Editor's note: Sometimes size matters. Global IT giant IBM has the wherewithal and often the willingness to tackle tasks beyond the scope of most other companies. In this wide-ranging conversation, Joseph Jasinski, program director for healthcare and life sciences at IBM Thomas Watson Research Center, talks about IBM's Global Pandemic Initiative and the three projects it has launched so far; he offers an upbeat report card on David Brailer's tenure as the nation's health-IT czar and explains why big companies that self-insure their employees will drive health-IT change. Jasinski has responsibility for IBM's Global Pandemic Initiative and plays a leadership role in IBM's overall efforts to develop and promote the use of IT. John Russell, executive editor for Health-IT World and Bio-IT World, conducted the interview. Send your thoughts about this article or other health-IT issues to firstname.lastname@example.org.
Q: Maybe we could start with the Global Pandemic Initiative. What's that all about?
A: In the middle of May we officially launched the Global Pandemic Initiative, [which] is an attempt to do a group of projects we believe will basically help the world get ready for the possibility of a 1918-like influenza pandemics which we expect would be much different in the modern world. The disease might be the same but the impact might be far more severe in that even though we have better medical care and in principle would be better off on that score, the world is much more connected. The economic impact would be more devastating, we believe, than in 1918 when the world was a relatively isolated place.
So we gathered a group of external advisors from the World Health Organization, from NGOs, universities, and basically asked them what they thought IT could do or a company like IBM could do that wasn't currently being done in helping to get the world ready for the next pandemic disease.
We worked through a bunch of ideas, and we came up with a portfolio of projects. We've launched three of them. The first one is Checkmate, a project to understand the virus well enough through high-throughput wet-lab experiments and computation to have a good chance to figuring out what mutation might occur that would be virulent and human transmissible. The idea [is to have] a vaccine or at least some kind of medical response in terms of a treatment ready for use before the first outbreak of the disease. That's a project between the Scripps Institute in Florida and IBM research using their experimental biology and our Blue Gene supercomputer in the Watson lab, which is the second-fastest machine in the world currently. The name Checkmate comes from playing chess with the virus and ultimately figuring our where its going before it gets there.
Isn't there also a project around software to monitor the spread of disease?
Yes. The next project is around how we develop better predictive models from an epidemiological perspective that might allow public-health officials and government officials to do more accurate computational models and more what-if games in terms of public planning scenarios. The technology we are using there is called STEM; it stands for spatio temporal epidemiological monitor, which is why it has a short acronym. STEM is not a model; it's a modeling framework that provides you with a user interface and access to data sets, and you can use them to construct your own models of a particular disease that you're interested in.
STEM is currently available free for use for nonprofits on our alpha site, sort of a standalone application, and we're very far down the path of incorporating STEM into an open-source community called the Eclipse run by the Open Healthcare Framework. The idea there is to see if we can build an open-source modeling community of experts around the world who might contribute their unique data sets. The goal is to have a description of what the world looks like from an epidemiological perspective which you can use to understand the disease you're interested in.
Do you have some data sets now?
We have some that are relatively easily available, like where all the cities are, where all the street boundaries are, the roads are, where all the airports are, where the population centers are for large chunks of the world. We have a few pieces we need to fill in. But hopefully if we can get enough interest from the community, you might find somebody, for example, who's an expert in migratory bird pathways and has the world's best data set on where birds go, particularly relevant in H5N1. From the poultry industry or university research on poultry, you might get data sets on where all the chickens in the worlds are.
The point is to try to take the common infrastructure that everybody needs and make it open source so instead of spending a lot of time for someone to figure out where the cities are -- that's already been done many, many times -- and providing that information upfront and then saying I want to study this disease, here are the properties of the disease, and here's the scenario I want to explore. You know, 14 people showed up sick in NYC in Queens with this particular disease on Monday. How many cases will there be by Tuesday? What are the next cities to be impacted and so forth? If you can do that at a reasonably accurate level then you can start to try to develop rational response strategies -- for example, should I close the airports, will that do any good in this day and age? Where should I position antiviral drugs or vaccines? Should I close the country borders?
How far along is the project, and how do you get access to the tools?
In the current version, they download executable code. It's been looked at by a number of universities and some companies. Hopefully, as the open-source version goes out, we will get modelers from academic institutions and other institutions to actually contribute and become part of the community. So it's a sociological experiment in science as well, and it will be interesting to see if it works. It runs on a workstation and isn't particularly computationally intensive.
