Flatiron Well being, which has constructed up an oncology-focused EHR community and a de-identified database with greater than 4 million affected person data, just lately introduced a milestone of over 1,000 analysis publications utilizing its EHR-derived real-world knowledge. Neal Meropol, M.D., the corporate’s vp of analysis oncology, just lately spoke with Healthcare Innovation in regards to the growth of the forms 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 embrace 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 in regards to 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 among the locations the place that occurs. You have been at Flatiron for seven years. What are among the vital adjustments you’ve got seen when it comes to 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 lengthen lives by studying from the expertise of each particular person with most cancers. The best way we do that has largely remained unchanged over this time, and that is by means of offering software program and companies to practising oncologists, the place we’re an EHR vendor, but in addition by curating knowledge largely derived from digital well being data that is collected throughout routine care to realize insights that assist tackle 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 method, have been industrial arms in biopharma. However we have developed to have a much wider scope of analysis areas that our knowledge are actually utilized to. That features academia, authorities, NCI and regulators, nonprofits just like the American Most cancers Society and Pals of Most cancers Analysis. Having a broader array of shoppers of Flatiron real-world knowledge opens up avenues to all several types of of purposes. Additionally, we’re now 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 photographs, genomic knowledge. That actually opened the door to plenty of several types of insights that we’re in a position to glean.
HCI: Does broadening out the forms of analysis embrace 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 purposes of our knowledge right now not solely embrace understanding adoption of latest therapies, but in addition 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 affect of drug shortages on healthcare supply and the outcomes of sufferers, and in addition taking a look at nationwide insurance policies — for instance, growth 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 various areas of well being fairness, together with how rapidly sufferers provoke care, together with whether or not adoption of latest improvements is equal throughout totally different teams, whether or not the place you obtain care, whether or not it is an instructional setting or neighborhood setting, impacts the care you obtain. The info are simply very wealthy when it comes to 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. By way of new options in OncoEMR, one thing that is actually notable is we’ve over the previous a number of years developed determination assist instruments. We have now an utility known as Flatiron Help, which helps information the suitable number of therapy based mostly 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 determination making.
HCI: Often, we hear from tutorial medical facilities that creating and updating medical determination assist guidelines is a posh governance process. 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 resolution is constructed on Nationwide Complete Most cancers Community medical apply pointers. The second function is that it is extremely customizable, so practices can select to customise the suggestions of Flatiron Help based mostly on their very own apply preferences.
HCI: What about including these AI scribe instruments to the EHR as effectively? 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 path, completely.
Additionally, one of many new areas which is absolutely essential is that with a view to leverage knowledge on all the 4 million most cancers sufferers we comply with, we’ve to search 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 will increase the variety of sufferers that we’re in a position to have significant details about.
HCI: Might the ambient AI instrument develop into sensible sufficient to determine what to place within the structured knowledge and what to place within the narrative?
Meropol: There’s plenty of dialogue taking place about what the digital well being report of the long run will seem like. Traditionally digital well being data weren’t constructed for analysis, but when there are instruments that allow higher seize of knowledge on the level of care in structured or usable format or purposes that embrace medical care billing, but in addition analysis purposes, that might be good for everybody and really enabling when it comes to advancing the standard of most cancers care. So I feel all people is trying in the direction of a future the place that turns into extra doable, 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 targeted on workflows and guaranteeing that we’re serving to clinicians present essentially the most environment friendly and high-quality care doable. And there is at all times a danger that implementation of latest applied sciences causes elevated clicks on the pc, and leads to 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 offer the very best high quality care to sufferers, however a serious driver for clinicians in an instructional setting is skilled development. They may be extra considering participating in analysis and publishing outcomes, however I ought to notice 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 wishes to have the ability to present innovative care within the type of medical trials exists each in the neighborhood 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 in addition with the switch of knowledge from the digital well being report to check databases. So we’ve a instrument known as Scientific Pipe that may be a knowledge switch instrument for medical trials, which reduces web site burden and permits extra websites to take part in additional research than they could in any other case have been in a position to 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 instrument.
Meropol: Group oncologists, in actual fact, are sometimes very considering constructing out their medical analysis capabilities, however the investments in medical analysis in an instructional middle and in the neighborhood apply 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 notice that knowledge collected in routine care — what we contemplate 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 purposeful 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 imagine that we’ve a chance to lower the complexity of medical trials that exist right now by means of pragmatic research design, but in addition pragmatic operational design that may broaden accessibility to medical trials for most cancers sufferers.
