HIStalk Interviews Peter Embi, MD, CEO, Regenstrief Institute

Peter Embi, MD, MS is president and CEO of Regenstrief Institute; professor of medicine and associate dean for informatics and health services research at Indiana University School of Medicine; vice-president for learning health systems at Indiana University Health; co-founder and chief medical officer of Signet Accel; and chair-elect of AMIA.

Tell me about yourself and your work.

I am a physician and an informatician. My main role is as president and CEO of the Regenstrief Institute here in Indianapolis, which is a support organization to Indiana University and specifically the Indiana University School of Medicine. We work with a number of elements of the School, the University, and the various healthcare systems around the region.

I wear other hats at Indiana University. I’m a professor at IU, associate dean in the School of Medicine, and vice-president for learning health systems in the Indiana University Health System, which enables us to take a lot of the expertise that we have in informatics, health services research, and aging research and bring that to bear on how we create the learning health system of the future by leveraging our health system. Not just that health system, but also others in the region that we traditionally have collaborated with. There’s a lot more I can say about that, but those are my titles at the moment.

My history is that I’m a physician. I trained in Florida, where I was born and raised. Then I went to Oregon, where I did my internal medicine training and then did my fellowship and got a master’s degree there in informatics under the group led by Bill Hersh. Then I went to Ohio, where I had been  until a few months ago when I took this role. I started off at the Cleveland Clinic, where I did training in rheumatology and immunology. I’m still a practicing rheumatologist. That’s a pretty small part of what I do these days because of all my other responsibilities, but that is my clinical practice.

I went to University of Cincinnati for almost seven years, where I started the Center for Health Informatics and did a number of things there around informatics. Then I went to The Ohio State University, where I was until just recently. I served as the first chief research information officer for the organization, really the first person to hold that role nationally. I also served as the vice-chair and ultimately the interim chair for biomedical informatics before I departed at the end of November.

What areas of biomedical and clinical informatics are most promising or most exciting?

It’s an exciting time to be doing informatics. The kinds of things that we’re seeing emerge with what can be done — now that we’ve gone a long way toward deploying electronic health records — is very promising.

There’s a lot of work to be done to improve our use of electronic health records to make them more usable and to incorporate them into practice better. There’s a lot of interesting work ongoing to help with the efficiency and use of electronic health records. Then, some of the most exciting things have to do with how we leverage the data that’s increasingly growing from not only those electronic health records, but from other sources, like genomic data and other ‘omics, if you will — environmental data, the kinds of social and behavioral determiners of health that increasingly we all recognize to be terribly important for not only improving what we do in healthcare, but fundamentally improving health.

Part of what we need to focus on moving into the future is how to leverage the data, the technology, the capabilities that we have, and the exciting developments happening in technology — including apps, wearables, and the Internet of Things — to understand how it is that populations — not just our patients, but people generally — are interacting with the world in ways that we need to understand better if we’re going to, as a system, inform improvements in health. Keeping people healthier, preventing disease, and then when people do become sick, most effectively getting them the kind of treatment that they need. Then being able to enable research so that we can learn how to better take care of people in the future.

One of the things that I have been studying for a long time and have focused a significant part of my career on is the area of research informatics. How do we take technologies and solutions to improve the elements of the research process, whether it’s designing studies, recruiting participants for studies, or making systematic evidence generation a more routine part of what we do through practice so that we can be learning from every patient and create what the Institute of Medicine has called the learning health system at the local level as well as at the regional and national level? That provides context for a lot of the exciting things that we can do moving forward. It’s certainly a lot of what drives me and the group here at Regenstrief on a day-to-day basis. Actually, it is a lot of what drove us and continues to drive us with regard to Signet Accel, too, and the work that’s happening there.

It’s been said that Facebook knows a lot more about people than their doctor. Can we combine enough data sources to create a holistic view of an individual that can support public health instead of just episodic healthcare encounters?

