Flatiron Well being, which has constructed up an oncology-focused EHR community and a de-identified database with greater than 4 million affected person information, not too long ago introduced a milestone of over 1,000 analysis publications utilizing its EHR-derived real-world knowledge. Neal Meropol, M.D., the corporate’s vice chairman of analysis oncology, not too long ago spoke with Healthcare Innovation concerning the enlargement of the kinds of analysis being completed with its knowledge.
Based in 2012, Flatiron is an unbiased affiliate of the Roche Group. It collaborates with companions in tutorial establishments, coverage teams, regulators, and biopharmaceutical firms. Some key tutorial collaborators embody Abramson Most cancers Middle of Penn Medication, Yale Most cancers Middle of Yale College of Medication, Huntsman Most cancers Institute of College of Utah Heath, and Fox Chase Most cancers Middle of Temple Well being.
A medical oncologist, medical investigator, and outcomes researcher, Meropol oversees Flatiron’s medical groups supporting retrospective and potential proof technology.
Healthcare Innovation: At Healthcare Innovation, we deal with writing concerning the healthcare supplier facet and never a lot about life science firms or drug growth. However clearly the 2 worlds are linked collectively, and Flatiron’s work is without doubt one of the locations the place that occurs. You have been at Flatiron for seven years. What are a few of the vital modifications you’ve got seen by way of the corporate’s capabilities?
Meropol: In plenty of methods, it has been outstanding, however all throughout the context of a constant mission, which has been to enhance and prolong lives by studying from the expertise of each individual with most cancers. The best way we do that has largely remained unchanged over this time, and that is via offering software program and companies to working towards oncologists, the place we’re an EHR vendor, but additionally by curating knowledge largely derived from digital well being information that is collected throughout routine care to realize insights that assist deal with care high quality and coverage, and that assist speed up drug growth and contribute to a studying healthcare system.
HCI: So what has modified over the previous 5 years or so?
Meropol: After we first began, our knowledge have been mostly used for market monitoring — how are new remedies being adopted? So the purchasers, in a approach, have been business arms in biopharma. However we have advanced to have a wider scope of analysis areas that our knowledge at the moment are utilized to. That features academia, authorities, NCI and regulators, nonprofits just like the American Most cancers Society and Associates of Most cancers Analysis. Having a broader array of shoppers of Flatiron real-world knowledge opens up avenues to all several types of of functions. Additionally, we’re now not simply depending on the information within the digital well being report; we now have linkages to different exterior sources of knowledge, like mortality databases, claims knowledge, digital pictures, genomic knowledge. That actually opened the door to plenty of several types of insights that we’re capable of glean.
HCI: Does broadening out the kinds of analysis embody issues like taking a look at well being fairness, at how individuals are receiving care in plenty of several types of settings?
Meropol: Precisely. The functions of our knowledge as we speak not solely embody understanding adoption of recent therapies, but additionally understanding the real-world outcomes related to totally different patterns of care, with the ability to carry out comparative effectiveness, to know variations in approaches which may not be amenable to doing a potential medical trial.
We have completed work with what are known as pure experiments — trying on the influence of drug shortages on healthcare supply and the outcomes of sufferers, and in addition taking a look at nationwide insurance policies — for instance, enlargement of Medicaid and the way that impacts most cancers care. We measure high quality with Flatiron knowledge, taking a look at how individuals are utilizing biomarker testing, and whether or not sufferers are receiving care directed by biomarkers, and the way sufferers are being handled on the finish of life.
We have checked out many alternative areas of well being fairness, together with how rapidly sufferers provoke care, together with whether or not adoption of recent improvements is equal throughout totally different teams, whether or not the place you obtain care, whether or not it is a tutorial setting or neighborhood setting, impacts the care you obtain. The information are simply very wealthy by way of what is feasible.
HCI: Has the variety of oncology practices or tutorial medical facilities utilizing Flatiron’s OncoEMR or its different instruments continued to develop? And does the OncoEMR proceed to evolve with new options?
Meropol: Our footprint in neighborhood oncology and in academia continues to develop. When it comes to new options in OncoEMR, one thing that is actually notable is we’ve got over the previous a number of years developed resolution assist instruments. We now have an software known as Flatiron Help, which helps information the suitable choice of therapy primarily based on affected person traits, and this has been quickly adopted by our OncoEMR practices in an effort for the customers to enhance their high quality of care and streamline their resolution making.
HCI: Often, we hear from tutorial medical facilities that creating and updating medical resolution assist guidelines is a fancy governance job. So is that one thing that you must get enter from the community on?
