In just 5 years since its launch in 2014, CancerLinQ®, ASCO’s big-data, rapid-learning, health information technology platform, has grown from 37 vanguard oncology practices to 58 participating practices in 2016 to 100 diverse oncology practices nationwide this year. CancerLinQ (https://cancerlinq.org) has reached another milestone in 2019: the incorporation of data from 1.5 million patient records into the system, making it one of the most comprehensive sources of real-world data in oncology.
Cory Wiegert
The primary goal of CancerLinQ is to provide oncologists with evidence-based information to improve their performance and patient outcomes by utilizing technology to analyze millions of patient medical records to spot patterns and trends in patient and tumor characteristics and measure their delivery of care against clinical quality measures from ASCO’s Quality Oncology Practice Initiative (QOPI®) and recommended guidelines. Currently, CancerLinQ includes a national consortium of government agencies, medical societies, and industry leaders, such as the U.S. Food and Drug Administration (FDA), National Cancer Institute, American Academy of Physician Assistants, American Society for Radiation Oncology, Cancer Informatics for Cancer Centers, College of American Pathologists, Hematology/Oncology Pharmacy Association, Oncology Nursing Society, Society of Gynecologic Oncology, and AstraZeneca, among others. These collaborations help generate new insights into the delivery of high-quality patient care and ensure the long-term sustainability of the CancerLinQ platform, according to Cory Wiegert, Chief Executive Officer of CancerLinQ.
Evolution of CancerLinQ
In 2017, ASCO launched CancerLinQ Discovery®, which allows access to distinct sets of aggregated, de-identified patient data in CancerLinQ to everyone in the cancer community, including oncology providers, research institutions, life sciences companies, government agencies, individual researchers, and patient advocacy groups. That same year, CancerLinQ partnered with the FDA Center for Drug Evaluation and Research (CDER) to utilize patient data to examine the real-world use of emerging and newly approved cancer therapies, including how best to optimize the sequence of treatments, the impact patients’ comorbidities have on their treatment tolerability and outcome, and the effectiveness of combinations of immunotherapies compared with single agents in specific cancers.
Most recently, CancerLinQ has partnered with the technology companies Concerto HealthAI and Tempus to accelerate its joint research effort with CDER. Concerto HealthAI and Tempus are currently assisting in the analysis of a de-identified data set CancerLinQ has provided the FDA, which represents more than 10,000 patients who have been treated with immune checkpoint inhibitors for both approved and unapproved indications. In addition, CancerLinQ has launched the CancerLinQ Certified Electronic Health Record (EHR) System and named Integra Connect’s EHR Solution for Oncology as its first Certified EHR System, which will allow CancerLinQ to seamlessly transfer oncology-related data from practices in its network.
In a wide-ranging interview with The ASCO Post, Mr. Wiegert discussed CancerLinQ’s rapid expansion and implementation in oncology practices across all settings, including community and academic; how this big-data system provides patients with greater personalized care; and what’s ahead for CancerLinQ in the near future.
Second Phase of Growth
What is the current status of clinical implementation of CancerLinQ? Is the service available to oncologists in both the United States and internationally?
We have entered what we call the second phase of growth in CancerLinQ—CancerLinQ 2.0—and it very much ushers in a new era for us. We currently have 51 oncology practices on board that are using the system for quality-improvement activities (with active data flowing from those practices), and we expect an additional 49 practices to come aboard by the end of the year. That would bring our total sum of active practices to 100, with access to 1.5 million patients’ medical records and more than 900,000 of them from patients with cancer.
The number-one area we are focused on right now is CancerLinQ’s ability to deliver a quality management framework and the measures that oncology practices can use for federal compliance reporting to CMS for reimbursement.— Cory Wiegert
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Among the exciting developments of CancerLinQ 2.0 is its ability to deliver an automated way to report quality practice measures for ASCO’s QOPI programs and to the Centers for Medicare & Medicaid Services (CMS) for compliance with the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and the Merit-based Incentive Payment System (MIPS) programs. In 2018, three practices participated in a pilot submission of quality measures for MIPS, and in 2019, we have practices participating in a pilot for QOPI Certification using CancerLinQ-calculated measures.
