Download Realizing The Promise Of Individualized Health

Realizing the Promise of
individualized Health
Hopkins inHealth
Johns Hopkins will
advance population health through the
intelligent use of information to
individualize health promotion, disease
prevention, detection, and treatment.
By rights, the American population should be the
healthiest in the world. The United States is a world leader in advanced medical
technologies and practice. Its citizens spend almost twice as much on medical care as citizens of other
developed countries.1 Yet this extraordinary investment pays a poor return when it comes to citizens’
overall health. United States ranks 26th in life expectancy, 31st in infant mortality, and first in the
incidence of adult obesity out of the 34 OECD countries.1
What’s behind this extraordinary waste of resources? Poor use of health information-- false health
beliefs combined with non-scientific use of health data--is a substantial root cause. For example, it
makes sense to most Americans that more medical care is better care; most believe that controlling
consumption of medical services amounts to “rationing.” More care may help to treat illnesses for
which there are well-defined solutions. Yet only 15 percent of the $500 billion Medicare spends
annually goes toward “effective” or “necessary” care: treatments that provide benefits that
substantially outweigh their risks2. Moreover, each medical contact increases the likelihood of
medical errors, false positive diagnoses that can expose patients to risky treatments, or the
unproductive use of limited resources. As Dartmouth Professor Gilbert Welch recently asked in the
New York Times: “Isn’t it time to learn which practices, in fact, improve our health, and which ones
don’t?”3
While Americans struggle with the abundance and complexity of existing health information, a
tsunami of new information is reaching its crest. Twenty years ago, revolutions in biotechnology and
information unleashed an earthquake of new bioscience and medical data— DNA sequences, RNA
expression levels, protein structures, epigenetic markers, structural and functional images of the
brain, and other “big data.” This wave of information represents both a challenge and an opportunity.
Creative use of the emerging biological data can unravel the mysteries of an individual’s health and
disease. These data can help us to understand what distinguishes one person from another and to
tailor prevention, diagnosis and treatment to improve health dramatically. By allowing us to manage
health and disease on an individual level, this emerging data can also reduce the waste in our current
health expenditures.
The goal of the Johns Hopkins individualized Health Initiative or “Hopkins inHealth” is to develop and
disseminate tools that facilitate the intelligent use of existing and emerging information to
individualized health and health care. Toward this end, Hopkins inHealth will discover how best to
define, measure, and communicate each person’s health state and the trajectory along which it is
changing, and use these measurements to guide that trajectory in ways that enhance health and
quality of life.
A compelling example involves screening for common cancers. By integrating population data about
the age and risk factor-specific prevalence rates with personal data on family history and other
factors, we can individualize each person’s cancer screening protocol. Doing so increases the chance of
detecting the cancer early, while minimizing the risk and costs of false-positive screens and
inappropriate invasive tests or treatments. Each person’s risk of developing one of the major cancers
is unique; therefore, each should have a unique screening algorithm. In addition, Johns Hopkins and
other institutions are developing new genomic and epigenetic screening tools. These tests will
1
See OECD Health Data 2011—Frequently requested data. Accessed online 08/30/11 at:
http://www.oecd.org/document/16/0,3343,en_2649_34631_2085200_1_1_1_1,00.html
Wennberg E. 2010. Tracking medicine. Oxford University Press, New York, page 8.
Welch, H. Gilbert. 2012. Testing what we think we know. New York Times, Aug 19.
http://www.nytimes.com/2012/08/20/opinion/testing-standard-medical-practices.html
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generate a new kind of information that can further individualize detection and treatment, then
substantially increase savings over the coming decade.
Through the inHealth Initiative, three Johns Hopkins Institutions — the University, Johns Hopkins
Health System, and the Applied Physics Laboratory — will combine their assets to demonstrate how to
use health information effectively to make world-class, affordable health a 21st- century American
reality. They will first demonstrate the value of a new information-based strategy in populations
managed by the Johns Hopkins Health System. They will then share the approach with the much larger
Department of Defense and Veterans Administration populations via the Johns Hopkins Military and
Veterans Health Institute. These efforts will lead the way forward for society as a whole.