That’s a critical thing that we need to be focused on as a community, as a healthcare community, and as a biomedical research community, because I don’t think we’re there yet. We all understand that there’s incredible potential to be unlocked in those sources. Despite some pockets of work that are doing excellent early work in figuring that out, we have a lot more to learn in terms of how we can take all of these other socio-behavioral determinants of health, environmental information, information about what eat, what we consume, what we breathe, the activity that we track increasingly. All of those elements that say a lot more about how healthy we are, or how not healthy we are, than the sliver of information we have when people happen to intersect with the healthcare system. To me, it’s at that intersection point while we’re simultaneously trying to improve what we do in the healthcare systems.

When people interact with their physicians, care providers, and hospitals, we need to make that as good as it can be and as evidence-based as it can be and use those encounters and opportunities to learn. But I think one of the most exciting things is exactly what you allude to, this idea that increasingly as we look at populations and we look at how we can help keep people healthier out in the community, we’re necessarily going to have to understand how we analyze and interact with all the other data in the world. That data, one can easily argue, has a much bigger impact on health than a lot of the kinds of things that we do in healthcare, except for those who are ill. That’s an area where I’m starting to focus a lot more attention and I know a lot of other people are. More work is needed, but it’s critically important.

Have incentives evolved where there’s a business case to be made for providers and thus their technology vendors to look at an individual consumer beyond those little chunks of automation that exist just to improve the business of healthcare?

It’s an open question. A lot of people are banking on that. There’s some examples of folks that are moving in the direction of recognizing the importance of that and the potential of business models around how you can help people stay healthier. There certainly are individuals who are motivated to keep themselves healthier. Some of them are voting with their wallets in terms of apps that they’re buying and devices that they’re buying, increasingly taking control of and responsibility for their own health in ways that increasingly leverage technology and information. I think we’re seeing some of that emerge. I don’t think it’s settled. 

Beyond that, we have incentives in a number of other areas in terms of our systems, one being the healthcare systems. Increasingly as they go at risk for populations — which you know inevitably is going to happen considering the cost of healthcare –  how do we go about keeping our populations healthier so that we can spend the limited dollars we have on those who are sickest and keep people healthier so that they are healthier and they cost the system less? Forward-thinking health systems are already working along those lines, focusing on programs around keeping populations healthier, keeping people out of the hospital. That kind of thing can be seen increasingly through incentives that have been aligned around some of the reforms in healthcare payments and the like that one way or another are critical to what we’re doing and have to continue.

The other is from the perspective of our society — and I think increasingly we are seeing it from the perspective of companies — that recognizes that the healthcare costs of their employees are a big part of what they spend on. That’s a big expenditure. That the more that corporations and companies that are responsible for their employees can keep them healthier, can keep them happier, they’re more productive at work, they’re more present, and they cost less when it comes to the premiums that they’re paying for their employees.

Finally, our municipal, state, and federal governments are concerned in terms of trying to keep the population healthier, because one way or another, whether it’s focused on decreasing smoking rates or decreasing our rates of obesity, generally keeping our population healthier is just better for our economy. We’re seeing more focus on that at the state level and in different levels of government in terms of some legislation that’s already been passed and that will be passed.

I think it’s multi-factorial. It’s still coming together, but it does make sense from the perspective of what it is we need as a society, as individuals, and increasingly for our economy.

Precision medicine, artificial intelligence, and the idea of a cancer moon shot get a lot of technology attention. Is that a distraction from the fact that proven, well-documented medical information isn’t being consistently used on the front lines?

I don’t know that they’re a distraction. It’s important for us to have our eye on the future and to always keep an eye on where we need to be and what major items are on the horizon that are going to help us better take care of people in more innovative and impactful ways.

I think you’re correct that we can’t do that to the exclusion of — or in any way diminishing — how we can take better care of people with what we know today. I think you’re exactly right that probably not enough attention is being paid to the kinds of improvements that we can make in what may seem like the more mundane and routine activities of just making sure that, to the extent that we can, we’re practicing healthcare in an evidence-based way, that we’re leveraging our systems in ways that are going to make that more efficient and effective and easier for everybody involved to do the right thing and keep people healthier and avoid errors and do a lot of those sorts of things.

I see those as not mutually exclusive. I think we need to be doing both. But certainly to the extent that one overrides the other, that would be a mistake, so hopefully we don’t go in that direction.

