Getting a Center for Population Health off the Ground

April 10, 2013
Johns Hopkins is launching a Center for Population Health IT, which will aim to take healthcare and clinical data and use it for a broader, societal, organizational purpose. The ambitious center will use numerous components from the vast healthcare entity. In this exclusive Q&A, Jonathan Weiner, Ph.D, the center’s director, talks with HCI about his plans for the center, some of the initiatives, and its simultaneously launched partnership with various vendors.

Johns Hopkins Medicine, which includes an integrated health system and Johns Hopkins University’ School of Medicine, is one of the most famous names in healthcare, nationwide. Thus, when something like the Johns Hopkins Center for Population Health IT (CPHIT) is created, it’s impossible to brush off as simply another provider-led endeavor. The new center is an effort by leaders at Johns Hopkins to take healthcare and clinical data and use it for a broader, societal, organizational purpose.

The key term behind CPHIT is “population health.” According to Jonathan Weiner, Ph.D, professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health and director of CPHIT, the center will look at how EHRs, PHRs, and other eHealth applications can link data across an entire community that lead to evidence-based outcomes. It’s a notable goal, and Johns Hopkins is in a unique position to try and achieve it.

“We’re lucky [to have a strong reputation], and I think we’ve earned much of it and we take it as a responsibility. I think we wanted to do the right thing, we’re not the only institution, but we’re one of the few with this type of vision,” Dr. Weiner said. “We’re one of the few academic health centers with a managed care plan, so there’s nothing like capitation or focus budget to bring out the value of HIT.”

The CPHIT, which has had a “soft start,” will be based within the Bloomberg School of Public Health’s Department of Health, Policy and Management with faculty from there, School of Medicine, Whiting School of Engineering, Carey Business School at Johns Hopkins University, and the Johns Hopkins Health System. Along with announcing CPHIT, Johns Hopkins also announced the Johns Hopkins CPHIT Industry Partners Program. The university in doing so aims to align with private companies interested in using information technology to support population health. The first such company to join was DST Health Solutions (Birmingham, Ala.), a business processes provider.

Recently Dr. Weiner spoke with Healthcare Informatics Associate Editor Gabriel Perna to discuss his plans for the center, some of the initiatives, and its simultaneously launched partnership with various vendors.

Jonathan Weiner, Ph.D

Below are excerpts from that interview.

What will the center entail – what kinds of programs, initiatives, resources will it provide?

Hopkins is a big place. There are informatics specialists, IT specialists, computer specialists – often people work in silos. The goal is to bring in public health experts, healthcare experts, medical experts, ethics experts, all of whom we have at Hopkins, and focus on big data. There have been bits and pieces of that already, academics working on that – but we’re trying to develop a new comprehensive focus. The goal being that organizations that are responsible for large numbers of people, it could be public health officers, a director of an ACO, it certainly could be an employer or an insurance company – those organizations need to look at how we use EMRs, EHRs, and of course mobile health as well as administrative systems to meet the needs of a population.

We have health informatics specialists, we have computer scientists, we have hired a new one who’ll specialize in health issues. We have hired a medical informatics person who will specialize in public health and chronic care issues. We’re blessed with an applied physics laboratory, it’s 4,000 engineers and IT specialists, and we hope to collaborate with them on devices and healthcare surveillance. We have the biggest and many say ‘the best,’ public health school in America.  We also have thousands of clinicians, who are interested in the digital aspect of healthcare.

So we have the human capital, and we’re blessed with that. The goal is to get the resources and get the data. For instance, we have something called Johns Hopkins Healthcare. It’s our medical care plan with three hundred thousand members. They get it in terms of population health. Through this, we have launched a small project, with public health experts, experts on natural language processing, and experts in managed care, and we’re trying to take the EMR data and link it with claims data, and we’re using that information to identify high-risks [pregnant] women. That’s an example; it has a clinical component, a managed care component, and a computer science component. And for that project, it’s not just about the women who come in, but it’s about those who don’t as well.

From a clinical standpoint, population health is a fairly broad term. Are there any specific populations – diabetes for example – that you have an interest in looking at extensively?

When I say population health, of course, I mean classic public health. Most public health is only 3-4 percent of the U.S. healthcare dollar, and a high percentage of that is providing a safety net to providers. It’s not public health; it’s medical care. To think about population health just as public health is limiting. We want to take public health principles and bring them to medical care. The Kaiser Permanentes of the world are doing that with EMRs, and for chronic care management, which is a huge piece of the healthcare dollar and need. Additionally, ACOs, medical homes, are taking public health and managed care to medicine. That’s our philosophy.

Obviously, an important part of population health is that term population, something that is not fragmented. How do you plan on linking the various communities in healthcare whether its public agencies, providers, payers, etc.?

That’s the $64 million dollar question. It’s easier for Kaiser or Geisinger, everyone is all in one building, they’re getting one paycheck, that’s how they’ve accomplished it. The ACO movement, the integrated movement, that’s what that’s about. Frankly, health IT is the virtual glue that holds these systems together. There will not be an integrated system without health IT, it’s impossible. We’re trying to take advantage of this information to provide methods and evidence of how we can develop a comprehensive population-based method. Our vision is big, but we hope to act on it, one piece at a time. As they say, think global, act local.

[Regarding the applications] Some of them include developing metrics of health risk and need. So whether or not you’re an ACO, or a public health agency, you know where you stand with your population. Another is using natural language processing to improve non-structured EHR data, and improving physician workflow. Another priority is the linkage of mHealth and EHRs.

What is DST Health Solutions providing to the Partners program? What kinds of companies do you see joining this – providers, vendors, etc?

We hope to be a comfortable place where the industry sees us as an honest broker, where competitors can collaborate with each other. We’d like to learn what the industry challenges are. We hope some companies will take our ideas. We hope they will convene conferences. We also have a big educational program, currently 150 students in medical informatics, and we think that some of that will be useful to our partners.

And we also recognize, this type of center, isn’t the thing that will get a lot of government money at this time. We hope to do grants. We very much feel industry partnerships is what will get it off the ground. We’ve modeled our industry partners program after an MIT engineering program. They have successfully learned from industry, invited industry in from sabbaticals, educated industry, tested things out, and if there are good ideas, they shared them. DST is a company, that does both financial IT, but also a lot of managed healthcare IT. We’ve had a partnership in another venture with them, where we’ve developed software that is used around world for case mix, predictive modeling, and risk adjustment.

We’ve been approaching a dozen other companies, and we’ve had good interest so far, and we hope to open it fairly broadly. We’re looking to healthcare IT and EMR vendors and mHealth, who fill like they want to push the envelopment in this field.

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