Tangle of Tech: How Community Oncology Practices Can Successfully Navigate the Health Technology Landscape

With health care turning increasingly digital over the past 2 decades, many new and exciting technologies have entered the arena—from electronic health records (EHRs) to e-prescribing to telehealth. With thousands of health tech platforms¹ available today, the market size for such technology is expected to soar from $240 billion in 2022 to $1043 billion by 2030.² Many of these health care technology platforms pledge to make daily tasks easier for providers and patients.

Nini Wu, MD, MBA | Image: Cardinal Health

Oncology, an inherently complex specialty that treats patients who require some of the highest levels of care, stands to benefit from riding this technology wave.

Anish Arora | Image: LinkedIn

Technology can help provide a holistic view of patients’ health, streamline clinical and operational workflows, and facilitate financial management. In doing so, technology interventions can improve care quality and lead to significant time and cost savings.

Adopting the latest health care technology is likely an easier endeavor for large health systems and hospitals, who have in-house information technology (IT) expertise that can prioritize and maintain software platforms to suit their clinician, administrator, and patient needs. However, for community oncology practices that care for most Americans with cancer,³ getting on the tech bandwagon can be daunting.

As a first step in their journey to adopt new health care technology, community oncology practices must carve out time to identify current challenges, map future goals, and select platform(s) that can best address both. Once a practice identifies a list of candidate software tools and platforms, leadership must assess the technology’s interoperability and its security and compliance with privacy regulations, such as the Health Insurance Portability and Accountability Act (HIPAA). Finally, community oncology practices must consider the cost. This can be a limiting factor, especially with the recently skyrocketing costs that have negatively impacted many practices.⁴ For every dollar spent on new technology, community oncology practices must reasonably justify the expense and guarantee a return on investment in the form of value added for clinicians, administrators, and patients.

Without the right support, selecting new technology can prove challenging even for community practices with years of experience in this area. Unfortunately, practices are often sold technology tools and platforms they don’t need, creating unnecessary complexity. When combined with the frequent acquisition of technology to fix perceived operational or workflow problems, practices soon find themselves lost in layers of disparate software platforms and caught in an intricate tangle of tech. Despite investing thousands to millions of dollars on technology, community oncology practices often end up with a patchwork of disconnected and siloed solutions that require human intervention to tie them together and realize value.

On the other hand, staying out of the health care digital revolution is not an option for community oncology practices, especially when services such as telehealth and EHR management are becoming more important to deliver patient-centered care and meet key regulatory requirements. So, how can community oncology practices untangle themselves from a technology web and realize the value of their investments? Read on for a pragmatic playbook that sheds light on the process and considerations that practices must deliberate.

The Community Oncology Tech Stack
Although many applications, tools, and platforms are available for providers today, in our collective experience, we have found that small community oncology practices with 1 to 2 physicians need a basic stack consisting of a minimum of 10 to 15 applications to run their practice successfully. These include EHR software, a practice management system, pharmacy and inventory management software, and a secure and HIPAA-compliant patient communication platform with text and chat capabilities.

When community practices expand to include additional services and disciplines, their technology stack can quickly balloon to several dozen to as many as 50 systems in some cases. Growing community oncology practices need software for email communications and telephony, cybersecurity, accounting and payroll, appointment scheduling and staffing, human resources, finance, and claims management, just to name a few. Practices also need data analytics systems to gain actionable insights from their data.

Although the technology stack mentioned above is commonly seen, it’s crucial to understand that each community practice has its own unique workflow. A chosen technology stack must align with this workflow and be customizable. It’s also critical that each platform within a stack can communicate with other platforms. This concept, known as interoperability, is a seminal technology-related challenge faced by community practices today.

Achieving Interoperability Is Vital
The Healthcare Information and Management Systems Society, a global adviser on the use of IT in health care, defines interoperability in health care as “the ability of different information systems, devices, and applications to access, exchange, integrate, and cooperatively use data in a coordinated manner.”⁵ This coordinated data exchange within and across organizational, regional, and national boundaries provides timely and seamless portability of information and optimizes the health of both individual patients and entire patient populations around the world.

Simply put: When technology is interoperable, systems can seamlessly and securely exchange electronic health information without human intervention. In the absence of interoperability, many practices must dedicate precious staff time toward the repetitive, error-prone manual transfer of information from one system to another. Many practices also continue to use antiquated strategies, such as fax and postal mail, to share and receive information. According to a 2021 report by the National Coordinator for Health Information Technology, fax and postal mail continue to be the most common methods for hospitals to exchange case record summaries.⁶ We can both attest from our personal experiences that more than half of clinicians communicate via fax every day.

Interoperable systems also enable patients to self-schedule appointments, access medical records, and better communicate with their care team. When systems are interoperable, they eliminate unnecessary administrative tasks and streamline practice workflows. Adopting interoperable technology is vital as the health care system becomes increasingly distributed with telehealth, at-home monitoring systems, and remote monitoring devices. Interoperability ensures data from each of these services can seamlessly integrate and help clinicians deliver holistic care.

Without interoperability, clinicians are unable to get a complete view of a patient’s medical history and make the best decisions regarding their care. Because human intervention is needed to input data from one system into another, this can lead to errors or clinicians missing a data point during diagnosis and/or treatment, both of which can negatively impact patient outcomes. Lack of interoperability can also result in data silos and, ultimately, inefficiencies within the practice.