Johns Hopkins is uniquely qualified to discover, implement, and disseminate information-based
solutions to key aspects of the American health crisis. Collectively, the Johns Hopkins Schools of Public
Health, Medicine and Nursing comprise the best academic health institutions in the world. Faculty in
Johns Hopkins’ schools of Engineering and Arts and Sciences, and scientists at the Applied Physics
Laboratory bring world-class expertise in statistics, applied mathematics, computer science, and
systems engineering. Johns Hopkins has a strong tradition of entrepreneurial faculty seeking
solutions to societal problems. The Johns Hopkins Health System, rated among the best in the United
States for more than two decades, is poised to innovate by testing information-driven, individualized
health tools. It has 275,000 health-plan members with whom health decision-support tools can be
implemented and continuously improved. The Applied Physics Laboratory (APL) is an internationally
renowned leader in designing and engineering information-systems to solve complex problems. APL
will disseminate Johns Hopkins inHealth advances to the Department of Defense, for whom it serves as
a trusted agent, expanding the utility of Johns Hopkins discoveries to the country as a whole.
Hopkins inHealth is ambitious. It is our plan to lead, from the inside out, a transformation toward
intelligent use of health data in the American health care system. It starts with the individual –
empowering each person to use information, including emerging, complex data, to take full
responsibility for his or her health and healthcare choices. Hopkins inHealth also has sharp focus. The
initiative will create and continuously update a list of the top ten targets necessary to advance
affordable health. Individualizing cancer screening is first on the list. Johns Hopkins solutions will be
tested locally, then disseminated internationally. Building on its strength as a trusted provider of
world-class medicine, Johns Hopkins will become a promoter of world-class health.
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What is the objective of the Johns Hopkins Individualized Health Initiative, or Hopkins
inHealth?
In simplest terms, Hopkins inHealth (HiH) is an initiative to discover, test, and implement health
information tools that allow the individual to understand, track, and guide his or her unique health
state and its trajectory over time. The goal of a health care system, then, is to consistently guide each
individual’s trajectory toward a health state that supports a better quality of life.
Figure 1. The Johns Hopkins individualized Health Initiative (Hopkins inHealth). The four cores depict methods research and
tool development, while the pilot projects illustrates the four initial health applications. The green arrows indicate the
replications of the initial successful pilots across many medical disciplines (vertical arrow) and across ever-larger
populations (horizontal arrow). The ultimate objective, shown in the red circle on the right is to improve health at more
affordable costs.
Like an airplane, one’s health changes over time, producing a trajectory. In both cases, the goal is for
the individual to arrive safely at a chosen destination. Pilots are aided by flight controllers and radars
that monitor position and trajectory. Similarly, individuals need tools to monitor and manage their
health trajectories. Johns Hopkins inHealth will discover how to define, measure and communicate
health state and health trajectories meaningfully, allowing individuals and their clinicians to make
educated decisions—to guide their own trajectories toward overall health and away from disabling
conditions and diseases. When diseases do occur, inHealth will provide information essential to
individualized early detection and treatments that minimize loss of function and maximize
engagement.
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What is Hopkins inHealth? – Ask Bal Carter, Professor of Urology and a prostate cancer
screening and treatment specialist. – “Hopkins inHealth will allow us to implement a uniquely
Johns Hopkins strategy for tailoring cancer screening protocols to the needs of each individual. Each
person has unique risks of cancer based upon their age, family history and other individual factors.
By designing a protocol specifically for a person’s risk, we will improve our capacity to detect
cancers early and reduce the fraction of false-positive tests that frighten the patient and sometimes
lead to unhelpful, invasive procedures with non-trivial medical risks.”
“Our goal is to implement this individualized screening method in an on-line system that has a
patient and clinician module. We want to educate both groups about how best to manage the cancer
risks. With patients and doctors working together, relying on more careful analysis of health
information, we will save lives, reduce fear, and reduce the costs of population health.
“What we learn from the cancer screening project will carry over into a multitude of other clinical
areas and beyond the walls of Johns Hopkins. The project is a chance to change medical screening
practice around the country and the world.”
How will the Johns Hopkins individualized Health Initiative be organized?
inHealth is envisioned as an initiative, not a center or institute or department. It will weave itself
throughout the JHU, JHHS and APL fabric to achieve its goals by providing intellectual and material
capital in support of a large number of existing centers, institutes and programs such as the Armstrong
Institute for Patient Safety and Quality, the Center for Public Health Informatics, the Institute for
Clinical and Translational Science, the Global mHealth Initiative, and the Systems Institute.
Figure 1 shows that inHealth will initially comprise four cores and four start-up applications.
