The American Medical Group Association, in partnership with Aventis Pharmaceuticals, plans to spend up to $42 million over five years to create a massive national database of financial and clinical data, potentially drawn from 67,000 physicians and 35 million patients.
The AMGA, based in Alexandria, Va., created a new, for-profit corporation, the American Medical Group Data Warehouse, to administer the database, according to a statement issued Feb. 9 at an AMGA conference in Orlando, Fla.
Aventis Pharmaceuticals is the U.S. arm of French firm Aventis Pharma.
"We've got to take medicine into the 21st century, and shared decisionmaking driven by benchmarks is the best way to do that," says Donald Fisher, AMGA president and CEO. He says the warehouse should start receiving data from AMGA's 300 member organizations this fall.
AMGA says the database company has a five-year budget of at least $32 million and as much as $42 million. Aventis signed on for a two-year commitment, Fisher says. Drugmaker Parke-Davis, which since has been acquired by New York City-based Pfizer, funded early development of the data warehouse concept, which began as an idea in 1999 but did not take shape as a company until last summer, Fisher says.
Fisher would not disclose the relative investments or ownership interests of the parties. He says the database company also plans to take on additional partners.
An Aventis spokesperson says the company will use the data in compliance with patient confidentiality rules under the Health Insurance Portability and Accountability Act as well as any guidelines imposed by the new company. Fisher says Aventis will use the database to identify patients eligible for clinical trials, helping it speed new drugs to market. Identities of patients will not be released to the drugmaker, and initial communication with patients about the trials will be through their physicians at AMGA member groups, he says.
AMGA members will be able to use the warehouse to access data on the cost of treatment and patient health outcomes. Data will be aggregated so that patients, physicians or groups cannot be identified. Reports will be sold back to members for a nominal fee. The bulk of the income from the venture, however, will come from the sale of data to outsiders, including other drug companies and large, self-insured employers, he says. Accenture, formerly known as Andersen Consulting, will prepare a business plan for the new company.
In December, the AMA House of Delegates passed a resolution asking the AMA to use all "legally appropriate means" to end the practice of pharmaceutical companies developing profiles of physicians' prescribing patterns. Testimony supporting the resolution deemed profiling "an inappropriate intrusion into the privacy of the physician-patient relationship." An AMA spokesperson said the association, in keeping with past practice, will not comment on the plans of other physicians' groups.
Fisher insists the proposed data warehouse and the AMA resolution are not at odds.
"I in no way see us coming even close to the resolution passed by the House of Delegates," Fisher says. "That data will be de-identified."
As a safeguard, the AMGA will own and license its data to the warehouse company, he says. "That license will have a lot of teeth in it, and (the data) could only be used according to the uses prescribed by members."
The Institute of Medicine, in its 1999 report on medical errors, called for the formation of regional databases "to obtain a sufficient number of cases for meaningful analysis . . . to improve analytic power and . . . facilitate collaboration to understand the extent and nature of errors in healthcare."
Molly Joel Coye, M.D., a member of the IOM committee that prepared the report, says the AMGA effort is "a very encouraging step forward. This will probably be useful in ways we can't even imagine now. It takes organization and leadership, money and big databases to track quality of care."
Coye is the CEO of the Health Technology Center of Menlo Park, Calif., a not-for-profit group that forecasts the impact of technology on the practice of medicine. Coye says a physician-controlled database "starts to put the physicians on an equal footing (with pharmaceutical companies), and in fact, to have a more thorough and more valuable set of data (than do the drug companies)."