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Quality Cancer Care Alliance Fall 2019 Leadership Summit

Evolving Healthcare Beyond the Conventional Walls of the Delivery System

Laura Joszt
Healthcare does not necessarily need to be disrupted, but it does need to evolve and utilize technology so that cancer care can move beyond the conventional walls of the healthcare delivery system, said Susan Dentzer, visiting fellow at the Duke-Margolis Center for Health Policy, during her keynote speech at the Quality Cancer Care Alliance’s Leadership Summit.
She explained that there are pieces of the future that we can already see in bits and pieces that will eventually grow and expand, and she highlighted some of them. Dentzer quoted science fiction author William Gibson who once said, “The future is already here—it’s just not very evenly distributed.”

Teleoncology, which can increase access to care and decrease costs of care, is taking place in some places of the United States. A meta-analysis of 20 studies of telehealth use in patients with breast cancer has shown that patients generally like it and are satisfied with care. Arizona has already made a major commitment to telemedicine and telehealth with a program launched in 1996 that includes telemammography and telepathology.

Telegenetics has been implemented at the University of Pennsylvania’s Abramson Cancer Center, which provides counseling via telephone and 2-way video conferencing to combat the shortage of genetic counselors.

LAUNCH, which stands for Linking and Amplifying User-centered Networks through Connected Health, is a project Dentzer is working on that provides broadband-enabled connected health in rural Appalachia. There is a lot of lung cancer in the region,  and patients will travel to the Markey Cancer Center and go home, but they will not make the regular trips back to Louisville, Kentucky, for follow-ups. This project will enable patients to be monitored in their homes and communities, but it needs a new payment mechanism and it needs universal broadband or 5G technology capability in rural Appalachia.

Dentzer also highlighted the work of Project ECHO, which launched in 2003 by the University of New Mexico to educate primary care providers on how to care for patients with hepatitis C so they could receive treatment in their communities without traveling long distances. India has been using Project ECHO to train community health workers to conduct cancer screening in remote villages.

“If this can happen in India why aren’t we doing enough of this in the United States?” she asked.

Other countries are utilizing technology more than the United States, she added. While US physicians cannot use WhatsApp because it’s not totally compliant with the Health Insurance Portability and Accountability Act, Israel has 96% of its physicians on the app and 71% use it for communication of patient information and consultations.

“Think about how the rest of the world is working in low-resource settings to take advantage of these capabilities,” Dentzer said. “And it really does kind of put us to shame.”

The United States is moving into an era of what Dentzer said has the “potential for democratized cancer care,” in which patients have greater access to care, more knowledge, and more power.

Making the needed changes to have Dave’s vision of care come true would result in more convenient care and an expanded provider base. Some of the downsides to keep in mind, she noted, are that this increased use of technology might not be good for all patients; making it easier to access care using telehealth might mean people utilize it more, which increases cost; there remain privacy and security concerns; providers will have more data to sift through; and a number of business models will be severely disrupted.

“When it comes to disruption or evolution…around cancer care, the status quo is not an acceptable option for us,” Dentzer concluded. “We have got to move as a country and as a world to embracing more of these capabilities and making them a reality.”

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