Humanwide: A Comprehensive Data Base for Precision Health in Primary Care

The innovation presented in the article by Mahoney and Asch highlights an important step in addressing a long-standing data gap and acknowledges the critical role of the primary care context and patients. The complexity of primary care was well reflected in the inclusion of data beyond the clinical visit for the Humanwide project. As we have long advocated, this overdue initiative has also included genomic information to enable precision medicine research for primary care (Bartlett G, Rahimzadeh V, Longo C, Orlando C, Dawes M, Lachaine J, Bochud M, Paccaud F, Bergman H, Crimi L, Issa AM. (2014) The future of genomic testing in primary care: the changing face of personalized medicine. Personalized Medicine 11(5) pg 477-486). Within the pilot demonstration, Humanwide already documented a change in point-of-care decisions for an improved patient experience. By any consideration, Humanwide may enable the much-needed learning health care system approach.

From this promising start, we would encourage the authors to consider going beyond the notion of a database, even if Humanwide allows for longitudinal follow-up, to consider moving into the biobanking sphere. This would entail the retention of biological samples and possibly more detailed follow up that would support much-needed research in primary care at the discovery level. Fundamental research is indispensable for understanding the interacting factors that predisposes humans to disease. Primary care is as much about prevention as it is about diagnoses, treatment and improved quality of life for patients and their families. We need the research base to support all aspects of primary care and the full spectrum of research. As Larry Green asked in his article on making research relevant, "if it is an evidence-based practice, where's the practice-based evidence?" (Green LW, (2008 Family Practice Suppl 1:i20-4.) The Humanwide represents a potential source to provide the data needed to drive the creation of practice-based evidence, improve discovery in primary care and contribute to a learning health care system.

Competing interests: None declared