The Promise and Peril of Technology
What seems like just a few years ago, oncology practice technology amounted to a billing system and an electronic medical records (EMR) system, possibly even a drug inventory management system. When a practice participated in quality or performance metrics, such as the American Society of Clinical Oncology Quality Oncology Practice Initiative, it was usually through the process of a manual chart review conducted for a subset of patients being treated by the group.
Oral drugs were often ordered through prescription pads, and were usually not tracked through the practice EMR or the drug inventory system if the practice did not dispense drugs.
As the use of technology started to be applied for performance and value-based pilots, oncology practices realized that the technology was woefully unprepared for the demands that were going to be made of it. The Center for Medicare and Medicaid Innovation (CMMI) offered grant funding to anyone with an idea of how to simultaneously provide better care, keep people healthier, and save money.
As most of you know, Barbara L. McAneny, MD, FASCO, MACP, created a company called Innovative Oncology Business Solutions and in 2012 received a $19.8-million grant from CMMI for her COME HOME project to implement new processes and build software solutions that could be replicated at her 7 practices. The grant was used to support the implementation of triage pathways, processes, and software development to collect data on care processes improvement and enhance services for patients with cancer.1
This became one of the most obvious examples of the technology transformation that would be needed to enable oncology practices to start looking at their patient management and processes in a different way.
A small number of oncology practices participated in a bundling project with UnitedHealthcare, and some of those went on to participate in the COME HOME project. Much of that work involved data collection and analysis outside of existing practice technology and EMR systems.
The Limits of Technology
By 2016 and 2017, oncology practices were facing new performance and value-based programs initiated by the Centers for Medicare & Medicaid Services, such as the Oncology Care Model (OCM) and the Merit-Based Incentive Payment System. These programs require that practices start to recognize and track more details around patient management within their practice walls, but outside them as well.
There are new demands for enhanced management of oral drugs prescribed for patients with cancer. Patient assessment, management, and triage are increasingly important inside and outside of the scheduled office visit. Traditional practice billing and EMR systems, both legacy and cloud-based, are not capable of delivering the data collection and analysis that is required.
Some oncology practices have added new modules, most specifically designed to collect the minimum required data for the OCM program, but these only scratch the surface of the analytics and reporting practices that cancer centers need in 2018 and beyond.
Practices are finding another challenge as they explore solutions to the limits of available technology. The few available software solutions are usually focused on 1 missing capability, such as Medicare claims analytics, oral drug management, or patient care management. However, in the days of supposed interoperability and transparency of information, many practices are finding the add-on fees (just to connect to complementary software) charged by their EMR vendors to be exorbitant.
It is ridiculous for a practice to face a setup charge of thousands of dollars, and then to face monthly fees of additional thousands of dollars, just to put the basic patient demographics into a complementary technology that augments what their EMR system cannot offer.
In addition, oncology practices have to worry about how their own data are being used, and by whom. When you read the contract details of many EMR solutions, the ability of the practice to pull and use its own data, once the data have been parsed and put into fields in the EMR, is very limited. Yet, data sales and analytics are the business backbone of several EMR vendors.
Potential Value of Big Data
In early 2016, Flatiron Health, described as a company “that gathers and analyzes data on cancer treatments and sells software based on those insights,” raised $175 million in a funding led by Roche.2
Many of its physician practice clients may define this company as a vendor that provides EHR solutions to them and not consider the data sales portion of the business model for a company such as Flatiron Health.
Part of the value of this investment for Roche was that Flatiron Health has a large amount of data that could help the pharmaceutical company to understand how medicines work in patients.2
In early 2018, Roche and Flatiron Health announced that Roche will acquire all shares of Flatiron Health, in a $1.9-billion transaction.3 The expectation is that Flatiron Health will continue its current business model, network of partnerships, and overall objectives. The information brought to the table by Flatiron Health was described by Roche Chief Executive Officer, Daniel O’Day, as “regulatory-grade real-world evidence.”3
This real-world evidence is derived from the EMR data entered by every physician who uses the Flatiron Health technology, not from any direct interaction and data collection between Flatiron Health and patients. Similar information is loaded into every EMR platform, which may become part of a major national investment.
The Value Conundrum
Such investments and similar transactions are not bad in and of themselves. There can be great promise for cancer care if useful information is gleaned. The peril for practices, physicians, and patients is when such data are obtained and used by others, but the practices and patients who generated the data do not get the value contained from these data.
Large EMR systems should be able to provide reports routinely for practices that mirror whatever reports and analytics they are selling or providing to data customers. Practices should routinely see not only their own data in the EMR system, but also reports with benchmarking against all other EMR customers in the system.
EMR vendors should not be charging practices for interfaces with complementary technology for transfer of the practices’ own patient and treatment data. Limitations on demographic and data transfers to complementary systems severely limit an oncology group’s ability to survive under new Medicare programs, let alone succeed.
- McAneny BL. “Come Home”: a Medicare Innovation Center project. Oncology (Williston Park). 2012;26:1145, 1156.
- Benner K. Roche leads a $175 million investment in Flatiron Health. New York Times. January 6, 2016. https://bits.blogs.nytimes.com/2016/01/06/roche-leads-a-175-million-investment-in-flatiron-health/. Accessed March 14, 2018.
- Flatiron Health. Roche to acquire Flatiron Health to accelerate industry-wide development and delivery of breakthrough medicines for patients with cancer. Press release. February 15, 2018. https://flatiron.com/press/press-release/roche/. Accessed March 14, 2018.