Dr. Michael Neuss
As we welcome you to the 2016 ASCO Quality Care Symposium, we hope that you are already planning on joining us in Orlando next year from March 3 to 4 for the 2017 ASCO Quality Care Symposium. Starting in 2017, a practice-focused business of oncology meeting will be held the day before the Quality Care Symposium, on March 2. When we gather in Florida for our 5th Symposium, we hope to continue to explore the subject of quality measurement and improvement in oncology care and to look particularly at the use and experience with electronic tools in this field of work.
Specifically, we hope to examine both the best and worst attempts to use information technology to promote increased practice efficiency though decision support and the integration of quality measurement in real time. These tools should promote measurement and reporting of the patient experience and allow improved practice workflow, provider satisfaction, and focus on the patient.
The ASCO Health Information Technology Work Group has been part of the Quality of Care Committee since its inception, because those of us involved in the Committee have believed that information technology can make things better when deployed correctly. Part of making things better is bringing back the joy of practicing medicine—something rarely discussed, perhaps because it’s so infrequently seen. Put simply, we want to explicitly think about how to make work fun again. And what better metaphor for this than the amusement parks you can visit in Orlando when you join us in March 2017?
Electronic Health Records in Closed Systems
Orlando’s first theme park, Gatorland, opened in 1949. The park is still open, and it remains privately owned. The primary attraction is the wildlife preserve, which can be accessed through a narrow-gauge railroad, available at an extra charge to support its unique 2-foot track gauge and locomotive called the Gatorland Express. Green Meadows Petting Farm, in Kissimmee, also uses the Gatorland Express. An example of a privately held system with limited interoperability, custom upgrades on the locomotive have been installed, with surcharges for things one would expect to be included. This sounds like electronic health record (EHR) systems to me. This brings up some questions to approach next year, such as how might we influence closed systems and share solutions?
The Walt Disney World Magic Kingdom opened in 1971. Its influence on America and the world has been profound, but many have wondered if we’ve ended up losing more than we gained. EPCOT opened in 1982. Most have forgotten the EPCOT stands for Experimental Prototype Community of Tomorrow and represents a dream of a top-down approach to order, efficiency, and innovation—the meaningful use of theme parks. Although perhaps not the most popular Walt Disney World venue, at least in original form, was it a good idea? Is the only way to standards and interoperability through external control in service of a grand plan?
Bringing Back the Joy of Practicing Medicine
SeaWorld Orlando opened in 1973 and created an entirely artificial environment in the middle of Orange County. It’s clear that no oranges are cultivated here, and moving saltwater animals to the middle of a freshwater swamp takes a great deal of resources and support. Although it is wonderful to see the native sea creatures, many feel that the animals have been captured to live an existence removed from their natural environment. As cancer care providers, there are days when most of us feel forced to do things that don’t feel natural. How can we make this better?
Hope for Evolution
Universal Orlando first opened as the Wet ‘n Wild Orlando water park in 1977, and by the time we meet next year in Orlando, we should have the opportunity to visit its replacement—Universal’s Volcano Bay. It’s hard to know whether to hope that the Brain Wash ride will be retired or recreated—there’s always nostalgia when there’s change. With the giddy excitement of a child visiting Orlando, I see this as our hope for evolution, building on our understanding of the technology, safety, and entertainment aspects of building a current system that gives all of us our money’s worth.
Submit Your Quality Care Symposium Program Ideas
As chair of the Planning Committee for next year’s meeting, I’m asking for your help and ideas. Specifically, we will be looking for objective information showing how practices have achieved increased efficiency in patient care using Allscripts, Athenahealth, Cerner, Epic, Flatiron Health, iKnowMed, and other systems. We’re looking for successful implementation tools to facilitate analysis and understanding of the patient experience—including both symptoms and satisfaction with care.
The four major areas of interest are:
- The patient experience,
- Efficiency and value, and
We’re looking for examples of the transfer of text and other structured information into reportable, structured, databases. It’s important that text transfers be accomplished without distraction or decrease in clinician and staff efficiency.
A 2015 ASCO Value Measure Workgroup confirmed that stakeholders look to the patient experience as a quality measure. Two types of experience are notable. The first is the patient’s experience of care—feeling respected, being engaged in care decisions, and accepting that their experience is reasonable under their circumstance. Additionally, it’s important that clinical status be measured, recording whether our patients are experiencing pain or nausea, as well as their level of functioning. Tools to help capture these metrics are being released and promoted at a staggering rate. We’d like to know what works and what doesn’t and understand changes and improvements measured or facilitated by smart deployment of these tools.
We can easily talk about how the most important quality outcomes are survival and functional status. But how can we make measurement of outcomes less cumbersome and more efficient? How, in conditions where death is rare or delayed do we compare outcomes to other conditions where death is inevitable? For example, are physicians who treat imatinib-sensitive gastrointestinal stromal tumors delivering more value than physicians who treat metastatic ALK-positive lung cancer just because imatinib works in the former group of patients for a longer period of time? If a practice has negotiated higher payment rates, are they by definition more expensive and providing less value? It’s nice to think that the highest-value practices are those taking care of large numbers of uninsured or publically insured patients, but is that right? How can we address these questions?
Most importantly, we’re looking for projects that help show how to improve in all these arenas. Learning from each other’s success is, of course, the real goal of the ASCO Quality Care Symposium, and we hope to hear examples that will inspire us all.
But we need your help. In addition to inviting you to Orlando, please allow me to ask that you contact the 2017 Planning Committee with any and all any suggestions for next year’s meeting. We hope to see you in Florida.
About the Author: Dr. Neuss is the chief medical officer with the Vanderbilt-Ingram Cancer Center. He is the chair-elect of the 2016 ASCO Quality Care Symposium Planning Committee.