Information Technology for Health will, one health problem at a time, define health state and develop
tracking systems--analogous to radar for tracking an aircraft--using statistical models, simulation, and
Bayesian network methods4. As we develop experience in tracking and defining health states, we will
partner with others to develop a new platform for inHealth IT applications or “inHealth apps.” These
applications will support health experts to create innovative tools that improve decision making for
population and patient health. These tools will extend the reach of Johns Hopkins doctors and health
experts to communities around the country and globe.
Learning communities for health will allow each Johns Hopkins patient or study participant to benefit
from knowledge gained and catalogued from previous patients and participants. These learning
communities will develop the bioethics, biostatistics, and clinical research methods to combine
information from clinical research and care over time and across populations. It will improve the
quality and affordability of health care by eliminating the arbitrary and inefficient divide between
clinical research and practice.
Bioscience discovery to advance health will make targeted investments in Pasteur’s Quadrant5 of basic
science to discover solutions to health measurement problems identified by the inHealth Initiative.
Just as the discovery of radio waves enabled radar, this core will seek basic discoveries that lead to
new measurement technologies for tracking health trajectories.
Congdon, Peter D. 2010. Applied Bayesian Hierarchical Methods. Chapman Hall/CRS Press.
Donald E. Stokes, Pasteur's Quadrant – Basic Science and Technological Innovation, Brookings Institution Press,
1997
6 Wennberg E. 2010. Tracking medicine. Oxford University Press, New York, page 9.
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Organizational Models for Affordable Healthcare. The long-term goal of this core is to test, and apply
the information-science tools from the first three cores to improve a population’s health at more
affordable cost. Johns Hopkins HealthCare, an inHealth partner, currently provides capitated medical
care for 275,000 persons. The inHealth methods and products will be tested here first.
The four initial case studies have been selected to represent the breadth of potential projects. Cancer
screening and obesity/diabetes management represent major components of the wasted health
investment, within the Johns Hopkins populations and across the country. The brain imaging and
autoimmune disease case studies will motivate and test the inHealth approach on specific technically
challenging problems.
To perform meaningful cancer screening, we must know the population rates of a particular cancer
for persons like the individual being screened - those of a similar age and with a similar family
history, prior lab results, and so forth. Designing studies and collecting and analyzing such data is
the work of epidemiologists, such as those employed at the Welch Center, jointly operated by the
Bloomberg School of Public Health and the School of Medicine. We call such population data the
“prior” or “starting place” for diagnosing the individual. Cores I and II exist to collect and manage
population information drawn from both research participants and from JHHS patients.
Of course, the best way to improve cancer screening is to invent a sensitive, minimally-invasive
urine or blood test that can detect genetic or epigenetic markers of the cancer. This is goal of
Core III. The screening methods produced in Cores I-III will be put to the real test by seeing whether
they can improve health among Johns Hopkins cohorts in Core IV.
Hopkins inHealth will help create the infrastructure for cancer screening, but also for hundreds of
other clinical decisions that determine the health of our population. This infrastructure will
dramatically accelerate our progress toward truly individualized health.
Why Johns Hopkins?
Johns Hopkins will combine the assets of its University, Health System, and Applied Physics
Laboratory—leaders in their fields—to improve the quality and affordability of health for people
within the Johns Hopkins community. We will then disseminate the lessons learned to make worldclass affordable health available to all Americans. Johns Hopkins Health System (JHHS) is a $5 billion
per year integrated global health enterprise and one of the leading health systems in the United States.
JHHS comprises four academic and community hospitals, four suburban health care and surgery
centers, and 35 primary health care outpatient sites serving a total of more than 1,000,000 patients
per year. Johns Hopkins Health Care manages care for 275,000 persons in three plans. Our Home Care
Group treats 82,000 adults per year. For 21 consecutive years, U.S. News and World Report has ranked
Johns Hopkins Hospital the best in the nation.
The Johns Hopkins University comprises nine schools. Together, they cover the academic fields
essential to addressing the U.S. health care crisis: population health, medicine, bioscience, behavioral
science, computational and data science, and systems engineering. Seventy-five percent of Johns
Hopkins professors—roughly 2,000 of its 2,600 faculty—work on problems of human health. The
Johns Hopkins University is the largest recipient of federal funding for health research, and our faculty
thrives within a culture that encourages entrepreneurial approaches to solving societal problems.
