American Thoracic Society

American Thoracic Society


Using COI-SMART, the American Thoracic Society:

  • Satisfied their requirements to both report and review data efficiently
  • Enables two people to manage conflict of interest for 3000+ busy physicians annually
  • Adopted a solution that reduces the input requirements for individual reporting
  • Benefited from system flexibility to encompass multiple purposes and audiences
  • Increased members’ transparency about their relationships within the healthcare industry


The American Thoracic Society (ATS) is an international professional medical association whose mission is to improve health worldwide by advancing research, clinical care and public health in respiratory disease, critical illness and sleep disorders. ATS has a membership of more than 15,000 physicians, research scientists, nurses and other allied healthcare professionals—25 percent of whom reside in countries other than the U.S. Multi-disciplinary specialties represented within ATS membership include pulmonology, critical care, sleep medicine, infectious disease, pediatrics, allergy/immunology, thoracic surgery, behavioral science and environmental and occupational medicine.

As many as 13,000 doctors, nurses and scientists attend the ATS international conference each year in May, where more than 300 medical and scientific symposia are presented after a competitive selection process. More than 300 reviewers of varying expertise evaluate and recommend appropriate sessions, which are taught by as many as 1,000 volunteer faculty members. As a part of this rigorous process, ATS has unique needs when it comes to managing conflict of interests (COI) disclosure among its large number of respondents and reviewers worldwide.

The organization also sponsors additional courses and activities worldwide throughout the year, along with numerous annual projects to develop clinical practice guidelines and policy positions. Moreover, panels of ATS experts meet in-person and online to develop official statements on a variety of topics.

COI has to be taken into account with each and every one of these vital activities.

Facing Daunting COI Challenges

Efficiency is paramount for the society’s COI management efforts, since ATS is a membership organization of volunteers whose time must be respected. It’s important, therefore, for ATS to avoid duplication and redundancy in informationgathering. Its members are primarily clinicians who work a variety of shifts and long hours over a wide range of time zones. That’s why it’s vital for members to have access to disclosure questionnaires and review mechanisms at all times.

“These people are all volunteering their time to us, so we need to respect their time with efficiency,” says Shane McDermott, ATS Senior Director of Ethics and COI Management. “We may be calling on ICU physicians whose only available time to submit a disclosure is at 3:00 a.m. Our system must be efficient, successful and available 24 hours a day.”

Despite this need to gather information quickly and efficiently, the society’s disclosure expectations are high. For ATS to grant CME credit, for example, the organization must comply with a rigorous set of Accreditation Council for Continuing Medical Education (ACCME) rules. Every single person on the ATS conference faculty must disclose, and that information must be relevant to the subject matter being presented.

In addition, ATS requires robust reporting. For transparency, ATS provides an online summary of all presenters’ disclosures to conference attendees. To maintain credibility, ATS must also meet the rigorous standards of other authorities— including the Institute of Medicine (IOM) and the Council of Medical Specialty Societies (CMSS).

Past Solutions Had Limitations

Because of the size and scope of ATS, paper-based processes have long been regarded as inefficient and prone to information security risks. In 2005, the group created two in-house automated systems to aid in COI disclosure. One was based on HTML and performed well in terms of efficiency and storage. The other incorporated rewritable .pdf files.

However, neither system was capable of “speaking” to the other—nor were there any tracking or reporting capabilities. ATS was able to obtain information online, but there was a high level of duplication and redundancy. For example, previous years’ disclosures weren’t available to users.

“Our goal was to create a system that made it easy for a physician to enter disclosure data,” says McDermott. “Yet that system also had to accommodate our large number of reviewers around the world.”


As ATS laid the groundwork for a more robust, comprehensive COI management system, several “must-have” capabilities were determined:

  • Efficiency—ability to design a time-efficient questionnaire that’s easy to complete.
  • Flexibility—questionnaire design that could be tailored to meet the disclosure needs of differing audiences (e.g., conference faculty vs. clinical practice guideline panelists).
  • Reporting—ability to generate ATS reports and deliver submissions to ACCME and other authorities– plus allow users to immediately print a disclosure PDF.
  • Tracking—sending email reminders to those who haven’t yet responded to disclosure requests.
  • Archiving—allowing users to update previous submissions rather than disclose “from scratch” each time.
  • Same-site review—eliminating the need for different log-ins and passwords.
  • Sophisticated data-sharing—visibility to disclosed information for numerous reviewers.
  • Security—ability to make information securely available to numerous reviewers.


In its search for a comprehensive software solution for COI management, ATS leadership evaluated three potential partners. Health Care Compliance Strategies (HCCS), a HealthStream Company, was the only one to offer a solution that met the comprehensive “wish list,” but also had the vision to develop a system flexible enough that it would not be limited to one area of disclosure operations—such as CME or research. Ultimately, the HCCS COI-SMART application was chosen because of its dual capabilities for both receiving and reviewing disclosures.

ATS contracted with HCCS in 2009 and its COI-SMART application was first used to manage disclosures for ATS’ May 2010 annual international conference. As with most software implementations, there were a few bumps in the road. The initial version required somewhat longer response times than ATS desired, but HCCS worked closely with ATS to resolve those issues—as well as accommodate the high volume of information the society required.

“With COI-SMART, we were able to create “autocomplete” lists in the questionnaires that reduce the typing a respondent has to do. That allowed us to consolidate our questions and sub-questions, which is a real time-saver for our members.” Shane McDermott, ATS Senior Director of Ethics and COI Management, American Thoracic Society



“With COI-SMART, we were able to create “autocomplete” lists in the questionnaires that reduce the typing a respondent has to do,” says McDermott. “That allowed us to consolidate our questions and sub-questions, which is a real time-saver for our members.”

COI-SMART is now helping ATS meet its large, growing and sophisticated COI demands with just two employees involved in COI management.

Disclosure: The First Step in Effective COI Management

ATS recognizes that COI disclosure is just one aspect of the ethical conduct of its members. As in other fields, most medical professionals have outside interests such as interactions with drug or device companies that could potentially be regarded as conflicts of interest. However, as McDermott points out, it is important for physicians to continue to interact with the industry to advance patient care.

This is a vital, two-way street: physicians know patient needs and medical best practices, while industry develops the drugs and devices that are crucial to improved patient care. It’s neither desirable nor practical to eliminate all outside interests, but there can—and should be—reasonable transparency.

Still, disclosure alone is of limited value and can be misunderstood. The key is to manage potential conflicts in a way that assures the public that ATS activities and opinions are independent and scientifically rigorous. Effective COI management also plays a key role in meeting other compliance regulations, such as ACCME rules for continuing education credits.

To keep all of these synergies healthy, partnerships between professional medical associations such as the ATS and experts in online compliance systems such as HCCS are crucial. It’s one way to quickly adapt to change in this fast-moving environment. COI-SMART is one example, helping ATS do more with less—and with an efficiency that demonstrates great respect for its members’ time.

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