The American Medical Group Association's plan to partner with a major pharmaceutical firm and create a national data warehouse is being met with reactions ranging from wholehearted support to wary skepticism.
"I think this is a glimpse into the future, that we can substantially improve the quality of care," says Molly Joel Coye, M.D., CEO of the Health Technology Center of Menlo Park, Calif., a not-for-profit medical technology assessment group.
"I am skeptical that they won't be identifying people," says Betsy Mahoney, coordinator for the Medical Privacy Project of the Maine Civil Liberties Union. "The average American would have the same skepticism."
The AMGA said Feb. 9 that it had entered into a partnership with Aventis Pharmaceuticals, the U.S. arm of the French pharmaceutical giant Aventis Pharma, to create a national database of information gleaned from its 300 healthcare group members.
AMGA member groups work with 67,000 physicians, the organization says.
In the next five years, the AMGA estimates it will spend up to $42 million to create the database to provide members with clinical and financial information that's deeper and more broad than what is currently available, says Julie Sanderson-Austin, AMGA's vice president of quality management and research.
The project will expand on AMGA efforts begun 10 years ago, says Sanderson-Austin. For a decade, AMGA has gathered outpatient clinical information from about 95 member groups and financial information from more than 100, she says. The AMGA reports to member physicians and groups on nine clinical benchmarks.
The data is coded so member groups will be able to identify only their own data, she says.
As yet, few AMGA member groups use electronic medical records systems, Sanderson-Austin concedes, and the dearth of key data gathering technology will create a huge hurdle for AMGA members and project sponsors to overcome, according to technical experts.
"We're starting with claims data," she says. "Most of our groups have electronic lab data and, where they have it, pharmacy data."
Groups will contribute data from patient encounters when available, she says.
The goals of the project are in line with the aims of two Institute of Medicine reports on medical errors and quality of care, which called for creation of regional databases to better track quality of care.
Coye was a member of the IOM committee that produced the reports. A large database is a "critical underpinning to being able to improve quality of care," she says.
Walter Menning, vice chairman of information systems at the AMGA-member Mayo Foundation, says the Rochester, Minn.-based group analyzes its own clinical data and has worked with the Cleveland Clinic on a joint benchmarking project. His take on the AMGA plan is positive.
"We still look to be able to compare ourselves and see if somebody else has a best practice," Menning says.
The scope of the AMGA project is enormous, says Michael Millenson, a Chicago-based principal with Mercer Management Consulting and an expert on the use of computer technology to improve quality of care.
"To my knowledge, there has never been that much money dedicated to a national database and that much cooperation," Millenson says.
Physician support will be a key to success. "Your average working physician is not going to take the time out of his (or her) busy schedule to collect this data unless there is an excellent clinical reason to do so," he says.
Stewart Gleischman, M.D., vice president for strategic business development of Newport Beach, Calif.-based TriZetto Group, a software and application services provider, says the project is technically feasible but calls it "a question of time, resources and technical know-how."
In December, the AMA voted to take steps to protect physicians from the use of prescribing pattern information by pharmaceutical companies. AMGA says it plans to track prescriptions and diagnoses, two key data elements for pharmaceutical marketers, but insists it won't share that information with Aventis.
The AMA declined comment on the AMGA plan.
A further complication is Aventis itself. Last fall, after a congressional investigation, Rep. Fortney "Pete" Stark (D-Calif.) lambasted an Aventis progenitor, the German firm Hoechst, for what he called "fraudulent price representations" for its injectable form of the antinausea drug Anzemet.
Aventis was formed in 1999 from the merger of Hoechst and Rhone-Poulanc of France.
Criminal or civil investigations into infusion drug marketing schemes are active at the federal and state levels against several drug companies, though Aventis has not been named in any of those probes.
Stark expressed ambivalence about the AMGA-Aventis venture.
"I hope that the agreement includes firewalls to protect the patient and the physician from being steered toward the use of Aventis drugs--drugs which may or may not be the best for the patient," Stark says. "The data has shown that when a drug company gets involved with doctors, somehow that company's product sales increase."
Aventis refused to disclose its equity interest in the venture, as did the AMGA.
Aventis did not answer questions on whether it currently aggregates data by physician or has access to that information. Through a spokesperson, Aventis says identifying information about physicians and patients will be stripped from the data before it enters the warehouse.
Aventis says it hopes the venture will provide information on health outcomes and the cost-benefit of therapies to improve patient care as well as help the company improve product offerings and clinical research.
Mahoney, of the Maine ACLU, says "the frightening thing about any information is this stuff isn't thrown away. Who's to say what's going to happen next day, next month and next year?"
However, having patient data compiled in a meaningful way and reported back to physicians can lead to improved patient care, says Sarah Corley, M.D., who has used a healthcare database called Practice Partner Research Net in her two-physician internal medicine practice in Arlington, Va., for six years.
"You get wonderful reports showing how you're doing on guidelines," she says. "The more data you have, the better you can practice medicine. It's a nonthreatening way (to) know you're not perfect."
Finally, all the data in the world won't change patient care if someone isn't riding herd on doctors at the institutional level, according to Gregory Cooper, M.D., co-author of a study that concluded quality programs need someone in-house to keep physicians using best practices.
"If there isn't some kind of daily interchange, they (physicians) don't adhere to them," he says.