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 information. Neal Meropol, M.D., the corporate’s vp of analysis oncology, just lately spoke with Healthcare Innovation concerning the enlargement of the forms of analysis being completed with its information.
Based in 2012, Flatiron is an impartial 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 Heart of Penn Medication, Yale Most cancers Heart of Yale Faculty of Medication, Huntsman Most cancers Institute of College of Utah Heath, and Fox Chase Most cancers Heart 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 concentrate on 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 number of the important modifications you have seen by way of the corporate’s capabilities?
Meropol: In a whole lot of methods, it has been exceptional, however all inside the context of a constant mission, which has been to enhance and prolong 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 working towards oncologists, the place we’re an EHR vendor, but additionally by curating information largely derived from digital well being data that is collected throughout routine care to achieve 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: Once we first began, our information have been mostly used for market monitoring — how are new therapies being adopted? So the shoppers, in a method, have been business arms in biopharma. However we have developed to have a wider scope of analysis areas that our information are actually utilized to. That features academia, authorities, NCI and regulators, nonprofits just like the American Most cancers Society and Buddies of Most cancers Analysis. Having a broader array of customers of Flatiron real-world information opens up avenues to all various kinds 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 information, like mortality databases, claims information, digital photos, genomic information. That actually opened the door to numerous various kinds of insights that we’re capable of glean.
HCI: Does broadening out the forms of analysis embody issues like well being fairness, at how individuals are receiving care in numerous various kinds of settings?
Meropol: Precisely. The functions of our information at this time not solely embody understanding adoption of latest therapies, but additionally understanding the real-world outcomes related to totally different patterns of care, having the ability to carry out comparative effectiveness, to grasp 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 — wanting on the impression of drug shortages on healthcare supply and the outcomes of sufferers, and in addition nationwide insurance policies — for instance, enlargement of Medicaid and the way that impacts most cancers care. We measure high quality with Flatiron information, 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 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 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 over the previous a number of years developed resolution help instruments. We’ve got an utility known as Flatiron Help, which helps information the suitable number of remedy 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 resolution making.
HCI: Often, we hear from tutorial medical facilities that creating and updating medical resolution help guidelines is a fancy governance activity. So is that one thing that it’s a must to 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 follow tips. 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 follow 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 need to go in that path, completely.
Additionally, one of many new areas which is actually vital is that with the intention to leverage information on all the 4 million most cancers sufferers we comply with, we’ve to seek out extra environment friendly methods to curate unstructured data, 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 develop 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 information and what to place within the narrative?
Meropol: There’s a whole lot of dialogue occurring about what the digital well being report of the longer term will seem like. Traditionally digital well being data 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 feel all people is wanting in direction of a future the place that turns into extra potential, the place that turns into a actuality, but it surely’s not going to occur in a single day, as a result of EHR distributors like Flatiron are actually targeted on workflows and making certain that we’re serving to clinicians present essentially the most environment friendly and high-quality care potential. And there is all the time a threat that implementation of latest applied sciences causes elevated clicks on the laptop, and ends in extra burnout and has unintended penalties.
HCI: Are the shoppers who’re working in neighborhood oncology practices totally different from the folks 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 an instructional setting is skilled development. They is perhaps extra eager about 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 wishes to have the ability to present innovative care within the type of medical trials exists each in the neighborhood and within the tutorial heart. 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 raised allow them to participate in medical trials. That features serving to with medical trial recruitment affected person matching, but additionally with the switch of information from the digital well being report to review databases. So we’ve a device known as Scientific Pipe that may be a information switch device for medical trials, which reduces website burden and allows extra websites to take part in additional research than they may in any other case have been capable of do.
HCI: I do not forget 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, in truth, are sometimes very eager about constructing out their medical analysis capabilities, however the investments in medical analysis in an instructional heart and in the neighborhood follow could also be very totally different. What we’re attempting to do is assist help 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 need to discuss a bit about your medical trial community?
Meropol: On the highest stage, we understand that information collected in routine care — what we contemplate retrospective real-world information — can’t reply all questions in oncology. There are particular analysis questions, sure proof wants that require the gathering of what we name deliberately collected data 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 are going to help medical trials’ potential information assortment, ideally for research which are pragmatically designed and extremely aligned with routine care.
So we’re constructing out the capabilities for conducting medical research inside the neighborhood setting. That features working with sponsors on the design of research, utilizing Flatiron information 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 at this time by means of pragmatic research design, but additionally pragmatic operational design that may broaden accessibility to medical trials for most cancers sufferers.
