Professor's retirement highlights lifetime of work advancing health care research at ASU

Thursday, September 12, 2019

Nowadays, you don’t have to look very hard to see the power of big data. From targeted advertisements to specially curated Netflix queues to optimized navigation routes, algorithms, data capture and cloud computing do nothing less than make modern daily life possible.

In a research setting, big data has massive potential to inform and expand our understanding of a particular field, especially if that field produces incredible amounts of data every day.

Twenty years ago, ASU College of Health Solutions biomedical informatics Professor Bill Johnson saw that potential where others did not when he founded the Center for Health Information and Research (CHiR), Arizona’s first and only health care data analytics repository — no small feat at a time when not many had attempted anything on that scale, let alone succeeded.

According to a number of Johnson’s friends and colleagues, because CHiR works mostly behind the scenes, it hasn’t always gotten the attention it deserves for the impact it has had on Arizonan's health. To date, CHiR has been responsible for approximately $7.6 million in sponsored research that has aided Arizona policymakers and health care professionals to better address such issues as Medicaid, opioid abuse and child drownings. His colleagues say it would be a misstep to overlook the value of such an entity, of which there are precious few in the country.

At a retirement ceremony for him Tuesday evening on the Downtown Phoenix campus, they praised Johnson for as much, and more.

“Bill really built a health care data infrastructure at a time when health care data infrastructures were not very prevalent,” said Eugene Schneller, a professor of supply chain management at the W. P. Carey School of Business. “The other thing he did is he took a generation of students, many of whom are now CEOs in major systems around the country, and he really made them economics literate. And that’s something that’s really tough to do.”

An economist by training, Johnson’s first foray into health care was as a graduate student when he participated in research looking at the impact of health conditions on individuals’ ability to work. Later, as a professor at Syracuse University, he was invited to participate in a Harvard medical malpractice study, the largest such study ever conducted, and then followed that up with a study on asbestos for the Mount Sinai Health System in New York.

After nearly two decades at Syracuse, Johnson joined ASU in 1991, assuming a joint appointment at what was then the School of Health Management and Policy and the W. P. Carey School of Business’ Department of Economics. He soon found that his research reputation preceded him, and he was fielding numerous requests for contributions to studies assessing various aspects of the health care industry.

Johnson put together a small group of researchers to take on the work. One request came from the Flinn Foundation, which for many years had been concerned with quantifying the number of uninsured Arizonans — without much success. They asked if it was possible and Johnson told them it was, but that it would take time and patience due to the amount of data that needed to be collected, catalogued and analyzed.

The foundation was game and Johnson set about his task.

“The idea was that we'd go to health care providers and we would just ask them to share their data,” he said.

Some researchers had tried before, but failed because they were only willing to accept data in certain formats.

“We just said, ‘We'll take whatever you have,’” Johnson said. “Which in a few cases turned out to be pretty rough. Some of those systems were pretty old. I remember bringing back a tape from Yuma and my programmers, who were relatively young, had never seen one. They asked, ‘What is that?’ I told them, ‘That's a DOS-based tape.’

“So we found that despite all that carrying on about different softwares making it impossible, that you could certainly translate the data from one software to another.”

As the dataset grew, it eventually became the Center for Health Information and Research, officially founded in 1999. Today, it contains health care information on roughly 9 million individuals and roughly 300 million health care episodes. Crucially, it also contains the entire Medicaid database of Arizona.

Over the years, CHiR moved around the university with Johnson as new departments were created and old departments were restructured, finding a home for a time in the biomedical informatics department of the engineering school before it moved to the College of Health Solutions, where it exists now. At various points in time, its focus has shifted from health care delivery to the health workforce.

In one NIH study, researchers at CHiR were asked to look at the long-term outcome of Medicaid-required preventative procedures on infants. Because their database covers such a wide timespan, they were able to determine the effects on  children into their early teens, whereas other organizations might only be able to look at the effects two or three years out. (CHiR found that the children who received preventive procedures were less likely to be injured but not necessarily less likely to become ill.)

“It's like a library,” Johnson said. “So let's say you want to start a research project and you want to look at people with Alzheimer's. Well, what are your choices? You could go out and do a survey, which is time consuming and expensive and it's a one-time shot. Whereas every hospital, every health care provider, every insurance company, every day produces detailed data that now exists in this centralized database that is constantly updating from as many sources as possible. So you don’t have to go through that whole long collection period and you actually have better data because you can follow people over time.”

CHiR also has datasets on every pharmacist, nurse and physician in Arizona from as far back as 2007 for nurses and as far back as 1991 for physicians. That information is useful in instances where, for example, government and university officials are deciding whether to open a medical school or not.

“So there again we’ve got a longitudinal picture from, in some cases, the day a physician started to practice until they're middle-aged or older,” Johnson said. “Because of CHiR and only because of CHiR, that data will be there the next time somebody wants to know about the distribution and age of primary care physicians in Arizona, for example. You're not going to have to wait two years to collect the data and then maybe find what you’re looking for.”

Johnson admits it’s a hard sell to investors.

“It's very hard to get external funding to maintain the database during periods when nobody's interested in certain questions. But CHiR is pretty much operating at capacity all the time, which then very much limits its ability to take on new projects. And there's plenty of opportunities to explore new questions with the data we already have."

Community impact has always been at the core of CHiR’s work. In 2005 and again in 2008, the center won the President’s Medal for Social Embeddedness.

“I think it goes to Michael Crow’s vision to impact the community in which we live,” said George Runger, current director of CHiR and a professor of biomedical informatics at the College of Health Solutions. “I think that’s really what our role is.”

CHiR has no less than 28 projects currently underway, ranging from improved effectiveness of community health centers to tracking electronic health record adoption to the effects of extreme weather on asthma to child eye exam coverage.

Though Johnson relinquished his role as director of the center in 2012, he still plays a vital role in its research and day-to-day operations, something those who know him well expect will continue in spite of his retirement.

“I really don’t believe him, that he’s retiring,” university provost and Executive Vice President Mark Searle said at Tuesday evening’s ceremony. “So I said to him, ‘That just means you’re not on the payroll anymore, right?’

“Bill was doing this work long before this became a part of the national dialogue and the national rhetoric around public policy. He was truly a pioneer in this space. … And I’m so glad to see people here today to honor Bill for that work because it’s truly a remarkable commitment. At ASU, we believe that we have to take responsibly for the health and the well-being of the communities that we serve, and that’s exemplified by CHiR and all the work Bill has done over many, many years. He has really done the kinds of things that a university wants to be known for.”

Top photo: ASU College of Health Solutions Professor of biomedical informatics and founder of the Center for Health Information and Research Bill Johnson and his wife, Saundra, listen to the accolades at his retirement celebration after a 28-year tenure at the university, on Tuesday, Sept. 10, 2019. About 50 former colleagues, staff, students and family came to honor the prolific researcher who combined his skills in economics with his passion for health solutions. Photo by Charlie Leight/ASU Now