Of particular importance, the Bloomberg School of Public Health was the world’s first school of public
health and remains the best. Its population health expertise is essential to population health
management. The Johns Hopkins School of Medicine, among the best in the world, is a leader in basic
bioscience and in clinical research. The School of Nursing is ranked first in the nation. It can play a
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central role in devising effective ways to communicate information to healthy persons, patients and
their care providers. Finally, the Whiting School of Engineering is home to the country’s top-rated
biomedical engineering department and is a leader in systems engineering, central to a successful
inHealth program.
The Applied Physics Laboratory (APL) brings the capacity to engineer and implement the inHealth
methods and tools. Comprised of 3,000 scientific and engineering staff, APL offers enormous expertise
in designing and building complex information systems and powerful analytic tools. With an annual
budget of $1 billion, APL is a global leader in applying information science and systems engineering to
national security and defense, space science, and bioscience. APL is already working with the U.S.
Department of Defense to ensure that its medical manpower is deployed efficiently and to discover the
utility of genomic data to individualize uniformed service members’ health care.
How will inHealth benefit the patient?
inHealth will enable both patient and doctor to better understand the patient’s health state and its
trajectory to make better-informed health decisions. Approximately 25% of Medicare expenditure
goes toward “preference-sensitive” care, whereby patients are confronted with different treatment
options with different outcomes.6 For example, in prostate cancer treatment, watchful waiting and
surgery are options that depend critically on patient preferences. Where information is presented
clearly and effectively to patients and their physicians, they are empowered to make better decisions
that improve health outcomes at reduced costs.
In the near future, it will become routine for a doctor to order targeted genomic and epigenomic
profiles in those situations where the new information has value. When analyzed carefully, these
profiles can improve prevention, diagnosis and treatment decisions. Of course, the patient’s complete
health record—showing the genetic and epigenetic profile, medical history, and much more— will
follow the patient wherever he or she may go, precluding the need for new diagnostic tests every time
there is a move or change of doctors.
Consider inHealth’s potential in the field of cancer screening and early detection. Clinical trials have
suggested that the prostate-specific antigen test (PSA) for prostate cancer can save lives. Yet the
imprecision of this tool is well-documented. Its advantages are offset by overuse among people who
can derive little benefit, and by over-treatment of non-life-threatening cancers that the test
reveals. Biostatisticians estimate that, to save a single life from prostate cancer, more than 1,400 men
over age 50 would need to have PSA tests. These tests, in turn, would lead to 47 unnecessary radical
prostatectomies, many with severe side effects such as impotence and incontinence.
Using inHealth tools, Johns Hopkins doctors will be able to clearly communicate each person’s
individual odds of positive and negative outcomes from screening and then better tailor the screening
approach to manage the risks. Johns Hopkins researchers are also actively pursuing methods to
identify and classify cancer tissue using non-invasive genomic and epigenomic technologies. The key
next step is to engineer methods that work using small numbers of cells that are available in a serum
sample. These methods can be much more accurate and sensitive than PSA. In fact, the tests we
envisage will be capable of detecting many of the common cancers—not only colon or prostate
cancer. By testing and deploying these tests in managed care populations such as the Johns Hopkins
Employee Health Plan, inHealth will enhance the usefulness of prostate cancer screening, benefiting
everyone.
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Wennberg E. 2010. Tracking medicine. Oxford University Press, New York, page 9.
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How will genomic data improve my cancer treatment? Ask Dr. William Nelson, Director of
the Kimmel Comprehensive Cancer Center. “Most of the new so-called targeted drugs, including
trastuzumab for breast cancer, gefitinib for lung cancer, and imatinib for chronic myelogenous
leukemia, are effective only for a small fraction of affected individuals: those whose cancers carry
a specific gene defect. Increasingly, doctors test for these gene defects using cancer biopsies and
then prescribe medications only to those who will benefit. Through inHealth, Johns Hopkins
physicians and other doctors will be better able to use the genomic information in the patient’s
record to determine whether or not such a drug will be effective. Doctors can then focus
treatments where they can provide benefit, and avoid them where they can only cause
undesirable, serious side-effects.”
How can the experience of many patients inform an individual’s treatment decision?