Meropol: Two issues: One side is that out of the field, the Flatiron Help answer is constructed on Nationwide Complete Most cancers Community medical observe tips. The second characteristic is that it is extremely customizable, so practices can select to customise the suggestions of Flatiron Help primarily based on their very own observe preferences.
HCI: What about including these AI scribe instruments to the EHR as properly? Is that one thing Flatiron is engaged on?
Meropol: Sure, we have facilitated the testing of ambient AI for practices that wish to go in that route, completely.
Additionally, one of many new areas which is de facto important is that as a way to leverage knowledge on all the 4 million most cancers sufferers we comply with, we’ve got to seek out extra environment friendly methods to curate unstructured info, and we’re now routinely making use of machine studying and synthetic intelligence to help with curation the place the efficiency is high-quality, in order that we are able to broaden the variety of sufferers that we’re capable of have significant details about.
HCI: May the ambient AI device develop into good sufficient to determine what to place within the structured knowledge and what to place within the narrative?
Meropol: There’s plenty of dialogue occurring about what the digital well being report of the long run will appear like. Traditionally digital well being information weren’t constructed for analysis, but when there are instruments that allow higher seize of data on the level of care in structured or usable format or functions that embody medical care billing, but additionally analysis functions, that might be good for everybody and really enabling by way of advancing the standard of most cancers care. So I believe everyone is trying in the direction of a future the place that turns into extra potential, the place that turns into a actuality, nevertheless it’s not going to occur in a single day, as a result of EHR distributors like Flatiron are actually centered on workflows and making certain that we’re serving to clinicians present probably the most environment friendly and high-quality care potential. And there is all the time a threat that implementation of recent applied sciences causes elevated clicks on the laptop, and ends in extra burnout and has unintended penalties.
HCI: Are the purchasers who’re working in neighborhood oncology practices totally different from the individuals working within the tutorial medical facilities so far as the toolsets they need or want?
Meropol: The frequent drivers in neighborhood oncology settings and tutorial settings are that they’re attempting to supply the best high quality care to sufferers, however a serious driver for clinicians in a tutorial setting is skilled development. They could be extra fascinated with participating in analysis and publishing outcomes, however I ought to word that Flatiron’s neighborhood oncology community has many practices in it that conduct medical trials analysis and are closely motivated to take action. So the incentives and the needs to have the ability to present leading edge care within the type of medical trials exists each locally and within the tutorial middle. And one of many issues that that we have actually constructed out over the previous a number of years is the availability of software program and companies to neighborhood oncologists to higher allow them to participate in medical trials. That features serving to with medical trial recruitment affected person matching, but additionally with the switch of knowledge from the digital well being report to check databases. So we’ve got a device known as Scientific Pipe that may be a knowledge switch device for medical trials, which reduces website burden and permits extra websites to take part in additional research than they could in any other case have been capable of do.
HCI: I keep in mind that there was an announcement of a Flatiron partnership with the Affiliation of Most cancers Care Facilities to work on broadening entry to that device.
Meropol: Group oncologists, actually, are sometimes very fascinated with constructing out their medical analysis capabilities, however the investments in medical analysis in a tutorial middle and locally observe could also be very totally different. What we’re attempting to do is assist assist the infrastructure of conducting analysis in routine care settings. So we’re attempting to align medical research with medical care, and in doing so, make it extra of a routine method to how sufferers are cared for.
HCI: Do you wish to discuss a bit about your medical trial community?
Meropol: On the highest stage, we understand that knowledge collected in routine care — what we think about retrospective real-world knowledge — can’t reply all questions in oncology. There are specific analysis questions, sure proof wants that require the gathering of what we name deliberately collected info that goes past what’s routinely collected, whether or not that’s measuring tumor dimensions, or whether or not it’s ensuring that the affected person’s useful standing is precisely documented earlier than care is initiated. So Flatiron has constructed out a enterprise the place we’ll assist medical trials’ potential knowledge assortment, ideally for research which can be pragmatically designed and extremely aligned with routine care.
So we’re constructing out the capabilities for conducting medical research throughout the neighborhood setting. That features working with sponsors on the design of research, utilizing Flatiron knowledge to assist inform research design, supporting affected person identification for research, after which supporting the information assortment that we have talked about. We consider that we’ve got a possibility to lower the complexity of medical trials that exist as we speak via pragmatic research design, but additionally pragmatic operational design that may broaden accessibility to medical trials for most cancers sufferers.
