Tag Archives: information technology

Cancer Research and Care Embrace Technology

Oncology is about to take a huge step toward changing the way that cancer is understood and treated with the development of a breast cancer-specific prototype for a rapid learning system in cancer care. This system takes advantage of health IT advances (such as EHRs) in order to connect oncology practices, measure quality and performance, and provide physicians with decision support in real time.

The prototype is part of the American Society of Clinical Oncology’s (ASCO’s) vision for CancerLinQ  a “system that assembles and analyzes millions of unconnected medical records in a central knowledge base, which will grow ‘smarter’ over time,” according to the organization.

Illustration courtesy of the American Society of Clinical Oncology

As part of ASCO’s focus on quality improvement, the protoype will use clinical practice guidelines and measures of the Quality Oncology Practice Initiative to build quality measurement and clinical decision tools. Next, breast cancer patient records and data (stripped of identifying information) imported from the electronic health records (EHRs) of academic centers and oncology practices will be added.

As a proof of concept, ASCO says that the prototype will:

  • provide the foundational information and lessons learned to allow ASCO to move into a full-scale implementation;
  • provide real-time, standardized, clinical decision support integration within a demonstration EHR;
  • demonstrate a set of value-added tools; including a physician’s ability to measure their performance against a sub-set of QOPI measures in real-time;
  • demonstrate the ability to capture data from a variety of sources and aggregate the data using novel methodologies;
  • and create a demonstration which will allow exploration of data in unprecedented ways and generate hypotheses related to breast cancer.

Once the full technology platform is completed, CancerLinQ ultimately is expected to improve personalized treatment decisions by capturing patient information in real time at the point of care; provide decision support to cancer teams to adapt treatment plans to each patient and his or her cancer; and report on quality of care, compared with clinical guidelines and the outcomes of other patients. It’s also hoped that the system will help to “educate and empower patients by linking them to their cancer care teams and providing personalized treatment information at their fingertips.” Lastly, the system stands to be a powerful new data source for analysis of real-world quality and comparative effectiveness, as well as to generate new ideas for clinical research. It’s hoped that in time, this approach can be adapted to all types of cancer.

Kerri Wachter

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Filed under Health IT, IMNG, Obstetrics and Gynecology, Oncology

Will Electronic Health Records Kill Private Medical Practice?

Last January marked the official start of America’s ambitious program to turn its health records electronic, spearheaded by a federal incentive program that will award some U.S. physician up to $44,000 to help pay for their electronic system. The first payments from the government’s $27 billion piggy bank earmarked for electronic health record (EHR) funding began flowing on Jan. 5, including a $42,500 initial payment to two practitioners from the Gastof Family Clinic in Durant, Okla., who had the distinction of being the first individual docs to receive incentive payments.

Gastof Family Clinic staff receives the first EHR incentive check last January. courtesy EMR Daily News

But what fraction of the EHR cost will $44,000/physician actually cover? Can every U.S. doc, especially those in private practice, afford to pay whatever the cost balance will be to make their system work, and more importantly to keep their system in compliance with the data-reporting demands of the Center for Medicare and Medicaid Services (CMS)?

Some serious questions about the cost and feasibility of compliance came up in a session I covered last week in Las Vegas at the annual meeting of the National Association of Medical Directors of Respiratory Care, when the president of the group, Dr. Steve G. Peters, a Mayo Clinic pulmonologist, talked about what he’s seen as Mayo’s massive resources mobilized in an effort to comply with the demands of the 2009 law that set up the EHR system for Medicare and Medicaid.

The problem is that CMS demands automatic feedback from each physician’s or hospital’s EHR system on several patient-assessment measures and management decisions. “It sounds easy, but it’s not,” Dr. Peters said. “It’s very tricky, and it differs from measure to measure,” leading to a big IT challenge. Even though the Mayo Clinic already had a system-wide EHR in place, tweaking it so that it reports the data that CMS wants remains a work in progress. “We have 85% of it there, but the last 15%is hard.”

What will this mean for the private practitioner with shallow pockets? After Dr. Peters spoke, a comment came from audience member Dr. Theodore S. Ingrassia III, a pulmonologist from Rockford, Ill. He said that he had checked into the costs, and the $44,000 incentive likely will cover just a fraction, perhaps less than 25%, of the eventual cost for IT support to refine a system so that it can do and report everything that the regulations require. And, Dr. Ingrassia added, he can’t foresee himself being in a position to spend that much.

The major hospitals in his area, recognizing his dilemma and those of his fellow private docs, have offered them a deal: the hospital will fund their future IT needs if they forsake their independence and join the hospital’s staff, an option that Dr. Ingrassia didn’t like much either. His current solution? Stall, and hope the 2015 deadline, when CMS penalties are scheduled to start for physicians who have not yet installed an EHR system, will eventually get pushed back or that another, more palatable option emerges.

“Many predicted what you’re experiencing, that this incentive will not buy much,” Dr. Peters said in reply to Dr. Ingrassia. And, Dr. Peters added, “no one will admit it, but there is de facto pressure that there won’t be private practice in the future. Everyone will need to report measures on hundreds of patients,” and to afford to do that they “will need to be part of an organization.”

In short, the U.S. mandate for an EHR that can report back to the government a specified list of patient measures and treatment decisions may become a big, and possibly the final nail in the coffin of private U.S. medical practice.

—Mitchel Zoler (on Twitter @mitchelzoler)

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Filed under Family Medicine, Health Policy, health reform, Hospital and Critical Care Medicine, IMNG, Internal Medicine, Physician Reimbursement, Practice Trends, Primary care, Pulmonary Diseases and Sleep Medicine