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Professor's retirement highlights lifetime of work advancing health care research at ASU

September 12, 2019

Founder says goodbye on 20th anniversary of Center for Health Information and Research

Nowadays, you don’t have to look very hard to see the power of big data. From targeted advertisements to specially curated Netflix queues to optimized navigation routes, algorithms, data capture and cloud computing do nothing less than make modern daily life possible.

In a research setting, big data has massive potential to inform and expand our understanding of a particular field, especially if that field produces incredible amounts of data every day.

Twenty years ago, ASU College of Health Solutions biomedical informatics Professor Bill Johnson saw that potential where others did not when he founded the Center for Health Information and Research (CHiR), Arizona’s first and only health care data analytics repository — no small feat at a time when not many had attempted anything on that scale, let alone succeeded.

According to a number of Johnson’s friends and colleagues, because CHiR works mostly behind the scenes, it hasn’t always gotten the attention it deserves for the impact it has had on Arizonans' health. To date, CHiR has been responsible for approximately $7.6 million in sponsored research that has aided Arizona policymakers and health care professionals to better address such issues as Medicaid, opioid abuse and child drownings. His colleagues say it would be a misstep to overlook the value of such an entity, of which there are precious few in the country.

At a retirement ceremony for him Tuesday evening on the Downtown Phoenix campus, they praised Johnson for as much, and more.

“Bill really built a health care data infrastructure at a time when health care data infrastructures were not very prevalent,” said Eugene Schneller, a professor of supply chain management at the W. P. Carey School of Business. “The other thing he did is he took a generation of students, many of whom are now CEOs in major systems around the country, and he really made them economics literate. And that’s something that’s really tough to do.”

An economist by training, Johnson’s first foray into health care was as a graduate student when he participated in research looking at the impact of health conditions on individuals’ ability to work. Later, as a professor at Syracuse University, he was invited to participate in a Harvard medical malpractice study, the largest such study ever conducted, and then followed that up with a study on asbestos for the Mount Sinai Health System in New York.

After nearly two decades at Syracuse, Johnson joined ASU in 1991, assuming a joint appointment at what was then the School of Health Management and Policy and the W. P. Carey School of Business’ Department of Economics. He soon found that his research reputation preceded him, and he was fielding numerous requests for contributions to studies assessing various aspects of the health care industry.

Johnson put together a small group of researchers to take on the work. One request came from the Flinn Foundation, which for many years had been concerned with quantifying the number of uninsured Arizonans — without much success. They asked if it was possible and Johnson told them it was, but that it would take time and patience due to the amount of data that needed to be collected, catalogued and analyzed.

The foundation was game and Johnson set about his task.

“The idea was that we'd go to health care providers and we would just ask them to share their data,” he said.

Some researchers had tried before, but failed because they were only willing to accept data in certain formats.

“We just said, ‘We'll take whatever you have,’” Johnson said. “Which in a few cases turned out to be pretty rough. Some of those systems were pretty old. I remember bringing back a tape from Yuma and my programmers, who were relatively young, had never seen one. They asked, ‘What is that?’ I told them, ‘That's a DOS-based tape.’

“So we found that despite all that carrying on about different softwares making it impossible, that you could certainly translate the data from one software to another.”

As the dataset grew, it eventually became the Center for Health Information and Research, officially founded in 1999. Today, it contains health care information on roughly 9 million individuals and roughly 300 million health care episodes. Crucially, it also contains the entire Medicaid database of Arizona.

Over the years, CHiR moved around the university with Johnson as new departments were created and old departments were restructured, finding a home for a time in the biomedical informatics department of the engineering school before it moved to the College of Health Solutions, where it exists now. At various points in time, its focus has shifted from health care delivery to the health workforce.

In one NIH study, researchers at CHiR were asked to look at the long-term outcome of Medicaid-required preventive procedures on infants. Because their database covers such a wide timespan, they were able to determine the effects on  children into their early teens, whereas other organizations might only be able to look at the effects two or three years out. (CHiR found that the children who received preventive procedures were less likely to be injured but not necessarily less likely to become ill.)