Is there a commercial play here? Will there be a commercial product eventually?
The epidemiological modeling tool is going to be open source, although you can imagine it being used as the front end to other commercial products. So, for example, if I wanted to understand how my business would fare depending on where my locations are and what kind of business I'm in and what my cash flows are like and that kind of stuff. You can imagine using the epidemiological model as an input to that kind of an analysis.
What's the third initiative?
So the first effort was on developing vaccines faster. The second is predictive models that allow you to plan. The third project is work with a consortium called MECIDS, which is the Middle East Consortium for Infectious Disease Surveillance, to share food- and waterborne disease information in a real-time electronic interoperability framework. That project is built on a technology called IHII, which stands for Interoperable Health Information Infrastructure, which we announced about a year and a half ago. We don't have a lot of work on IHII in a clinical sense. We've shown it at HIMSS and at the Connectathon this year. It's part of the technology that's going into our pilot project for the RHIO [regional health information organization].
Now what we're trying to do is extend it to the public-health domain, and we found this interesting organization called MECIDS, and we're trying get started by allowing them share public-health information as I said, on food- and waterborne disease. So that's the Global Pandemic Initiative as it stands right now. We look for this to be a continuing effort with our steering committee as we go forward trying to define additional projects using a whole bunch of technologies you can imagine that would be applicable.
How has the progress been on these projects?
The next milestone for STEM is to actually get the version, the beta code if you will, into the open-source community. That should occur within the next month or two. It'll be available through the Eclipse open framework. The third project is in the planning stages right now. We need a few government approvals to go forward because of the region that we're trying to do this project in. MECIDS is a consortium that is mediated by the Nuclear Threat Initiative, but it consists of the ministries of health of Israel, Jordan, and the Palestinian Authority, which is what makes it very interesting.
Does the current political situation complicate making this happen?
Actually, the political situation in the region does not. The fact that the U.S. government has embargoed Hamas of the Palestinian Authority requires us to get a license, which we're in the process of doing.
What's your perspective on the progress towards interoperability in health-IT in the U.S.?
I'd say progress in the U.S. is good but not as fast as some of us would like to see it. I think the progress on technology, from our perspective, has been really quite good. We started looking at interoperability just before David Brailer's office announced all of their efforts around RHIOS and the National Health Information Network. We've based it on an open standards architecture, and what we've implemented are what's called cross-enterprise documents sharing actors or services as defined by a project called Integrating the Healthcare Enterprise, which is run by HIMSS, ACC (American College of Cardiology), and RSNA (Radiological Society of North America). So one of the key signs that there's a lot progress in this space is if you go to the HIMSS interoperability showcase -- I went two years ago in 2004, and it was very small showcase -- is now one of the centerpiece of one the main rooms at HIMSS.
What we do with our technology is actually help 28 vendors (ISVs) demonstrate full interoperability of their applications using our middleware technology. I think that and the other we've done which I think is a really interesting experiment is we've taken the client side of the platform, so not the repositories and the registries and the patient identifiers and things like that, but just the pieces that you need to connect an application to the infrastructure to allow data to go in and allow data to be sucked back out. So we're called the document consumer and document source, and we've actually open-sourced those connection pieces.
What's your perspective on the post-Brailer era?
I think talking about the future is always difficult. David did a spectacular job of tackling a very complex problem in a very sort period of time and actually getting industry and his constituents and major industries to respond. For example, one of the things we worked on with him was, he basically said, "I would like one architectural view from the IT industry, not 18." And so we actually worked together to pull together a consortium of major IT vendors and provided him with that document in the RFI phase. I think he's done the pilots very cleverly, which is not only do we have to show interoperability between the vendors we're working with but at the end of the project we all have to show interoperability essentially among our solutions. There are four of these. I think all of that will go a long way towards helping ultimately get us to where we want to be in terms of interoperability.
Has the user community acceptance kept pace with technology's progress?
I'm not sure the hospitals are all that convinced yet. Some of them are. Some of them aren't. I think the key challenge is getting primary-care physicians hooked, and that's why we've done this open-source play. Hopefully, we'll stimulate an ISV community which will actually develop offerings and services around getting small to medium clinics connected to this kind of infrastructure. That's important because that's where most of the data actually exists. If you think about it, unless you're incredibly unhealthy or unlucky, most of your medical records reside in your primary-care physician's office and not the hospital.