Under the inHealth initiative, the individual patient contributes to the wider community as an
anonymous source of medical data and information. What works for a particular patient —and for
patients with similar profiles—is logged and recorded into a database. When data from thousands of
similar individuals are compiled and analyzed, the results provide substantial knowledge about what
is likely to work best for the particular patient at hand. Because data is collected and shared
systematically, and because decision support tools are scientifically more rigorous, the quality of
decision making improves. The combination of essential health information and valid, optimal
methods of analysis is what Johns Hopkins scientists call the health state datascope; like a microscope,
datascope allows the scientist or clinician to view the underlying disease process more clearly and, as
How can my radiation therapy experience benefit another patient? Ask Jon Lewin, Chair of Johns
Hopkins Radiology. “When a radiation oncologist reviews images of a patient’s tumor to decide upon
the proper radiation dose, she relies upon past experience with other patients with similar tumors. But
experience has its limits, especially as the amount of information that must be processed grows. Until
now, the images of those tumors were stored mainly in clinicians’ minds. Thanks to a joint venture of
Johns Hopkins Radiology with the Harris Corporation, we now store images in a “cloud,” or shared
electronic repository, so that any oncologist can reference thousands of such images in making medical
decisions for the individual patient. But the utility of thousands of images for an individual patient
requires careful analysis using the methods of inHealth. Your data will be a part of the evidence base
that informs decisions about other patients in similar situations. What is wonderful about inHealth is
that you benefit from all the patients who came before you, and you contribute to all who come after.”
a result, to make better decisions.
How can inHealth reduce health-care costs across populations?
In the United States, one dollar in every six is invested in health care—a figure 50 percent larger than
the second-highest OECD7 country. According to a 2010 report from the Congressional Budget Office,
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The 34 signatory countries in the Organization for Economic Cooperation and Development.
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medical care costs are anticipated to grow at 6.8 percent per year from 2012 to 2020. Not only is this
level of spending unsustainable, it inhibits our investing—as individuals, businesses, and as a nation—
in other areas critical to quality of life.
For Medicare, the largest single American health care payer, only 15 percent of annual expenditures
go toward “effective” or “necessary” care.8 Another 60 percent of expenditures go toward treatment
strategies that vary dramatically, based upon the availability of services in a given region. For example,
the rate of cardiology visits for persons with chronic diseases in the last two years of life varies by a
factor of four across geographic regions. Clearly, supply drives demand; there are more cardiology
visits where there are more cardiologists.9
This uneven distribution and use of services that do not significantly improve health is the major
factor that makes medicine in the United States so much more expensive than any other country in the
world. Under inHealth, these unproductive costs will be reduced by more rapid scientific evaluation
and dissemination of whether particular services contribute to health. Systems engineering principles
and methods will be employed to systematically implement the best current knowledge into practice.
Johns Hopkins inHealth is working to reduce burgeoning healthcare costs through its partnership with
Johns Hopkins HealthCare (JHHC). A major first goal of the partnership is to reinvent the Johns
Hopkins Employee Health Plan (EHP) as a “learning health community” in which the employees,
providers, and payers all “own” the community’s health outcomes and where appropriate incentives
encourage each group to promote affordable health. Johns Hopkins is planning to re-launch EHP as a
randomized controlled trial10 to quantify precisely where and how implementing the new
organizational structure improves health and saves on wasted resources.
A second goal is to prioritize those decision-support tools that will benefit JHHC populations the most
and then to design, test, and implement them. Scientists will evaluate these new tools, and those that
are most successful in contributing to affordable health will be implemented first in JHHC populations.
JHCC will also market successful tools to other health care providers and companies.
An additional important opportunity for inHealth to influence national health care policy is through
the “trusted agent” relationship that APL has with the Department of Defense (DoD). For 50 years, APL
has provided unbiased advice to DoD in implementing systems engineering solutions to problems of
national defense, space exploration, and other technical fields. The DoD now spends $53 billion per
year to provide health care to its employees and their families. Recently, it asked APL for advice on
population health issues. Many of the solutions we build for JHHC will likely apply readily to problems
that DoD and other large populations face.
How will Johns Hopkins’ leadership in systems engineering be an advantage with inHealth?
Achieving the inHealth goals will be no easy task. But Johns Hopkins will heed the advice set forth by
the Institute of Medicine and National Academy of Engineering11, using systems engineering best
practices to establish a learning health care system.
Wennberg E. 2010. Tracking medicine. Oxford University Press, New York, page 8.
Dartmouth Atlas of Health Care. 2008. Tracking the care of patients with severe chronic illness, page 11, figure
1.3. http://www.dartmouthatlas.org
10 Brown, CA and Lilford, RJ. 2006. The stepped wedge trial design: a systematic review. BMC Medical Research
Methodology., 6:54.
