many of the top thinkers in clinical medicine and public health including Peter Pronovost, MD (Professor of Medicine, Johns Hopkins), Bob Wachter, MD (former chair of the American Board of Internal Medicine), Mike Klag, MD (Dean of Johns Hopkins Bloomberg School of Public Health), Gurpreet Dhaliwal, MD (Professor of Medicine, UCSF), and Tom Lee ,MD (Founder, One Medical Group).
Within 1 year, we aim to build the largest open project in medicine, with over 10,000 physicians and medical students contributing to the Project. Within 5 years, we aim to scale to over 100,000 contributors from the medical, scientific, and patient communities. Our mission is to empower anyone, anywhere, with the world’s collective medical insight.
How many cases are in the Human Dx library?
Human Dx currently has around 500 cases, a number that grows every day.
Please describe uses of the Human Dx initiative.
The primary reason why physicians and medical students (referred to as “contributors”) lend their efforts to the Human Dx Project is a shared interest in the project’s mission: to empower anyone, anywhere, with the world’s collective medical insight. In doing so, there are also practical benefits to each contributor. In 5 minutes, any member of the medical community can give and receive input on clinical cases from around the world. This enables them to:
- access the collective insights of colleagues and the medical community on complex clinical cases.
- accelerate personalized learning and clinical reasoning in many different fields of medicine, using rapid case simulation and feedback.
- store, modify, and share anonymized cases seen in the field, for personal reference and professional use.
- garner broader recognition within the medical community for problem solving capabilities and topical knowledge.
How can a cardiologist benefit from and/or contribute to Human Dx?
Cardiovascular disease is the number one cause of death globally and the vast majority of these deaths occur in low- and middle-income countries where access to health care is limited. As experts in the diagnosis and management of cardiovascular disease, cardiologists have an enormous amount of clinical insight to contribute to the Human Dx Project and, in doing so, make a significant impact on global health.
Some of the best diagnosticians I know and trained with are cardiologists. We need the best minds in clinical medicine helping us build the Human Dx Project.
Can you share your background on how you got to where you are right now?
Before medical school, I started doing research in medical malpractice. That introduced to the Institute of Medicine’s “To Err is Human” report. As someone who wanted to be a doctor since I was a kid to help people, I was shocked to learn that doctors sometimes hurt patients more than they helped them. In medical school, I got involved with patient safety efforts to reduce bloodstream-related catheter infections in the ICU and improve teamwork in the OR. Affecting immediate change in healthcare practice was exhilarating. From patient safety I went into healthcare quality to health systems and finally to population health.
Along the way, I became more and more of an “accidental technologist.” Health care is incredibly local; fix a problem here and you’ve fixed a problem here. Everyone deserves the best available health care, and technology is one of the best tools available to drive impact on a global scale.
ACC Efforts Result in ABIM Decision to Decouple Board Certification from Initial MOC Enrollment
In a major reversal, the American Board of Internal Medicine (ABIM) announced it is reversing its policy requiring physicians who have passed the initial Certification exam in 2014 or later to have enrolled in the Maintenance of Certification (MOC) process in order to be listed as board certified. Effective immediately, physicians who are meeting all other programmatic requirements will not lose certification simply for failure to enroll in MOC. This decision is a direct result of ACC’s efforts over the last 2 months seeking an expedited resolution of this issue by ABIM.
In May, College leadership was made aware of an email from ABIM to early career cardiologists who had passed the Cardiovascular Disease Certification Exam in 2014. The email informed them of the need to enroll in MOC by March 31, 2015, in order to be publicly reported as certified in Cardiovascular Disease. It also stated their certification would remain valid only as long as they were participating in MOC. Concerned about the implications of this new process, ACC leadership engaged ABIM leaders immediately, encouraging them to level the playing field for all diplomats.
“By tying together board certification and enrollment in Maintenance of Certification, the American Board of Internal Medicine appeared to devalue the secure examination passed by recently certified physicians, by setting different standards for them compared to those certified in previous years. The ABIM should be commended for recognizing the negative impact of this policy on current and future employment opportunities, particularly for those in the early stages of their careers, and taking the steps necessary to reverse it,” said ACC President Kim Allan Williams, Sr., MD, FACC.
This recent ABIM decision follows several other major changes to MOC over the last year that have occurred as a result of continued advocacy by ACC, other cardiology specialty societies, and internal medicine stakeholders on behalf of their members. On July 1, the ABIM announced it was eliminating the “double jeopardy” requirement to maintain underlying certification in a foundational discipline in order to remain certified in a subspecialty, effective Jan. 1, 2016. For cardiologists, this means that those specializing in interventional cardiology, electrophysiology, advanced heart failure and transplantation, and adult congenital heart disease no longer need to maintain certification in general cardiology in in order to maintain certification in a cardiology subspecialty. Other changes include an updated “Application for ABIM MOC Recognition” that provides more opportunities for physicians to earn MOC Part II points for activities with a self-assessment component that have traditionally been designated as CME credits only, and a suspension for at least two years for MOC Part IV practice improvement modules along with patient safety and patient voice requirements.
“The ACC and its members are being heard and this will no doubt continue,” said Williams. “The College is continually engaged with ABIM with a goal of engendering a constant dialogue and an atmosphere of change for the benefit of our members and their patients.” An ACC Task Force is currently identifying how best to work with the ABIM to address additional recommendations, while a second ACC Task Force is also exploring alternatives to ABIM MOC accreditation. Recommendations of both Task Forces are due to the Board of Trustees this month.
Shiv Gaglani is an MD/MBA candidate at the Johns Hopkins School of Medicine and Harvard Business School. He writes about trends in medicine and technology and has had his work published in Medgadget, The Atlantic, and Emergency Physicians Monthly.
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