The clinician and administrative leaders who are managing cancer care centers across the U.S. are finding their organizations squeezed between a number of different policy cross-currents these days, and are welcoming the imminent arrival of robust analytics tools to help them navigate uncharted waters. With oncologists seeing Medicare reimbursement shifts, and value-based purchasing pushing down on cancer care center payment as well, at the same time that expensive new medications continue to be approved by the Food and Drug Administration (FDA), oncology leaders are hoping to harness the power of analytics in their specialty, one of the last to begin to robustly use data and analytics to change practice.
One who hopes to do so is Laura Miller, R.N., the director of informatics at Illinois Cancer Care, a Peoria-based cancer care organization that encompasses one main cancer care center in Peoria and 12 satellite care centers across west-central Illinois. Illinois Cancer Care was formed in 1978 by two oncologists. Today, the organization encompasses 12 medical oncologists and four gynecological oncologists.
Miller spoke with HCI Editor-in-Chief Mark Hagland on Wednesday, April 15, immediately following a session organized by the Atlanta-based Elekta, which announced on that day the release of its new knowledge management solution, Elekta Healthcare Analytics. Elekta executives described that morning in presentations the need for robust analytics in oncology care, and their planned approach with their Elekta Healthcare Analytics suite, which they are moving to quickly implement at Illinois Cancer Care and a number of other customer organizations this spring. The Elekta session took place at the Hyatt Regency McCormick Place, which is connected to the McCormick Place Convention Center in downtown Chicago, during the annual HIMSS Conference.
Laura Miller, R.N.
Miller and her colleagues first implemented parts of the broad Elekta suite of solutions beginning in 2000, starting with converting their scheduling process from a paper-based system into an electronic one, then converting their chemo cards (chemotherapy cards) from paper to electronic, and then adopting the company’s electronic health record (EHR) solution six years ago. She notes that her organization attested to Stage 1 of meaningful use in 2013 and 2014, and is working to attest to Stage 2 this year. Below are excerpts from her Wednesday morning interview with Hagland.
Tell me about your plans for implementing this new analytics suite?
They’re releasing the solution now, and I’m on the committee that has been involved in advising on its development. We’re starting to test the suite in an alpha state. The need for analytics in cancer care is huge: you’ve got to have analytics to find out what’s going with your quality and your business, you’ve got to find out from a clinical perspective to make sure your physicians are using the right treatment; and for pharmacy forecasting and to keep your inventory down
One thing, among many others, that we need to know in medical oncology, is this: what is the gap in time between when we first see a patient and when we start their treatment? We refer to that as the conversion rate. In radiation oncology, which our organization does not deliver, the conversion rate is the period of time from what’s called simulation (marking the patient for treatment) and first treatment.
We also need to look at surgeon-created process delays. There are a lot of things we can find out. Some things we can control and some not; but either way, it is important to understand our processes, and any issues involved in those processes.
We also need analytics to help us rationalize all the many outcomes measures we’re having to collect and report on for a wide variety of federal agencies and other bodies. We participate in the meaningful use program for CMS [the Centers for Medicare & Medicaid Services], in PQRS [the Physician Quality Reporting System] for CMS, the QOPI program [Quality Oncology Practice Initiative] sponsored by ASCO [the American Society of Clinical Oncology], and others. We are QOPI-certified; QOPI certification must be redone every three years, and we’re in the process of getting recertified now. And CMS is now coming up with a new quality program for their oncology medical home, and we’re applying for that. That’s a fairly new program, and we’re looking at the criteria. In any case, it is astonishing how complicated and detailed all the collecting and reporting of data gets.
What’s your vision for the use of analytics?
Number one, using analytics will make our quality reporting easier. There are all these programs we have to report for, and a lot of the measures are the same and we have to report to different entities. So I do our meaningful use reporting, and there’s another staff member who does PQRS, and the time we spend is enormous. If we could share one report, it would be enormous, we could save staff time, and we could focus on the substance, which is actually the end goal of it. But right now we’re so busy collecting the data and running the reports that we hardly have time for that.
And the business leaders need to focus on the financials. Medicare physician payments are down and reimbursement for oncology drugs is down. So we’d like a regimen analyzer. If I can give regimen A or regimen B for a lady with breast cancer, and the evidence is equal, and she has a particular insurance, we can apply pharmacoeconomic analytics and decision support to that process. We have to look at a broad range of issues involving payer requirements, as well as the patient’s ability to pay. The cost of cancer care is outrageous for these patients. We have financial counselors who meet with each patient, and if their out-of-pocket or co-pay is really high, we get them into our financial counseling programs, and if we have a regimen analyzer we can say, oh, this would e better for this patient and for the practice, economically.
Oncology is one of the last medical specialties to begin to seriously apply rigorous analytics to practice. What are your thoughts on that?
I think it is time, and it is a difficult conversation to have. And you’ve got new drugs approved by the FDA it seems every month now, and the cost is very high, and often, the survival rate increases by only two or three months. And we have to decide whether it’s worth it to extend a person’s life for two more months. And that’s a tough one. But then when you get to the business side of it, it is only two more months and it’s $100,000 and the family’s going to have to sell the farm, and it’s really tough, but we have to look at it. And oncology is complicated, because there are so very many treatment options, and at what point do you stop? And those are very difficult questions, but it all feeds into quality, and we’re going to have to talk about it.