11 Reid PP, Compton WD, Grossman JH, Fanjiang G, editors. 2005. Building a better delivery system; a new
engineering/health care partnership. National Academy of Engineering and Institute of Medicine of the National
Academies. The National Academies Press. Washington, D.C.
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An excellent illustration of how systems engineering brings clarity, cohesion, and successful
completion to a project is APL’s five-year Messenger mission to Mercury. Its primary objective was to
send a satellite into elliptical orbit around Mercury to collect planet data. To accomplish this goal, each
component – the power system, thermal management, guidance and control system, propulsion,
sensors, and communications – had to be engineered to “best-of-breed” standards. Then, the entire
vehicle system had to be engineered to work together to achieve the mission objective of reaching the
planet, successfully inserting itself into an elliptical orbit, and collecting and transmitting data for one
year.
In some respects, the task of transforming a major academic health center into a learning health
system that practices individualized health is even more complex. After all, such a health system is
governed by the vagaries of human behavior, not the laws of physics. An approach based on systems
engineering principles will allow researchers to develop analogous “best-of-breed” standards in
various components such as health promotion, early disease detection, decision support tools,
electronic health records, financial models that incentivize prevention, and more. These elements will
then be coordinated to achieve the overall goal of improving population and individual health in a new
learning health care system. The application of systems engineering methods, in which the Johns
Hopkins Whiting School of Engineering and APL are world leaders, represents a unique opportunity
for Johns Hopkins to marshal its expertise in biological, medical, and information sciences to engineer
a new way to advance health for the 21st century.
What will Hopkins inHealth cost over the next decade?
Johns Hopkins University, Johns Hopkins Health System, and APL intend to invest more than $1.6
billion in Johns Hopkins inHealth initiatives over the coming decade. Johns Hopkins Medicine will
invest $800 million of its own resources over 10 years to develop an integrated, patient-centered
electronic health record system. This system will serve more than 1,000,000 patients annually.
Johns Hopkins researchers are committed to bring another $375 million in new grants and contracts
to pursue the information tools necessary to achieve the inHealth aims. Finally, while more difficult to
quantify with any certainty, we anticipate $25 million in revenues from commercializing intellectual
property discovered in this initiative.
But private philanthropy is essential to our success, especially in the early, proof-of-concept phase. We
seek $500 million in philanthropic assistance over ten years to invest in inHealth components that are
not readily fundable by competitive federal grants or health system revenues. These investments are
summarized by cores and projects in the following table.
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Cores/Projects Faculty
Staff
Number
Number
Millions
Millions
Students Start-up
funding
Number
Millions
Millions
I. Information
systems
15
10
20
$37.75
$20
$16
II. Learning
communities
10
10
20
$22.5
$10
$16
III. LABS
15
5
20
$37.75
$5
$16
IV. Affordable
health orgs
10
5
20
$22.5
$5
$16
Phase I
projects
5
5
20
$11.25
$5
$16
Phase II
projects
5
5
20
$11.25
$5
$16
Director’s
office
2
10
5
$5.5
$10
$4
Total
$140
$60
$100
(35%)
(15%)
(25%)
Equipment Total
and
Supplies
Millions
Millions
$108.75
$5
$30
(27%)
$54.4
$5
$1
(13%)
$93.75
$5
$30
(23%)
$49.5
$5
$1
(12%)
$43.25
$5
$1
(10%)
$43.25
$10
$1
(10%)
$21.5
$2
(5%)
$35
$65
$400
(9%)
(16%)
What will be the inHealth deliverables in Year 1?
1.
2.
3.
Individualized cancer screening methodology with computer and smartphone applications for
patients and for clinicians: prostate and cervical cancers
Individualized rheumatoid arthritis diagnosis and treatment protocols using patient
questionnaire, joint imaging, and immunologic biomarker data
Plan for an applications platform (Core I) that can decrease the development time for
individualization protocol and applications development; partnership with corporate software
developer
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4.
5.
6.
7.
Bioethics protocol whereby all Johns Hopkins patients, except those that opt out, become a
part of the “health learning community” that shares data for the purposes of individualizing
care
Plan for integrating genomic and/or epigenomic data in the detection or treatment selection
for at least one cancer
Agreement by JHU and JHHS for launching a new employee health plan based upon the
intelligent use of information to individualize health
Agreement with venture capitalist organization(s) to invest in companies created to
disseminate information tools invented by inHealth Initiative
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