October 2019 Edition Vol.11, Issue 10

OncoCloud ’19 Showcases the Benefits of Data Connectivity for Community Oncology

by Megan Garlapow, PhD

Much of real-world cancer care data are siloed. Broadly speaking, this may impede generation of advanced insights and deeper analyses from real-world evidence. For community cancer centers, connecting previously detached data can increase clinical trial accrual, improve precision medicine, and propel value-based care.

At OncoCloud ’19, Flatiron Health’s annual meeting on their cloud-based oncology software suite OncoCloud, issues facing community cancer centers were discussed. Sessions ran the gamut from trends affecting the future of community oncology to market overviews on the business aspects of oncology practices.OneOncology, a community-based cancer care network with practices in New York, Arizona, and Tennessee, was one of the largest community practices at OncoCloud ’19 and uses the OncoCloud software suite to drive its practice.

OncoCloud provides data connectivity across more than 280 community and academic cancer centers.2

Streamlining EMRs and Clinical Decision Support

Connecting electronic medical records (EMRs) across healthcare providers offers an opportunity to streamline treatment decisions, decrease time clinicians spend entering patient data and information, and propels value-based care. A fully integrated EMR enables secondary use of EMRs to support research.

In particular, patient diagnosis data can support research inquiries when the data are accurate, accessible, and structured in the EMR. Though patient diagnosis data often are not wholly inaccurate, neither are the data wholly accurate. Moreover, useful diagnosis information may remain locked in progress notes and be burdensome to retrieve.3

On a patient care level, ineffective transfer of information could result in communication failure and contribute to improper patient care, especially in the highly multi-disciplinary area of oncology. Indeed, results from qualitative research indicates general dissatisfaction among providers in the function of EMRs.4

Flatiron’s OncoEMR aims to address those issues. Jeffrey Vacirca, MD, the board director at OneOncology, emphasized the profound effect streamlining EMRs have: “We call it an EMR, but it’s more than that. It’s saving patients’ lives.”

According to Lee Schwartzberg, MD, FAACP, and Chief Medical Officer at OneOncology, the new capabilities of OncoEMR are cause for excitement given the ability to integrate the workstream in community oncology practice. He explained, “Putting together the EMR as part of a suite of services with billing and revenue cycle management has been very useful for us. Seeing that continue to grow has been something that facilitates the practice at the community oncology level.”

EMR integration can be further supported by clinical decision support. Flatiron Assist, a clinical decision support tool, may provide much needed structure for the increasing demands of clinical decision support and capabilities.

Clinical Trial Accrual

Accrual into cancer clinical trials is persistently sluggish, resulting in around 20% of cancer clinical trials failing due to an inability to enroll enough patients.5,6 According to the American Cancer Society, among recommendations to address barriers to trial enrollment at the provider and institutional levels are the following:

  • Management of trial portfolios so that they match patient characteristics in the community that is served by a practice with a clinical trial
  • Development of technology, tools, and processes for non-research sites that enable easier matching of patients to trial opportunities
  • Employment of protocols or technology to scale and systematize prescreening incoming patients for trial eligibility
    • Ensure that matching tools are easily available to providers in their workflow.
    • Standardize eligibility criteria so that it is machine-searchable.
    • Standardize clinical trial protocols into formats easily incorporated into EMRs.6

OneOncology’s research network looks similar to a national site management organization providing high-quality trials to centers participating in OneOncology. Interest in this program has been high, according to Dr Schwartzberg, as it offers a potential path to enrolling more patients.

“The value of a OneOncology-wide research structure is efficiencies that can be scaled in terms of centralizing and contracting regulatory functions, budgeting, and potentially even data management across the site management conversation,” said Dr Schwartzberg.

By establishing preferred relationships with pharmaceutical companies, OneOncology can understand the scope of drug manufacturers’ pipelines, allowing particular trials to be slotted at different sites. Since managing clinical trials can be complicated, OncoCloud’s OncoTrials can quickly identify patients, decrease screening volume, and centralize management of a clinical trial portfolio.

Precision Oncology in the Community Cancer Center

Prioritizing the building of “best-in-class precision oncology capabilities,” OneOncology has established molecular testing in a routinized fashion. Scaling precision medicine in the community setting is equally important as it can support clinicians’ adherence to recommended clinical testing.

“It’s now virtually impossible to be up to date, even with the tools that are available,” said Dr Schwartzberg. With OneOncology’s molecular tumor boards, the organization has now passed a so-called inflection point of whether broad molecular profiling is appropriate. In the current age of tumor-agnostic drugs, Dr Schwartzberg indicated that it may be a disservice to patients if they aren’t tested broadly.

