Chief Medical Officer, Center for Healthcare Improvement, Thomson Reuters
Q: Explain your role. What are your objectives in this position?
A: I have two separate roles. One of them is to lead the Center for Healthcare Improvement and the other is to represent the Healthcare business of Thomson Reuters to customers, media, and government. The Center for Healthcare Improvement team does research to support our solutions, but it also provides a substantial amount of research that we use to demonstrate our expertise in various areas. I'm principally responsible for identifying what we're going to study and working to describe what our research questions are going to be. I also do a significant amount of public speaking on behalf of Thomson Reuters, typically presenting our research and establishing our presence as a thought leader.
Q: Can you talk about the role of the Center for Healthcare Improvement research organization?
A: The Center for Healthcare Improvement is comprised of health service researchers - mostly physicians and PhDs. It does two kinds of research. The first kind is research to support our solutions. This means we develop methodologies and models to answer questions. To do this, we investigate the usefulness of various external data sources for analytic purposes, and create specifications that become part of our solutions. The other kind is research to support our non-funded, thought-leadership work. This research is designed to highlight our expertise as a company, our data assets, and our ability to understand and apply those qualities in useful ways for our customers' needs. We look for unexpected changes, unknown associations, answers to questions that would have a business impact but are not obvious in the generally available literature.
Q: Can you share any of your current research with our readers?
A: We've been tracking heart disease and its decline. All aspects of heart disease related to hospital stays are declining. That's an important factor because it has a lot of impact. It impacts the cost of healthcare to help the payers. It has an important impact on the strategy hospitals are going to use to grow their businesses. It also impacts things like hospital outcome measures because many of the measurements of hospital quality and outcome performance focus on conditions like heart disease. Now, that focus is becoming a smaller part of the total number of patients in hospitals. So we're attempting to make judgments about a hospital's quality based on a subset of patients which is becoming increasingly even smaller.
Another area we're looking at is the increasing number of patients with infections driven by antibiotic resistance in the community. We've seen a significant result over the last four years of hospitalizations because patients are getting resistant organisms that are giving them bloodstream or skin infections. For example, a person may get an infection working in the yard and it's resistant to oral antibiotics. Now they have to be hospitalized, and get intravenous treatment. That really changes the cost dynamics for hospitals.
The other factor we're looking at is the relationship between a hospital's financial performance and clinical performance. We're discovering that, using the current methods of judging performance, there doesn't appear to be a very strong correlation one way or another. Meaning that, with the hospital that is doing well financially, you'll find every range of clinical performance from good to bad. Similarly, with hospitals doing well clinically, you could find every level of financial performance from good to bad. Our research seems to indicate that this is happening partly because the number of patients we use to determine clinical performance is small compared to the total number of patients who might drive its financial performance. For example, a typical community hospital might hospitalize 15,000 patients in any given year and that will determine its financial performance, but the number of patients who determine its clinical performance may only be a few hundred. We do know that specific patients who get complications cost real money. Avoiding those complications will save money, but the number of those patients and, therefore, the number of dollars is minor compared to the total expenditures or total costs - or financial performance of the hospital. The moral of the story is that hospitals have to think about financial and clinical performance separately - and manage them separately, and not just manage one and assume an outcome in the other will occur.
Q: You have your pulse on the issues surrounding the healthcare industry. What would you say is the most pressing issue we're faced with today? How can Thomson Reuters help organizations face that challenge?
A: I wouldn't say there is a single pressing issue, but I think, broadly speaking, it is the concept of affordability - and that means efficiency. When payers think about affordability, they think about what their budget is for healthcare expenditures. When a provider thinks about affordability, they think about efficient resource use. So the concept of efficiency or affordability is one overarching issue. Clearly, the only way to improve your current situation is with data. You can't do that by instinct. You can't do that by doing what you did yesterday. The more pressure there is on efficiency, the more impetus there is for people to get serious about using information to run their businesses.
The other big issue within healthcare is reducing errors and improving safety - that is also information-dependent. Thomson Reuters can help improve care with all of our referential data, but it is the deployment of that referential data at the right moment that matters. You need both to make a difference.
Those issues are clearly two of our central business activities. Our solutions are in the bulls-eye of the issues our cutomers are struggling with. The biggest challenge is to move people from historically not using information to deal with these challenges. A fair percentage of the market hasn't really adopted information as one of their strategies for dealing with these problems and that needs to change.
Q: You're certified as both an internist and a pediatrician. Do you still practice medicine?
A: I practiced medicine for about six years, but I haven't seen patients for about 12 years. I didn't plan to stop practicing but as I got involved in creating a physician practice, I had the opportunity to actually build the business as opposed to just being in the exam room. I found I was very motivated by organizations and systems and getting to influence a whole organization. As a practicing physician, you deal with individual patients one at a time. So you never really get to deal with patterns and work across an organization. It's a different experience.
Q: At HealthSpring Medical Center you implemented one of the first complete electronic medical records (EMR) in the country. Tell us more about that.
A: At that time, in the mid '90s, no one had seen an EMR. We could review labs, review dictated notes, and refill medications from our homes using a very old dial-up modem. We were one of the first full implementations of that particular technology. Our building was even built specifically for that purpose. It had a computer room and built-in computer workstations - we were pretty far ahead of the game in those days.
Q: You also have a Juris Doctorate (J.D.) degree in Health Law. How has it supported your career?
A: Law school helped me with thinking, reading, writing, and speaking. Now I see critical thinking as a very important business skill. People who work in healthcare often underestimate the importance of critical thinking - particularly when it comes to the business of healthcare. The critical thinking skills I learned in law school have actually helped me in my professional, non-physician part of my career significantly.
Q: You've held leadership positions at organizations from a variety of healthcare sectors, including health systems, physician practice management, and health plans. With 20 years of healthcare experience in senior management, what position best helped prepare you for your current role with Thomson Reuters?
A: I've practiced as a physician, worked on the payer side, worked in the hospital, worked for an information business, and I've also served on the board of a biotech company. The fact that I'm conversant in the hospital, physician, insurance, and life science realms relates because Thomson Reuters serves all those constituencies, and I speak in front of all of those groups. The cumulative effect of having experience in all those various settings helped prepared me more than any one single position. My experience makes it easier for me to relate to people across healthcare. I have familiarity with their business issues and that allows me to figure out how to present our information, our expertise, and our insights to them in ways they find relevant.