New $1.6 Million Endowment Will Support Next Generation Health Information Technology Research

It is no longer unusual for researchers and scholars to develop profitable products. A portion of those funds sometimes gets reinvested in the research center that created it, in a virtuous cycle of sorts. But it’s unprecedented at the Bloomberg School for a research center to use a portion of its revenue stream to create an endowment that supports the work in perpetuity.

Yet that’s exactly what’s happening at the Center for Population Health Information Technology (CPHIT). Keshia Pollack Porter, PhD, MPH, chair of the Department of Health Policy and Management, recently announced that CPHIT founder and co-Director Jonathan Weiner, DrPH, has established a $1.6 million endowment to ensure that the type of research related to the vital health analytics tool they developed, adjusted clinical groups or “ACGs,” continues.

ACGs represent a set of software-based algorithms for understanding the diagnosis and medication use patterns of both individual patients and populations—whether that “population” is a group of patients in a given health plan, a sociodemographic group, or a geographic community. ACGs are used widely by both private and public sector health systems throughout the world.

In this Q&A, Weiner shares memories of the early days of health information technology, insights on what’s to come, and the purpose of the new endowment.

What led you to the health information technology field? How has it changed since you started?

Surprisingly, I am not that much of a “geek,” but I have always been interested in computers, and what they could do to improve our health care system. In the 1960s, my father was one of the first people in the country to help a state (Connecticut) use computers to manage a Department of Motor Vehicles. In the 1970s, he was the first person I knew to get an Apple 2-e computer (my college friends loved those Pong games), so I guess I have him to thank.

I have been privileged to spend my whole career at the Bloomberg School, and when I arrived in the late 1970s/early 1980s, those of us in public health had to eke out what number crunching time we could on someone else’s computer. For example, in the early days as an assistant professor, we had to borrow time from the hospital’s IBM mainframe or the School administration’s business computer. We were always getting yelled at for using too much run time. We also had to be careful not to drop our boxes of punch cards that held the data. In the early 1990s, I remember having hundreds of reels of data tapes with all of the Medicare insurance files from millions of patients living in three states piled high in my Hampton House office. Medicare itself [now the Centers for Medicare & Medicaid Services] did not even have this data at their headquarters. Things have changed a lot since then, and the iPhone in our pocket has 10 times the power of all the computers we had at BSPH back then.

Where is the Johns Hopkins ACG® System in use now?

The ACG System is widely used across the U.S. Globally, its use is well established in several Canadian Provinces, in the English National Health System, across Scandinavia, and in Israel, Germany, Spain, South Africa, Chile, Australia, Singapore, and Italy. In total, we are in about 24 countries, and every week, more than 250 million lives around the world are touched by the ACG System. Hundreds of public and private health care organizations use our software. Most of the big HMOs and insurance companies in the US use at least some aspect of it for care management, quality improvement, payment, or research.

Is it always for purchase—or is it sometimes free?

It’s free or inexpensive for academics. And Medicaid agencies can get it for free, including here in Maryland. But most organizations purchase the ACG System from software integrators who are business partners of JHU.

There are lots of costs associated with the maintenance and support of ACGs. Over three decades, the software has been refined and improved again and again. The current ACG R&D work is housed at CPHIT, which was founded in 2012. A business management unit here at Johns Hopkins Medicine helps distribute the software globally.

How profitable is the system?

The business is large by BSPH standards. Millions of dollars in ACG revenue are collected each year. This sum is then used to support costs across all of our distribution channels around the nation and globe and here at the School. At CPHIT, a portion of these funds help support our internal ACG Research and Development (R&D) Team to maintain and expand our ACG-related intellectual property (IP) as well. The University also has a standard formula for sharing of a portion of IP royalties across the University, the School, the Department, and participating faculty “inventors.”

But the main bottom line benefit of this commercial, fee-based approach is that we’re now on the equivalent of the 20th or 30th version of ACGs. If we had given the first one away for free, there would still be just one version. Instead, we’ve been able to support decades of innovation and we now positively impact millions of people daily across the globe.

You recently established a $1.6 million endowment for CPHIT. How will the money be used?

ACGs will not be forever. But the benefits of this endowment will be. We will use it to fund R&D efforts at our Center to help us create the “next ACGs.” We have so much going on, focusing on the application of data sciences and digital health to the fields of population health and social determinants of health. This endowment lets us test other ideas, undertake proof-of-concept pilots, and do things that might not otherwise be easily funded. It gives us flexibility.

While it’s a $1.6 million endowment, only its interest is being used. For now, that’s about $65,000 per year, which we will use it to move into cutting-edge areas. It’s important to note that I didn’t create this endowment alone. A very large team of colleagues helped create the revenue and the intent is that this revenue will, in turn, help the whole team and the institution that has supported us.

Will this endowment support the next big endeavor?

Yes, proof of concept, things that will lead to other funding, things that could not be funded otherwise. We will use it to support faculty, students, or staff. Most of our money is spent on labor, on people, although it can be used for other expenses too.

Do you think this kind of endowment could happen elsewhere within the University or the School?

I don’t know. More commonly these days, everyone wants to create a startup, but that's a different story. If we had done a startup, all the development work on improved versions of ACGs would likely be long gone. It would have been gobbled up 20 or 25 years ago by a distant corporation. This type of closely held product, that is owned and managed by BSPH, is quite unusual.

Can the endowment grow?

I hope it will. The work CPHIT is doing is critical for the field of public health and society at large and I hope others, including corporations or philanthropies, will donate. Some of the royalties generated from ACG could be directed into this fund. I and other faculty could donate in the future. As the endowment grows, it could even possibly support a formal professorship related to data science and population health.

ACGs will not be forever. The benefit of this endowment will be forever to help support CPHIT’s mission—creating digital and data science tools that improve the health of individuals and populations around the world.

How have you managed to stay on the cutting edge of a constantly evolving field? 

Working with students, young faculty, tech companies, and hundreds of users of our ACG software around the globe keeps me and our entire Center on our toes.

What would you say to young people considering entering the health information technology space? 

Now and forever, e-health tools such as telemedicine, health information technology, such as electronic health records, and data sciences such as artificial intelligence (AI), will be critical to public health and health care. No one in these fields can achieve their missions without these technologies. At a minimum, everyone will need to use these technologies in their day-to-day work, some will need to become digital tool managers and influencers within their organization, and a few—like our team at CPHIT—will become future leaders and developers of what comes next. The only question for a student is which of the three levels of digital expertise is the right one for you.

This interview was edited for length and clarity. 

Related Article: The World’s Foremost Population Health Analytics Tool