A Q&A With Dr Debra Patt: The Role of Applied Informatics in Oncology Care

The American Journal of Managed Care® discussed integrating applied informatics into the oncology care setting with Debra Patt, MD, MPH, MBA, executive vice president of policy and strategy at Texas Oncology. In addition to her role as a co-chair of the virtual 2020 Community Oncology Conference, hosted by the Community Oncology Alliance (COA), Patt will present a session entitled “The Exciting New World of Applied Informatics in Oncology.” In her presentation, Patt will discuss telemedicine, informatics solutions in cancer care, using tools to predict patient outcomes, and how this influences care delivery.

To register for the virtual conference, which takes place April 23rd and 24th, click here.

AJMC®: Where do we stand with informatics in the oncology setting? In other words, how is it currently integrated?

Dr Patt: Oncology is integrating informatics in many different places of care delivery. We see it in telemedicine and telehealth choices. This has been critical, especially during the pandemic, where many of our practices have ramped up telemedicine to decrease the volume in our clinics and make our clinics a safer place to see and treat cancer patients. We have also used it in our clinics to try to reduce the risk by seeing acute care patients that may be infected with the virus, and keeping them out of clinics and not sending them to the hospital. It helps us triage those patients and serve them better. We also see it in our ability to remotely monitor patients. Telemedicine has been a critical way that has grown dramatically during the pandemic to serve cancer patients. It's an applied informatics solution.

The Community Oncology Alliance (COA) is a nice intersection between policy, advocacy, clinical practice, and clinical information systems. COA has been instrumental in facilitating some of the policy changes that have led to these progressive telemedicine policies that have allowed us to make these changes in clinics. Telemedicine has been one really important way that applied informatics is helping to support care delivery for cancer today, and is really, in my opinion, one of the most important ways that we've supported cancer care during the crisis. There are other ways too that we're using applied informatics in clinical care today for oncology. Clinical decision support is one of those important ways. Oncology care has grown dramatically over time.

Applied informatics is also important because we're using it for clinical decision support at the point of care for patients with cancer. Cancer care has gone through many changes over the last several decades, it's really been a time of novel innovation. We have an appreciation of greater subtypes of different types of cancer. We have approval of unprecedented types of cancer therapeutic intervention. It's a lot of information to process and it's become very complex in cancer subtypes, in treatment stage, and understanding therapeutic interventions and how we combine them. Clinical decision support is an important way, at the point of care, that can guide physician behavior or provide appropriate choice architecture to guide decision behavior around cancer therapeutic choices, making sure they're evidence-based and that patients are going to have the best outcomes.

AJMC®: What are the next steps in incorporating applied informatics into the oncology setting and why do you think we should take them?Dr Patt: There are a lot of changes going on today in applied informatics. It's a really exciting time in clinical cancer informatics. Actually, coronavirus has led to unprecedented policy change. Both the administration and the state governments have had unprecedented policy change that has facilitated telemedicine being a meaningful solution for patients to receive cancer care in their homes when appropriate. That's really convenient for patients. It's the time now to extend those policies because right now, they've only been extended through the pandemic. But I think that after coronavirus, we will all work differently, interact with our doctors differently, interact with our loved ones differently. This is an important way that informatics can help support care delivery in cancer and other subspecialties, is to have some of those progressive telemedicine changes continue. What can happen now and in the near term is that we can have policies extended that were really just passed for the purpose of the coronavirus pandemic, but they can be extended past that and we can continue to use some of these helpful tools in the service of patients. The other thing that I think needs to happen in order for applied informatics to continue to grow and be meaningful for patient care, is we need large hospital systems and large clinical practices to invest in the necessary information systems to try to make sure that we're able to apply appropriate clinical decision support, give patients access to clinical trials, and appropriately aggregate their data to make meaning.

AJMC®: It's difficult to implement widespread technological change in the healthcare setting. How long do you think it will be before this shift is feasible across the board?

Dr Patt: It's a tough question. It's sort of like saying, 'How do you begin to implement smartphones in making your life easier?' I would say that people tend to start with smaller investments in minimal functionality, but they really rapidly escalate to more functionality, and it continues to evolve over time. The same is true of applied informatics in cancer care and throughout healthcare. These are tools that we use to improve our ability to deliver care in the community setting, in the hospital setting, and all settings and those tools will continue to grow and develop and be useful. But our adoption of them may be variable, just like our adoption of smartphones.

AJMC®: How can you balance integration of informatics in oncology care with lowering treatment costs?Dr Patt: I think that there's a real role for clinical informatics as we think about providing high-value care, which is not only lowering treatment costs, but also providing the best treatment that patients can get, making sure they have the best treatment to give them the best outcomes and being respectful stewards of the healthcare dollar. Value is a really important question right now. I think the clinical decision support is one important way that people can do that. In my own practice, and my network of practices, the clinical decision support system that we implement takes into account value-based prescribing. When you have therapeutic choices of equal efficacy, the differentiation and their inclusion has to do with toxicity and costs. That's a reasonable way to alter the architecture of choices for clinicians as we make choices about the patients we serve, and that way we've maximized those patients outcomes, while we try to minimize the cost and be respectful stewards of the healthcare dollar.