Putting Big Data to Work for Better Care in Oncology

Only 3% to 4% of all cancer pa­tients take part in clinical trials, which means that the rest not only miss the possibility of new thera­pies, but also the chance for their data to become part of the collective re­cord so that future pa­tients may benefit from their experience.

Flatiron Health, locat­ed in New York City, has been trying to change this since 2012. Robert Green, MD, a former community oncologist who is Flatiron’s vice president for clinical strategy and se­nior medical director, said that with­out a clinical trial, “we essentially lose the patient experience; the voice of the patient, what they went through becomes lost.”

Green, speaking at the 4th annual meeting of Patient-Centered Oncol­ogy Care, said too much oncology data is siloed; Flatiron’s goal is to take the patient experience and make it into meaning­ful data. The company employs oncologists, quantitative scientists, and other medical infor­mation specialists to en­sure the accuracy of the data being used to direct patient care. The com­pany coined the term “technology-enabled ab­straction,” which refers to combining technology with qualified personnel who can pull information from pathology reports and other data sources.

“It’s about trying to figure out how do you put all of the data points together so that in a structured and computer­ized way, you can look at a patient’s ex­perience over time using unstructured data from the EHR [electronic health re­cord], structured data from the EHR, but also pulling together multiple external data sources,” Green said.

Ultimately, Flatiron’s technology helps oncologists identify candidates for diagnostic tests that might other­wise have been missed. Better use of technology also records important data such as dates of death, which may often be missed. Beyond the individual level, their technology also looks at how often certain tests are being ordered, in what type of patient, and when.

Data collected from practices can be used to look at individual patients with­out having to pay someone to look back into charts, Green said, in a way that “doesn’t create a burden on [clinicians], but that allows them to get insight into how they’re taking care of patients,” and, hopefully, making improvements. He said this allows practices to ask, for example, “What is our lung cancer sur­vival rate? How do (our rates) compare internally, and how do we look com­pared to other institutions, other prac­tices, and other regions of the country?”

Besides looking back at data to see how practices can improve, community practices can use data to evaluate new patients and identify which ones might be candidates for a clinical trial. This will help raise the trial participation above 4%. “We need to increase that number, realizing that we’re never go­ing to be in an era where all patients go on what we consider now as standard prospective clinical trials,” Green said. At the same time, getting data back to clinicians and researchers offers oppor­tunities for all to learn “and hopefully improve care for all patients.”

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