Vendors selling health care technology
promise that their compliance with industry standards and groups such as the internationally recognized Health Level Seven International render them interoperable. In addition, national health information networks, such as the Sequoia Project’s Carequality and CommonWell Health Alliance, facilitate the exchange of medical data within systems. New regulations such as the Trusted Exchange Framework and Common Agreement aim to ensure health information networks such as the ones mentioned above as well as clinicians, health plans, patients, and other stakeholders can access real-time, interoperable health information.

Although there have been important steps in building nationwide interoperability frameworks, community oncology hasn’t quite caught up yet.

The broader momentum
toward nationwide health care interoperability represents an opportunity for oncology practitioners to remove humans from the loop where they are not needed. This shift in resources can help clinicians refocus their efforts on patient care and potentially help alleviate today’s well-documented shortage of health care workers.⁷ However, community oncology practice leaders need to understand how every piece of new technology under consideration works and connect the dots on how it aligns with their existing workflow and technology ecosystem. This is an arduous task for physicians without expert support and insight.

Although interoperability is vital in health care technology systems, community oncology practices must also consider several additional factors before selecting, investing in, and implementing new technology.

Looking Beyond Interoperability
In today’s technology landscape, nothing is more important than compliance and cybersecurity, especially in health care as it involves sensitive patient data. According to a 2023 report, a health care data breach costs approximately $10 million, which is more than twice the cost of breaches in other industries.⁸ What’s more, stolen health care data can sell for up to 10 times more than stolen credit card data on the dark web, making health care data more vulnerable to cyberattacks.⁹

As evidenced by the Change Healthcare cybersecurity hack earlier this year, which brought down one of the country’s most extensive health payment processing systems, the cybersecurity stakes in health care have never been higher. Investigations into the Change Healthcare hack later revealed that Change Healthcare’s parent company, UnitedHealthcare, was not using multifactor authentication to secure their systems, which is an industry-standard practice.¹⁰ Given the inherent sensitivity of protected health care information (PHI), practices must also consider data privacy as well as permissions and regulations as to who can view PHI.

Oncology practices must also evaluate the overall usability of new technology and whether associated vendor(s) provide sufficient training for clinicians and staff. Technology’s return on investment is only as good as if and how the technology can be used by a practice. Community oncology practices must choose reliable vendors with a positive track record of providing adequate
support during onboarding and are known to be responsive to their customers’ needs.

Finally, practices must also take a hard look at the cost of ownership of their technology stack. In addition to their initial investment to purchase and license a new software application or tool, practices must also consider the cost of continued maintenance, including ongoing subscriptions or upgrades.

Technology cost considerations must also include investments in staff training, interoperability of systems, and how well technology will scale with a practice—all of which determine the return on investment.

A Vision of the Future Can Guide Today’s Strategy
As community oncology practices expand and change—either by adding more locations, physicians, or specialties—so must their technology stack. However, at a time when there is a technology point solution for seemingly everything, practices should not implement new technology just for technology’s sake. Before they invest in any new technology, practices must evaluate it within the context of their business goals and plans for future expansion to ensure it can seamlessly scale with their practice.

One way to approach this is to conduct an audit of current practice technologies and the associated investment, return on investment, and goals for improvement. This exercise requires community oncology practices to have a vision of their technology and digital health goals. Without a strategic future vision, practices are often left with a hodgepodge of software applications that are challenging to tie together.

Any single community oncology practice, regardless of size, has only so much influence on the tools and applications that technology companies develop and sell. Most practices must purchase what is available off the shelf. That’s especially true with oncology, as there are only a few technology players to begin with, which further limits the influence of a physician or practice on available technology. To make the most informed decisions on technology, community oncology practices must look both within and beyond their walls—with help from experts who understand the technology landscape—to devise a strategy and a path forward.

With the advent of artificial intelligence (AI), generative AI, large language models, and machine learning, the technology market is rife with opportunity for the development of more tools and platforms, only adding to the technology noise, clutter, and overwhelm for community oncology practices. Community oncology practices must resist the temptation to give in to the latest buzzword and instead prioritize practical technology that offers pragmatic innovation to tackle today’s problems and close real care gaps in the community. Traversing the technology web with a firm grasp on their strategy—while understanding the critical nature of interoperability, security, compliance, and cost—will help community oncology practices make the best technology decisions for the good of their practice and patients.

Author Information
Nini Wu, MD, MBA, is chief medical and development officer at Navista. Wu is an accomplished hematologist oncologist and health care executive who is passionate about leveraging technology to transform the patient experience and enhance overall health care delivery. Prior to joining Navista, she spent 20 years as a clinical and administrative leader at community oncology practices in New York, Florida, and Alabama. Most recently, Wu served as senior vice president of strategic initiatives at McKesson, where she led strategic clinical, digital, and innovation initiatives for The US Oncology Network.

Anish Arora is vice president of product management and development at Navista. Arora brings a wealth of experience and a passion for innovation in health care technology to Navista. With more than 20 years of health care software development, implementation, and product management experience, he is an expert technologist who understands the practical product needs of clinicians and health care organizations. He most recently served as senior director of product management at Ontada, a McKesson business.

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