Robin Zon, MD is a medical oncologist at Michiana Hematology Oncology, an Indiana-based practice with six locations and 180 staff that care for up to 350 patients on a daily basis. The practice, which has attested for Stage 2 of Meaningful Use, uses Elekta’s Mosaiq v.2.62 EHR and Navigating Cancer’s patient portal. It is working with area hospitals on the coordination of care criteria required for their ACOs and its Commission on Cancer Oncology Medical Home accreditation, both of which are scheduled for survey in 2016. MHO is one of the eight initial practices that rolled out the American Society of Clinical Oncology’s CancerLinq data-aggregation software late last year.
What was the impetus for implementing CancerLinq?
While serving on ASCO’s Board of Directors, I had the privilege on learning about CancerLinq at its inception and was a strong supporter of the initiative. The idea of using “Big Data" to better enhance our overall learning as it applies to improving patient care and advancing scientific knowledge was gaining attention in several venues, including in IT, provider, and patient groups. In fact, my community oncology colleagues would often comment on how wonderful it would be to share our collective wisdom and lessons learned from taking care of our thousands of patients over the many years in a collective electronic system.
Similarly, patients sitting before me in consultation would patiently listen to my explanation of our medical recommendations based on clinical trial evidence and FDA approvals, which they learned were based on less than 5 percent of patients who usually did not mirror their health status and demographics. Patients would often ask, "Have you or the clinical trials upon which you base your treatment ever taken care of a patient just like me? And how did they do?" Based on these experiences, as soon as I learned about CancerLinq, I knew that my practice needed to participate and be contributors and eventual benefactors from this Rapid Learning System.
How do you hope its utilization will benefit MHO and its patients?
The promise of this technology lies, in part, in being able to better care for our patients. I hope one day we will be able to answer the question so often asked by our patients regarding our experiences in caring for patients just like them. Additionally, patients may derive some comfort and reassurance in knowing that another set of expert eyes is looking at their case via mass data collection and analysis, thereby comparing what we are recommending to what was learned from the RLS. Furthermore, the RLS may also be able to use the patient data in better informing research questions, which complements the expressed desire of patient willingness to contribute to advancing cancer care. From the practice standpoint, we have and want to continue to be involved in cutting-edge initiatives that will benefit our patients while simultaneously making us better doctors and oncology providers. By being early adopters, we hope to not only contribute as a vanguard practice, but be the first in the region adopting this emerging technology.
What other technologies have had a significant impact on MHO?
We currently use Flatiron Health’s OncoTrials as a workflow tool, assisting with screening, eligibility, and task assignment. OncoTrials serves as an efficiency workflow tool at this point, but also gives good data on enrollment and why a patient may be ineligible.
What sort of healthcare technology adoption/implementation challenges are unique to oncology clinics/practices?
Although a majority of oncology practices currently use an EHR, there are a number of identified challenges that impact patient care and provider/practice efficiencies. This includes the publicly discussed interoperability problem between systems. In caring for our patients, important health information is not able to be exchanged easily. In fact, there is posed danger in that patients do not always truly understand their medical history or even the know the medications they have been prescribed. Unless the IT systems are able to talk to each other, we may be missing information that would be critical to know in selecting the appropriate therapy for a patient. The EHR is also contributing to physician burnout, as physicians and patients alike often note the interruption to the physician/patient interaction with the presence of technology in the exam room. Additionally, physicians comment that they spend more time inputting a record than they actually spend with the patient.
Challenges also include having the IT support within a practice to support technology adoption. Considering the increasing demands on practice data, there is competition on a daily basis on how to prioritize, implement, and support multiple technologies. Remember, there is no payment system fully supporting IT in a practice, so this is an expense paid for by the physicians. Finally with quality reporting requirements, compliance with multiple pathways and differing portals for communication, these tasks are overwhelming some practices in many ways, including financially.
Given that you’re past the implementation phase of CancerLinq, what tips can you share regarding implementing new healthcare technologies?
An in-depth analysis of the problems you are trying to solve or the efficiencies you are looking to achieve are critical when determining the "need" for technologies. Map the flow and use of the technology before implementing for it to be successful. I would also recommend engaging a team of stakeholders that includes your IT department, practice managers, CFO, billing manager, nurse managers, physicians, and research staff. There should be clear communication of expectations and what is practical and not feasible. It is equally important to understand the cost associated with technology implementation and support. There should be a willingness and ability of the practice to dedicate resources to support IT personnel and the technology.