Recent changes in Medicare have further advanced precision oncology capabilities. Congress removed the extended waiting period following a biopsy, which meant that extensive testing could not occur lest it got billed back to the hospital. Now, molecular testing can be done upfront, allowing oncologists to know what clinical care and clinical trial options exist for each patient within around two weeks.

Value-Based Care

OneOncology has the long-term goal of participating in value-based arrangements, even as defining what that means is a process in and of itself. The organization is therefore building a suite of analytical tools at operational, financial, and clinical levels that can improve cost analysis and enable participation in risk-based payment arrangements.

Several presenters at the meeting noted that only around 20% of the overall cost of cancer care was due to the cost of drugs. While not absolving pharmaceutical companies from their important role in controlling drug prices, the critical role in growing and expanding community cancer care was underlined as it can combat the disproportionately higher cost of cancer care in hospitals.7

This, however, is no small feat as hospitals continue to acquire community cancer centers, but perhaps payers need an alternative.

“Consolidation of hospital systems has really more than anything we’ve ever seen driven up healthcare costs. The vast majority of healthcare spend is on emergency department visits and healthcare in the last thirty days of life,” said Dr Vacirca.

By providing infrastructure, Flatiron’s support of community oncology keeps community doctors practicing in the community, and, according to Dr Vacirca, that is “part of the solution in driving healthcare costs down while providing high quality cancer care.”

Transformation in the community setting over previous decades has allowed community oncology to differentiate itself from hospitals with value-based strategies. Payers may be recognizing community centers as a strong option over the more expensive hospital setting. As community oncology expands, they are able to use that as leverage with payers which can result in better contracting.

“Value-based care will evolve into population management. To do population management is all about data management. Having a technology partner is critical for thriving in the value-based world,” said Jeffrey Patton, MD, President of Physician Services at OneOncology.

Two primary obstacles can affect participation in value-based care according to Dr Schwartzberg. The external obstacle is engaging payers to participate in value-based projects.  As the consensus that value-based arrangements are the way of the future, larger payers are now at least interested in executing pilot value-based projects.

The internal obstacle is building and executing the capabilities for value-based projects. With lessons learned from the Oncology Care Model and the collaborative development of next-generation value-based care, surmounting this obstacle becomes achievable.

The Future

Current and near-future development of OncoCloud addresses many issues facing optimization in the community oncology setting, but opportunities for even more automation persist. An aggregation of technologies could make it so that a practice did not have to use ten different overlay systems.

In the short-term, Drs Schwartzberg, Patton, and Vacirca are working with the aggregate of data from the thousands of patients from OneOncology to develop pre-identification of patients at risk for hospitalization. The goal for OneOncology is to have this at-risk identification up and running within a year.

“When we formed OneOncology, the goal was to change the patient experience and delivery model and allow us to quantify what we actually do. We have to be nimble enough to make changes where they need to be made,” said Dr Schwartzberg.

References

  1. OncoCloud ’19 Presented by Flatiron. 2018. https://www.oncocloudconference.com. Accessed September 24, 2018.
  2. Flatiron Health. https://flatiron.com. Accessed September 26, 2019.
  3. Diaz-Garelli JF, Strowd R, Wells BJ, Ahmed T, Merrill R, Topaloglu U. Lost in translation: diagnosis records show more inaccuracies after biopsy in oncology care EHRs. AMIA Jt Summits Transl Sci Proc. 2019;2019:325-334.
  4. Asan O, Nattinger AB, Gurses AP, Tyszka JT, Yen TWF. Oncologists’ views regarding the role of electronic health records in care coordination. JCO Clin Cancer Inform. 2018;2:1-12.
  5. Murthy VH, Krumholz HM, Gross CP. Participation in cancer clinical trials: race-, sex-, and age-based disparities. JAMA. 2004;291(22):2720-6.
  6. American Cancer Society Cancer Action Network. Barriers to patient enrollment in therapeutic clinical trials for cancer. https://www.fightcancer.org/policy-resources/clinical-trial-barriers. Published April 11, 2018. Accessed October 5, 2019.
  7. Gordan L, Blazer M, Saundankar V, Kazzaz D, Weidner S, Eaddy M. Cost differences associated with oncology care delivered in a community setting versus a hospital setting: a matched-claims analysis of patients with breast, colorectal, and lung cancers. J Oncol Pract. 2018;JOP1700040.

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