“It's like a library,” Johnson said. “So let's say you want to start a research project and you want to look at people with Alzheimer's. Well, what are your choices? You could go out and do a survey, which is time consuming and expensive and it's a one-time shot. Whereas every hospital, every health care provider, every insurance company, every day produces detailed data that now exists in this centralized database that is constantly updating from as many sources as possible. So you don’t have to go through that whole long collection period and you actually have better data because you can follow people over time.”

CHiR also has datasets on every pharmacist, nurse and physician in Arizona from as far back as 2007 for nurses and as far back as 1991 for physicians. That information is useful in instances where, for example, government and university officials are deciding whether to open a medical school or not.

“So there again we’ve got a longitudinal picture from, in some cases, the day a physician started to practice until they're middle-aged or older,” Johnson said. “Because of CHiR and only because of CHiR, that data will be there the next time somebody wants to know about the distribution and age of primary care physicians in Arizona, for example. You're not going to have to wait two years to collect the data and then maybe find what you’re looking for.”

Johnson admits it’s a hard sell to investors.

“It's very hard to get external funding to maintain the database during periods when nobody's interested in certain questions. But CHiR is pretty much operating at capacity all the time, which then very much limits its ability to take on new projects. And there's plenty of opportunities to explore new questions with the data we already have."

Community impact has always been at the core of CHiR’s work. In 2005 and again in 2008, the center won the President’s Medal for Social Embeddedness.

“I think it goes to Michael Crow’s vision to impact the community in which we live,” said George Runger, current director of CHiR and a professor of biomedical informatics at the College of Health Solutions. “I think that’s really what our role is.”

CHiR has no less than 28 projects currently underway, ranging from improved effectiveness of community health centers to tracking electronic health record adoption to the effects of extreme weather on asthma to child eye exam coverage.

Though Johnson relinquished his role as director of the center in 2012, he still plays a vital role in its research and day-to-day operations, something those who know him well expect will continue in spite of his retirement.

“I really don’t believe him, that he’s retiring,” university provost and Executive Vice President Mark Searle said at Tuesday evening’s ceremony. “So I said to him, ‘That just means you’re not on the payroll anymore, right?’

“Bill was doing this work long before this became a part of the national dialogue and the national rhetoric around public policy. He was truly a pioneer in this space. … And I’m so glad to see people here today to honor Bill for that work because it’s truly a remarkable commitment. At ASU, we believe that we have to take responsibly for the health and the well-being of the communities that we serve, and that’s exemplified by CHiR and all the work Bill has done over many, many years. He has really done the kinds of things that a university wants to be known for.”

Top photo: ASU College of Health Solutions Professor of biomedical informatics and founder of the Center for Health Information and Research Bill Johnson and his wife, Saundra, listen to the accolades at his retirement celebration after a 28-year tenure at the university, on Tuesday, Sept. 10, 2019. About 50 former colleagues, staff, students and family came to honor the prolific researcher who combined his skills in economics with his passion for health solutions. Photo by Charlie Leight/ASU Now

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Hispanic Heritage Month a time for pride, inclusion and learning

September 12, 2019

ASU professor offers insight on the monthlong celebration of Hispanic culture

Hispanic Heritage Month is a time for pride and reflection, celebrating millions of Americans who have positively influenced and shaped our society.

Beyond that, it should be a time of learning and inclusion for Hispanics and people who have an interest in delving deeper into other cultures, said Vanessa Fonseca-Chávez, an assistant professor of English in the College of Integrative Sciences and Arts at Arizona State University's Polytechnic campus.

“Hispanic culture and communities are more deeply embedded in the United States than what most people realize, and it’s one of the fastest growing demographics,” said Fonseca-Chávez, whose work focuses on layered colonial relationships in pre-Chicana/o and Chicana/o literature and cultural production in the Southwest United States.

