Flatiron Well being, which has constructed up an oncology-focused EHR community and a de-identified database with greater than 4 million affected person information, not too long ago 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, not too long ago spoke with Healthcare Innovation in regards to the growth of the kinds 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.
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 give attention to writing in regards to 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 likely one of the locations the place that occurs. You’ve got been at Flatiron for seven years. What are among the important adjustments you’ve got seen by way of the corporate’s capabilities?
Meropol: In lots of methods, it has been outstanding, however all inside the context of a constant mission, which has been to enhance and lengthen lives by studying from the expertise of each particular person with most cancers. The way in which we do that has largely remained unchanged over this time, and that is by way of offering software program and providers to training oncologists, the place we’re an EHR vendor, but additionally by curating information largely derived from digital well being information that is collected throughout routine care to achieve insights that assist handle 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 remedies being adopted? So the shoppers, in a approach, have been industrial arms in biopharma. However we have developed to have a much 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 purposes. Additionally, we’re now 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 pictures, genomic information. That basically opened the door to a number of various kinds of insights that we’re in a position to glean.
HCI: Does broadening out the kinds of analysis embody issues like taking a look at well being fairness, at how persons are receiving care in a number of various kinds of settings?
Meropol: Precisely. The purposes of our information right this moment not solely embody understanding adoption of latest therapies, but additionally understanding the real-world outcomes related to completely different patterns of care, having the ability to carry out comparative effectiveness, to know variations in approaches that 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 taking a look at nationwide insurance policies — for instance, growth of Medicaid and the way that impacts most cancers care. We measure high quality with Flatiron information, taking a look at how persons 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 completely 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 info 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 now have over the previous a number of years developed resolution help instruments. We’ve an software known as Flatiron Help, which helps information the suitable number of therapy 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: Normally, we hear from tutorial medical facilities that creating and updating medical resolution help guidelines is a fancy governance job. So is that one thing that you need to get enter from the community on?
Meropol: Two issues: One facet 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 wish to go in that path, completely.
Additionally, one of many new areas which is de facto essential is that so as to leverage information on the entire 4 million most cancers sufferers we observe, we now have to seek out extra environment friendly methods to curate unstructured info, 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 in a position to have significant details about.
HCI: May the ambient AI device grow to be sensible sufficient to determine what to place within the structured information and what to place within the narrative?
Meropol: There’s lots of dialogue occurring about what the digital well being report of the longer term will appear like. Traditionally digital well being information weren’t constructed for analysis, but when there are instruments that allow higher seize of knowledge on the level of care in structured or usable format or purposes that embody medical care billing, but additionally analysis purposes, that will 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 the direction of a future the place that turns into extra doable, the place that turns into a actuality, nevertheless it’s not going to occur in a single day, as a result of EHR distributors like Flatiron are actually centered on workflows and guaranteeing that we’re serving to clinicians present probably the most environment friendly and high-quality care doable. And there is all the time a danger that implementation of latest applied sciences causes elevated clicks on the laptop, and leads to extra burnout and has unintended penalties.
HCI: Are the shoppers who’re working in neighborhood oncology practices completely different from the individuals working within the tutorial medical facilities so far as the toolsets they need or want?
Meropol: The widespread drivers in neighborhood oncology settings and tutorial settings are that they’re making an attempt to supply the very best high quality care to sufferers, however a serious driver for clinicians in an instructional setting is skilled development. They is perhaps extra considering collaborating 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 supply of software program and providers to neighborhood oncologists to higher 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 check databases. So we now have a device known as Medical Pipe that may be a information switch device for medical trials, which reduces web site burden and permits extra websites to take part in additional research than they could in any other case have been in a position to 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: Neighborhood oncologists, in actual fact, are sometimes very considering 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 completely different. What we’re making an attempt to do is assist help the infrastructure of conducting analysis in routine care settings. So we’re making an attempt to align medical research with medical care, and in doing so, make it extra of a routine strategy to how sufferers are cared for.
HCI: Do you wish to discuss a bit about your medical trial community?
Meropol: On the highest stage, we understand that information collected in routine care — what we think about retrospective real-world information — can’t reply all questions in oncology. There are specific analysis questions, sure proof wants that require the gathering of what we name deliberately collected info 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’ll help medical trials’ potential information assortment, ideally for research which might be 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 examine design, supporting affected person identification for research, after which supporting the information assortment that we have talked about. We consider that we now have a chance to lower the complexity of medical trials that exist right this moment by way of pragmatic examine design, but additionally pragmatic operational design that may broaden accessibility to medical trials for most cancers sufferers.
