Humanwide personalizes prevention
Pilot program focuses on preventive care
For years, physicians have sought ways to help their patients manage health risks and avert disease before it strikes. Now, a Stanford Medicine pilot program called Humanwide offers a promising new model to do just that, demonstrating how personalized, preventive care that combines biomedicine, digital health and a collaborative team-based approach can lead patients to healthier lives.
“Our vision of precision health is to predict, prevent and cure — precisely,” said Lloyd Minor, MD, dean of the School of Medicine. “Humanwide is that vision realized in a clinical setting. There is so much that each of us can do to be engaged proactively in our health and our well-being.”
In the Humanwide program, a care team partnered with each patient to create a comprehensive portrait of their health, using data from wearable devices, genetic and genomic testing, and wellness assessments. They used this knowledge to map a custom care journey for each patient, helping them achieve personal goals such as losing weight, managing stress or getting a chronic condition under control. In some cases, they helped patients understand and manage health risks when they had a family history of illness or genetic propensity for a disease.
The goal was to shift the health care focus upstream, using the latest technology to predict disease in time to prevent it or mitigate its impact, said Megan Mahoney, MD, Stanford Medicine’s chief of general primary care.
“With Humanwide, we’re able to focus on the whole human: who they are when they’re working, who they are when they’re playing, who they are when they’re at home,” she said. “This program demonstrates how we can zero in on what matters to a patient to craft the entire care plan around their goals.”
David Entwistle, president and CEO of Stanford Health Care, said the pilot paves the way for a new mindset about patient wellness.
“Looking at genomic data and other factors that actually predict patient health allows us to be proactive instead of waiting for something to happen and having to react to that,” he said. “Humanwide is an opportunity to build a deep understanding of each patient in a unique way.”
Gathering the data
Over the course of a year at Stanford’s Santa Clara clinic, 50 patients who were enrolled in the Humanwide project joined their primary care providers to take a deep dive into their own data.
They underwent family history and genetic assessments to gauge their risk for certain cancers and other diseases. Another screening evaluated how their genes influence their response to different medications — why some drugs may be more effective for them than others. And the providers interviewed the patients extensively, cataloging the behavioral, environmental and social factors that can influence health.
The patients then received tools to gather more data: a glucometer, a scale, a blood pressure cuff and a pedometer. Regular measurements taken at home automatically uploaded into patients’ electronic health records. Their care team monitored the data remotely and analyzed it in the context of the patients’ other health factors.
“We saw this as an opportunity to bring in data that was previously not available, giving us an unprecedented understanding of our patients’ health risks,” Mahoney said. “It gave us the ability to proactively take care of them in a way we’ve never had before.”
The patients welcomed the prospect of learning more about their health, receiving answers for persistent questions, and working with a certified health coach to define personal goals and create a plan for attaining them.
For Eugene Celis, 43, that meant finding out once and for all if he had high blood pressure and identifying a way to lower the level of triglycerides in his blood. Both were particular concerns because of his family’s history of heart disease.
Regular tracking through a portable blood pressure cuff indicated that Celis’ readings were high, even though the measurements had been normal at doctor appointments. Through Humanwide, a team of clinicians confirmed
the diagnosis and prescribed medication to manage his blood pressure. A health coach encouraged him to improve his diet and increase his physical activity.
Though it was difficult to accept his new reality, Celis felt confident in the diagnosis because it was backed by data he collected himself.
“I like the fact that they’re doing it systematically, not just guessing,” he said. “What motivates me about this program is that I see the results in real time.”
Early warning signs
Humanwide’s comprehensive, predictive approach flagged a number of early health concerns previously unknown to the patients. For example, five women learned they had a high risk for breast cancer and were recommended for enhanced surveillance.
Data from at-home devices helped providers identify and address prediabetes in several patients, as well as more quickly fine-tune medication dosages for others with chronic illnesses. Evaluating genetic influence on medication responses also helped clinicians better match drugs and dosages to the biology of individual patients.
For participant Debbie Spaizman, the evaluation was a breakthrough. Some types of narcotic pain medication made her feel woozy and itchy without any pain relief. Spaizman had nasal surgery coming up, and she didn’t want to repeat the experience.
What motivates me about this program is that I see the results in real time.
Through Humanwide, she found out that her body metabolizes some types of medications more slowly and less effectively, and that other types would be better for relieving her pain without the side effects.
“It was life-changing,” Spaizman, 53, said. “I finally understood why I react this way, and I got answers about what drugs I could take instead.”
An early evaluation of the Humanwide pilot found that both patients and providers liked its holistic focus, the care-team model and the longer interactions it allowed, said Steven Asch, MD, vice chief of primary care and population health, who led the analysis.
Mahoney and her team now are tailoring the program to more precisely fit the needs of healthy, chronically ill and medically complex patients.
“There’s an unmet need — a lot of people are walking around with risk factors that are currently going undiagnosed,” she said.
“With Humanwide, we’re able to diagnose them so that patients can take action toward eliminating those risks. That’s really the promise, and that’s exciting.”