The COVID-19 pandemic may have put the world on pause, but it also showed the medical community that rapid progress is possible with focus and collaboration. During the National Comprehensive Cancer Network (NCCN) Virtual Oncology Policy Summit, “Defining the ‘New Normal’ 2021 and the State of Cancer Care in America,” five panelists discussed how to apply health innovations from the pandemic to cancer treatment, including the evolution of the electronic health record (EHR), telehealth technologies, and real-world data and analytics.
EHR: Another Form of Virtual Care
The technology behind EHRs may not have changed significantly in response to the pandemic, but the interaction of patients and providers using them did, according to Jennie R. Crews, MD, MMM, Vice President and Medical Director of Seattle Cancer Care Alliance Community and Network Programs. As COVID-19 travel restrictions took hold, said Dr. Crews, EHRs increasingly became a patient/provider portal for communication and education rather than just a record of medical care.
“With the EHR, we can virtually address patient concerns in real time and send them information that helps them manage their conditions more effectively, without unnecessary face-to-face interaction,” she explained.
Gwen Darien, Executive Vice President of the National Patient Advocate Foundation, noted that using the EHR as a communication tool can promote patient empowerment as well as real-time information. “Ultimately, these records are ours, and this is our information,” said Ms. Darien. “The EHR presents a partnering opportunity for patients and health-care providers post pandemic.”
“The electronic health record presents a partnering opportunity for patients and health-care providers post pandemic.”— Gwen Darien
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According to Jeff Allen, PhD, President and Chief Executive Officer of Friends of Cancer Research, the EHR has evolved from an administrative and efficiency tool to one that has improved communication between caregivers and patients. The next step, however, is utilizing the EHR as an additional tool for research.
“We learned a fair amount during the pandemic by trying to understand rapidly evolving information across very large populations, which we would not have been able to do in a formalized observational registry or clinical trial,” said Dr. Allen. “The EHR can expand the extent of research by aggregating data in a way that was not technologically possible years ago. It could also help us design better clinical trials in the future,” he added.
Advancing Telehealth Options
The emergence of telehealth enabled continuity of care during the pandemic, but the technology is more than just a temporary salve. According to Timothy Kubal, MD, MBA, Senior Medical Director, Moffitt Cancer Center, telehealth is developing into a lasting presence in oncology.
“When the pandemic started, my patients stopped showing up, but then they started showing up again on telemedicine,” said Dr. Kubal. “In Florida, 50% of my patients are still using telemedicine—even the ones who live down the street from us. They have their labs done locally, and they’re seen the next day via telemedicine. They don’t have to come in.”
Telehealth is still in its nascent form, said Ms. Darien, but if done correctly, the reorganization of health-care delivery could benefit all stakeholders. “We have the opportunity to sculpt [telehealth] into a contemporary house call, allowing health care providers to see the challenges and barriers that patients face and the social context of their health,” she said.
Telehealth is not just about remote consultation, however. Dr. Crews also highlighted the potential for remote patient monitoring. “Remote patient monitoring is a huge opportunity,” said Dr. Crews, who noted that several companies are currently developing products. “However, interoperability and the ability to interface with EHRs are necessary to make them usable for the medical team.”
According to Dr. Crews, artificial intelligence will ultimately help providers manage the level of intervention required based on data obtained remotely. If self-intervention is needed, for example, educational materials and reminders can be sent to patients, whereas more urgent cases can be escalated to a health-care team, she said.
Increased adoption of telehealth has created new possibilities for health care, but there are also disparities in access that need to be addressed. Ms. Darien said that providers must make sure they’re not inadvertently leaving out vulnerable populations as health-care services continue to evolve.
“It’s not just about having the most up-to-date iPhone or Android,” she added. “It’s also about the divide between rural communities, with lack of broadband access, and urban communities, which often have more access.”
Leveraging Real-World Evidence to Broaden Knowledge
Another major trend to emerge from the pandemic is the use of real-world evidence to broaden knowledge beyond the typical clinical trial population. As Dr. Allen explained, the COVID-19 and Cancer Consortium, which started at the beginning of the pandemic, was a global effort to collect outcomes information on patients with cancer who had tested positive for COVID-19.
“It’s remarkable how quickly we were able to obtain insights from the data collected,” said Dr. Allen. “In just a few months, we had real-world data that made a difference in how oncologists and communities were managing patients with cancer. I hope we can keep that momentum going forward to answer so many questions that are burning in oncology now,” he added.
“We have now reached the tipping point in using real-world data to accelerate trial design and have demonstrated that this real-world evidence can be trusted.”— Sarah Alwardt, PhD
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According to Sarah Alwardt, PhD, Vice President of Real World Research, Ontada, the full impact of COVID-19 may be unknown, but the importance of real-world evidence in clinical trials is a clear outcome. “We have now reached the tipping point in using real-world data to accelerate trial design and have demonstrated that this real-world evidence can be trusted,” Dr. Alwardt said.
Clifford Goodman, PhD (moderator), Senior Vice President at The Lewin Group, Falls Church, Virginia
Jeff Allen, PhD, President and Chief Executive Officer, Friends of Cancer Research, Washington, DC
Sarah Alwardt, PhD, Vice President, Real World Research, Ontada, Houston, Texas
Jennie R. Crews, MD, MMM, Vice President and Medical Director, Seattle Cancer Care Alliance Community and Network Programs, Seattle, Washington
Gwen Darien, Executive Vice President, National Patient Advocate Foundation, Washington, DC
Timothy Kubal, MD, MBA, Senior Medical Director, Moffitt Cancer Center, Tampa, Florida
Although the use of real-world evidence may be beneficial to some patients, Ms. Darien underscored the importance of not leaving other patients behind. “The impact of real-world evidence is only as good as the representation of the people who are impacted by these diseases, and this is an ongoing and intractable problem,” said Ms. Darien. “We need to make sure we can use real-world evidence and analytics equitably to close these gaps in care.”
DISCLOSURE: Dr. Crews, Dr. Allen, Dr. Goodman, Ms. Darien, and Dr. Kubal reported no conflicts of interest. Dr. Alwardt has been employed by McKesson; has an immediate family who has been employed by McKesson; holds stock or other ownership interests in McKesson; and has an immediate family member who holds stock or other ownership interests in McKesson.