One of the things we've wondered about is whether funding for Brailer's office was adequate. Do you think the lack of funding or lateness of funding hurt his ability to work?
It's always nice to have all the money you think you need. I think he did an incredible amount with the amount of funding that he had. And given that the idea was always that this is going to be a public-private partnership, not something funded by the U.S. government, the funding was probably at a reasonable level.
Maybe what's needed now is a government stick for adoption, or will market forces be enough now to keep pushing interoperability reform forward?
In the U.S., there are two major driving forces -- those are the entities that actually fork over the dollars. One is CMS. It pays about 42 percent of the doctors' bills in the U.S. The other force is companies like IBM and other Fortune 500 companies, all of which are self-insured.
IBM spends about $1.7 billion dollars a year in paying healthcare bills for its covered lives, which I think is about half a million covered lives in the U.S. There are other examples. And you know we do a good job. We have a global well-being service that I think is recognized very heavily across the industry as being very effective and very good at what they do. Nonetheless, that's a lot of money, and it's causing companies like General Motors to have severe business problems. I don't know what their number is, but they face the same problem. I think increasingly industry, at places like IBM and GM and other large companies, are starting to realize they are going to have to help drive this change. That can be done with both carrots and sticks.
What about the payers, are they enthusiastic?
and large they are enthusiastic because the more data they have access to, they believe the more effectively they can run their business and the better quality of service that can provide. So we've actually had very interesting discussion with some of the large payers about their positions. You see some very interesting business trends, actually, which may actually -- I don't know how far you want to get into the business side because we've gone about off the technology -- but for example, United Health Group owns a bank called Exante Bank so that they can supply a master card for health saving accounts.
Bank of America announced a couple of months ago that they are going to take some of the money that they thought they were going to invest in expanding operations in Europe and invest in healthcare instead. There's a whole new business play around health records as a service, health savings accounts, wellness companies. At Virgin Atlantic, Richard Branson started a thing called Virgin Wellness. So they essentially are a wellness company that sets up wellness programs for other corporations and part of the benefit is, if you walk the number of miles you promised you were going to walk a week, you get Virgin Atlantic frequent flyer miles.
All kinds of interesting business models are developing that I think are going to help drive overall national interoperability. Then there are examples outside the U.S. where countries are already doing this. Everyone in Denmark has a patient-centric electronic medical record kept, and the system happens to be run by IBM, but that's there today. That's proof of concept, if you will. I was recently trying to get a sense of how big this effort is around the world, and there are 20 to 25 major countries that are either already funding or have announced plans to start some sort of patient-centric electronic medial record program. The U.K. is probably the largest in dollar volume at this time with about $11 billion dollars committed. Canada is doing some really great stuff. A number of other Scandinavian countries have very effective programs, so they're largely in place already.
What's the business case for IBM in all of these efforts?
The business case for IBM is that [healthcare] is one of the largest, fastest-growing opportunities for IT and services and solutions, which is what IBM really does as a business. So, for example, we have a large healthcare consulting practice, which we acquired when we bought Healthlink about a year ago. So really the play is across all the things IBM does: services, software, and platforms. Certainly we're talking about our own well-being practices because that can be a strong driver, and obviously we want to use our selves as guinea pigs in some sense, and then that's a proof point.
What haven't I asked about that I should?We and other large IT companies are looking at this as an important, we believe, opportunity for improving the quality and safety and overall wellness, especially for people with chronic disease. We've got a coupe of pilots out there. In Denmark we're using this technology to help elderly people who are living alone monitor their health. Another case is in Heidelberg Germany, where we are working with a group of pediatric kidney failure patients. We think the technology has enormous potential, and what we're trying to do is to get enough data to show return on investment and make the case that this really does give you a lot of bang for your buck.
The one other thing we're very interested in healthcare -- and again it has to do with patient-centric healthcare -- is solutions for pervasive and remote monitoring of at-risk individuals. These are solutions that typically use some sort of a medical monitoring device, like a blood pressure cuff or a pulse oximeter or a bathroom scale, wirelessly enabled to talk through your cell phone and using the phone to connect to a server.