ASU Now spoke to Fonseca-Chávez about the roots and intricacies of Hispanic Heritage Month, which runs from Sept. 15 to Oct. 15.

Question: Why do we have Hispanic Heritage Month?

Answer: Hispanic Heritage Month began in 1968, which is fitting because it coincides with the Chicana/o movement of the 1960s and 1970s and the struggle for educational, cultural and political recognition for Chicanx and Latinx communities. Hispanic Heritage Month allows us to take pause and reflect on the contributions of these communities, some of whom have been in the present-day U.S. since the late 1500s. The timeline for Hispanic Heritage Month is Sept. 15 through Oct. 15 to recognize the independence of many Latin American countries from Spain in the 19th century. I think Hispanic Heritage Month can be useful when conceptualized as both a learning and cultural process of inclusion. This means, whether inward or outward facing, we have to move beyond just painting a palatable image of Hispanics/Latinx and think critically about how Hispanics/Latinx have suffered from various forms of injustice and oppression over time.

Q: Where did the term Hispanic come from and is that preferable to or more accurate than Latino?

A: The word Hispanic came from the Nixon administration and later was used as a census term intended to embody a heterogenous group of individuals from Spanish-speaking countries. In 2000, the census began using the term Latino to refer to those who came from Latin America, recognizing that not all individuals who come from Latin America speak Spanish. Both are umbrella terms and fail to recognize region-specific and/or complex identities. Someone who identifies as Latinx might also identify as Puertoriqueña or Boriqua, and perhaps even Afro-Latinx. There has been a trend to use Latino over Hispanic, though I would not say that one is more accurate or preferable. In New Mexico, for example, people often refer to themselves as Hispano or Hispana. This may be viewed by those outside of New Mexico as assimilationist, but it is not up to us how one chooses to identify. When identities are imposed upon a population, it strips them of the agency to explore identity for themselves and come to terms with an identity that best frames their particular experiences.

Q: What do Hispanic Heritage Days across the United States look like and how do they vary?

A: Hispanic Heritage Month celebrations vary across the United States and, oftentimes, can be a reflection of the cultural/ethnic heritage of the region that has historically been shaped by migration patterns. This is not dissimilar to universities whose academic units represent regional identities and concerns. You see more Chicanx studies programs in the U.S. West and Southwest and more Latinx or Caribbean studies programs as we move toward the East Coast. However, we need to be cognizant of how we include other Latinx groups within Hispanic Heritage Month celebrations so that, regardless of where we are located geographically, we can learn more about all Latinx communities. 

Q: When you have such a catch-all term as Hispanic Heritage Month for the 25-odd countries it represents, does that run the risk of a generic picture of one culture?

A: Absolutely; we are not one singular culture and should not be celebrated as such. This is a challenge that nearly all heritage month celebrations face. Those who are in charge of programming for Hispanic Heritage Month should be as inclusive as possible. This doesn’t mean that we have to do something directed toward each country; that would be nearly impossible and potentially shallow. However, we can invite folks to the planning and presentation table who can expand our understanding of Latinx communities and be intentional in our efforts to bring in as many voices and perspectives as possible.

Q: What do you personally do to celebrate Hispanic Heritage Month?

A: Throughout the year, I consistently am looking for events in the community and at ASU that celebrate and highlight Hispanic communities. Every fall, I teach a transborder Chicana/o literature course and encourage my students to go to at least two events during the semester that can broaden their understanding of Chicanx/Latinx culture. I believe that representation matters and that learning about and appreciating other cultures can make us better human beings.

Top photo: Vanessa Fonseca-Chávez, in front of artwork by Calle 16 at the Barrio Cafe in Phoenix, is an assistant professor of English in the College of Integrative Sciences and Arts. Her teaching focuses on Chicana/o and indigenous literature and cultural production. Photo by Charlie Leight/ASU Now

Reporter , ASU Now