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More Medicine Fewer Clicks: Creating an Informatics Enabled Oncology Practice
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Dr. Debra Patt discusses More Medicine Fewer Clicks: Creating an Informatics Enabled Oncology Practice at ASCO 2017. For the ability to view on your mobile phone please visit us at

This transcript is software driven, please understand there may be errors.  Should any inaccuracies or omissions be found, please notify for correction.

My name is Dr. Debra Patt and I'm the Vice President of Texas Oncology and the medical director for analytics from McKesson specialty health in the U.S. oncology network. I also serve as the editor and chief of the journal of clinical oncology, clinical cancer informatics.

I'm gonna talk to you today about creating an informatics enabled oncology practice. How do we use data systems to make us better? We have big problems to solve in a big world. We have a goal of making cancer care better throughout that world. I suffer some of those unique challenges in our large network of oncology practices which comprises over 29 practices and in Texas oncology where we have over 176 sites of service.

One tool we've implemented to help us is tele-medicine. We've seen telehealth and tele-medicine platforms grow substantially over the last several years and now we're growing into applications for oncology. Traditional retail in medicine has been used in teleneurology, telestroke. For example in emergency situations when patients are seen in the hospital and may need to have the administration of TPA. Frequently also organizations will use tele-psychiatry services to allow psychiatric medications to be modified by telehealth platforms in interaction with their doctors over those platforms.

We've launched a tele-health initiative within Texas oncology this year which has been very exciting. It helps us think about how we bridge gaps that we have today in geography, expertise and staffing. This has been a unique way in which we've been able to use our neural oncologist to consult at remote sites of service and allow us to offer those sub-specialty services at remote sites which otherwise would not have access.

This is growing over time. I look forward to have all use it in some of our alternative payment model contracts to provide a heightened level of infrastructure services for the patients we serve, social work, financial counseling and even genetic counseling.

A second functionality of informatics that can improve cancer care and help us at the practice level are the nudges we use in our information systems. A nudge that I've been part of for the last 10 years is a clinical decision support system to facilitate pathways compliance. Pathways are a subset of evidence based guidelines to help improve cancer care. My organization has previously published on these guidelines with regards to cost effectiveness and quality demonstrating a similar to improved quality outcome and a reduction in cost. So this has been validated. But we implemented a clinical decision support system in our health records to determine if that was an effective way to improve quality adherence. And in fact it was.

We studied this over nine state wide practices in 31 thousand patients over a six month period. We evaluated if pathways compliance hitting greater than a 75th percentile was improved over that timeframe and in fact it was as a hole and in most of the practices that participated. Mind you these are different practices. They have different cultures, different contracts, different alternative payment model contracts and participation in different quality based initiatives.

Despite this across most of these practices and across the group as a whole there was substantial and significant improvement in quality performance and compliance with these pathways. In addition, there were improvements in accessible data. What you see before you is the accessible data pre and post to the pilot period. And our accessible data got up to 99 and a half percent or a significant improvement. Our quality compliance or compliance with evidence based pathways also improved over the study interval demonstrating the decision support system embedded within our health record not only led to improved accessible data but also heightened compliance with the pathways.

We saw over the time interval that this was on average a little bit better than 7% improvement in overall compliance with using this clinical support system. The other thing it showed us is that it improved exception reporting so we could understand why people are varying from the pathways we use. This helps us both in terms of facilitating quality initiatives within our practice, having quality oversight and centralized review across our many sites of service and having accessible data to use for prior authorization.

Another way we're using informatics to improve our practice is to look at predictive analytics. Can we predict which patients are going to have a poor outcome or require additional services and partner what services we provide to those patients given their increased risk. We are starting a pilot in Texas oncology identifying patients at high risk and identifying different services that they need to try to reduce that risk over time.

I'll say that today we use many different information systems and it's more desperate. Patients use them and they engage with different systems. Doctors use them, engage with different systems and it's challenging. But by having a parcemoneus engagement with different data systems and try to have them inter graded, we'll have a better future. Part of that better future is us sharing information. That's why I'm happy to service the editor and chief of the journal of clinical oncology, clinical cancer informatics where we will share information about these information systems and we can all help each other get better faster.

Thank you for your time and listening to my presentation today.