Andrew L. Pecora, MD, CPE: The gorilla in the room is electronic health records and how they have transformed the practice of medicine. There are many doctors who believe that this is wonderful. There are others, probably an equal number of doctors, who feel that this has been an incredible intrusion. They’re spending more time at the computer than they are at the bedside.
You add onto it the things that Brenton and I are doing with big data and health analytics, and you add to that what government is doing. You almost worry if there will be information overload. Will it just shut the operation down? You still have to see the patient, touch the patient, and do something to make them better. That takes time, and time is the only thing that’s not fungible here, unless you go really fast. Brenton, you’re an expert in this, and you’re spending your career on it now. How do you see, in a positive way, information technology changing how you practice medicine?
Brenton Fargnoli, MD: That’s a great question. As you were mentioning, electronic medical records, to date, have been used as a historical chart and [a tool for] facilitation of billing, documentation for malpractice, and [other] things that don’t necessarily get doctors very excited about taking care of their patients. So I think, right now, with alternative payment models, we’re at an inflection point, where the electronic medical record can really move beyond being that kind of receptacle of information in terms of being able to pull out unstructured fields and information and perform analytics. [Moving forward, we can] bring that back to the point of care. I think a lot of things we see today with alternative payment models [are] that there’s new requirements and there’s a lot of different technologies that physicians are trying to patch together to work with. They’ll open up a pathway portal here, they’ll open up a patient-reported outcome portal here, they’ll document their note. And what happens in those circumstances, as you know, because we’re practicing under time constraints, is that those [tasks] become relegated to back-office tasks if there’s friction with the technology.
So, the first piece is to make it frictionless [as] part of that workflow. Then, it does create the opportunity to really leverage information across a clinic so you can see, at your clinic, who are the types of patients who need more care and who are the types of physicians who are providing the highest-quality care. But even more importantly, across the country, we can unearth, whether for clinical research or for practice transformation lessons, what the best ways are for treating our cancer patients. I think that’s what gets me excited and what gets a lot of physicians excited about the future of technology. But we need to very quickly move beyond the electronic medical record as a receptacle of information and instead [utilize it] as a vehicle for a higher level of data analytics that can then be brought back to the point of care. And with alternative payment models, there’s certainly the opportunity for that.
Andrew L. Pecora, MD, CPE: Rena, add to that whatever you’d like. But I’d like you also to focus, again from your area of expertise, on the whole idea of right now—I’ll just say it in a general way—that we’re really trying to move people away from fee-for-service, gradually. Is this something a lot of people cling to because they’re comfortable, as you alluded to before, and we’re in this intermediate zone, where we’re trying these things like pathways and the oncology care model?
You can actually pick those apart pretty easily—about whether or not they really are going to bring value to the ecosystem. And ultimately, everybody wants to pay for outcomes. The FDA approves drugs based on outcomes. You shouldn’t get a huge check if your drug didn’t work. The doctor, if they do something wrong, shouldn’t get rewarded for that. So, it’s really going to go to outcomes.
How do you see heavy information technology being able to do this at scale? Where do you see this residing? Is this going to be [driven by] private industry coming up with novel solutions like, for example, “Apple changed the way we think about phones,” or as an example, “Microsoft changed the way we thought about typewriters.”
Is it going to come from something like that? Or do you see, because it’s healthcare, that government may start providing big data initiatives and things for people to use [instead of change coming] from the commercial [side]? How do you see it playing out?
Rena M. Conti, PhD: I’m a big believer that the private sector will find solutions to these problems now that they’re identified as problems that need solutions. And I think, for a very long time, the medical providers have been comfortable in a space where they’re practicing using paper records or electronic medical records that are not really very smart machines. We’re moving away from that. There are some practices that are in the vanguard of that. There are some companies that are in the vanguard of that. But I think we’re going to see a lot more innovation in this space. We’re certainly seeing a lot of investment in technology moving toward the medical sphere now.
One thing I want to point out is that right now, our existing electronic medical record systems are very siloed. They sit in a medical practice or in a hospital, but they really can’t talk between one provider group to another provider group or from a hospital to a provider group in the community. Government needs to allow this siloed behavior to stop and create incentives—not for providers or for hospitals to hold on and hoard their data—but instead, to create win-wins where these types of information systems can start to talk to each other between the inpatient and outpatient settings or between your oncologist and your diabetes provider. That’s going to make a big difference, I think.
Andrew L. Pecora, MD, CPE: Once again, I’d like to toss this over to Dr Sagar and get her opinion on the subject.
Bhuvana Sagar, MD: The health information technology impact on oncology care, I think, is a necessary evil, unfortunately, at this point. We want to collect data. We want to make sure our patients and our customers are getting evidence-based medicine, which will lead to better outcomes. So, to understand that, to define quality better, we have to be able to collect data. Health information technology is an integral component of that.
It’s not always the easiest thing to work with. It’s not always the easiest thing to get data from. There are a lot of challenges that we are having in collecting this information and having this data exchanged back and forth. But I think if we can come up with better solutions, as we go forward, and [learn] how to understand this, how to get data better, and how to measure quality better, I think that’s where the challenge lies for the next several years.