I can tell you that here, for instance, we have a big emphasis on precision health and understanding that there’s a lot of elements to that. Of course it’s about genomics and proteomics and the like and how that can better inform tailored treatment of individuals when they develop certain conditions that have a genetic basis. But there’s also other elements of precision health which have to do with non-genetic components, a lot of the information that we have today. We’ve always wanted to make sure that when we’re treating an individual, we’re applying the best evidence to the care of that individual, taking into account their particular circumstances. If we do that right, we necessarily will benefit from a lot of knowledge that we already have.

A lot of it just informs the way we implement and deploy and use our systems today. I don’t see that necessarily as the dichotomy that it may seem, but I think it’s an important question to ask and make sure that we don’t fall into that trap of thinking that it’s just about one thing or something that we’re going to figure out 10 or 20 years from now. It’s what do we do today and what do we do in 10 years.

A newly published study found that patient advocacy groups are often funded by drug and device manufacturers in what could be perceived as a conflict of interest involving their patient members, especially in the area of support for drug pricing decisions. Is it difficult for member organizations to figure out that line between the interests of patients, provider members, and corporate members?

That’s a good question. Certainly at AMIA, we have a very diverse group of members, very thoughtful, that represent the broad constituency. Businesses are motivated by what they exist to do, which is to innovate and bring things to market and ultimately be profitable so that they can keep doing what they’re doing. While it can of course be at odds, I haven’t really found that that in any way negatively impacts what we do as a society or as an association. In fact, making sure that we’re listening to all voices and recognizing the perspectives of those who are working in different sectors actually helps to inform the overall membership.

Not to take away from the concerns that of course sometimes business interests will conflict with social good. More often than not. that’s not the case. If you find that a company is working on trying to solve a problem that is impactful to society, then it’s good to recognize that that work is ongoing and take it into account as you’re thinking about where it is that we need to be going as a group of informaticians, in that case, or as another society.

There’s clearly areas that people recognize very well around conflicts of interest and the like that need to be managed very carefully. I was the former chair of the ethics committee at AMIA and helped to author the conflict of interest policy, so I take that very seriously and we have to be very careful about that. I have found that the industry representatives who interact with professional societies tend to come at it from the perspective of, how do we all win? How does it help society? How does it help everyone? Because ultimately that creates more opportunity for them and allows them to have a bigger impact in their market, which happens to be the world. Not to be naïve about it, but I think it can be a win-win. You just have to keep your eye on the details.

Sunshine laws, being transparent, being open … increasingly because of some examples where that wasn’t done effectively and did cause problems in, for instance, the medical publishing world, right now we have very clear guidelines about making sure that whenever anybody does work, whenever they publish, whenever they talk about what they’re doing, they have to declare all of their relationships and the like. You have to know that in order to be able to then discern what’s happening.

AMIA is not, per se, a patient advocacy organization, although we obviously have patient members and are very concerned about patients as a driver of what we do, like any medical organization. So I can’t speak directly to that piece of it, but I can tell you that whole idea of transparency and openness is critical to everything we do, because trust ultimately is what that’s all about. I would think for a patient advocacy group, it’s even more important.

What makes you most optimistic about the role of informatics in improving of the healthcare system?

Everything that we do in healthcare, population health, and the like fundamentally comes down to making sure that we understand what’s happening. That means we have to have data, information, and ultimately the knowledge that comes out of analyzing all of that to be able to inform what we do moving forward.

Increasingly in the information age, people who have expertise at the intersecting points of health, healthcare, and informatics are at that junction that is going to ultimately inform how we improve the health of our populations. How do we do that in the most cost-effective way? How do we ultimately achieve the goal of having a healthier population at a lower cost?

That means that those of us who are working in this area of informatics and data science are sitting at a very exciting point, at the juncture, at a very exciting time. To be able to influence where healthcare is going and have a real impact on the lives of everybody, because everybody’s concerned with their healthcare, as they should be. That’s what excites me the most. 

The maturation of the technologies that we’re seeing now, the kinds of platforms that we have available, the interconnectedness that we have, the vast amounts of data, while daunting, are just really so promising. The health of all of us, the health of my children, is going to be so much better because of the work that we’re doing. That gets me up every day and makes me excited about what we’re doing in this field.