There was so much promise for CancerLinQ when it was initiated 5 years ago, and that promise still holds true. Now we are hitting our stride and are accelerating our rate and pace of onboarding oncology practices by almost 400%.
Today, CancerLinQ is available only to oncology practices in the United States, but we are working on a plan to offer the service internationally in 2020.
Planned Value-Added Applications
Is there a subscriber fee to participate in CancerLinQ?
Currently, there is no subscriber fee involved to access the platform. However, we are evaluating a subscription fee for some of our planned value-added applications or capabilities, such as quality improvement tools, which we will be releasing at the ASCO Annual Meeting in June. We are also assessing oncologists’ need and desire for these value-added applications. As we finish that market research, we will determine if and how we might provide a solution.
Improving Patient Care
How do you envision CancerLinQ being used by oncologists to facilitate care for their patients?
The number-one area we are focused on right now is CancerLinQ’s ability to deliver a quality management framework and the measures that oncology practices can use for federal compliance reporting to CMS for reimbursement. Currently, CancerLinQ provides automated capability for MIPS and MACRA submission to CMS and for ASCO’s QOPI Certification.
In addition to the reporting tools, CancerLinQ has a discovery tool, CancerLinQ Discovery, which provides curated, de-identified sets of clinical data to help providers gain novel clinical insights to improve patient outcomes they likely wouldn’t gain with an individual patient. This work is ongoing with input from ASCO’s Clinical Affairs Department and others to assess what pertinent information we need to include at the point of care.
Network of Real-World Data
Can CancerLinQ be used as a treatment decision-making tool that physicians can access to call up study abstracts and patient data showing how a specific patient with the same cancer and molecular biomarkers might benefit from a particular treatment?
That is our long-term intention, and we are in the early phases of defining a cohort builder tool to do what you describe, but CancerLinQ does not have that ability today. What is here today is its ability to assemble clinical and patient-generated data that can be analyzed and used to immediately impact patient care; ultimately, it will enable greater personalized oncology treatment and better outcomes for patients.
We are very cautious about rolling out the concept of a clinical decision-support tool, for example, like IBM’s Watson for Oncology. It is not our intention to create a system that changes the way oncologists make clinical decisions. Our intention is to present information from what happened with the care of patients in a way that is usable to doctors and caregivers.
We are in the early stages of evaluating artificial intelligence and finding the right technologies to apply to our structured and unstructured content.— Cory Wiegert
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Where we are going with the different types of unstructured data collected, such as clinic notes as well as pathology and imaging reports, and structured data collected, including cancer stage, in CancerLinQ is to provide oncologists with real-world patient data that exist within the network that shows patients’ experiences with cancer. That’s what separates us from others. Instead of making recommendations, we are serving data from actual care that patients receive, providing information physicians can use when they make decisions on what treatment to use and how to care for a patient.
We are in the early stages of evaluating artificial intelligence and finding the right technologies to apply to our structured and unstructured content. As artificial intelligence technologies become better at analyzing structured data, we may consider integrating tools in CancerLinQ to guide treatment decision-making. Until we have evidence that we can do this successfully, we will stop short of providing treatment recommendations and continue with our approach of supporting physicians with information.
Collaboration With Data-Services Companies
How might CancerLinQ’s partnership with Concerto HealthAI and Tempus improve care for patients with cancer as well as inform research efforts and clinical trial design?
These data-services companies do our de-identified data curation to extract structured and unstructured information into high-quality data sets to be used to improve the quality of cancer care and support research. They also bring analytic expertise to our research effort with CDER to make sure the studies the FDA is engaged in are operating from accurate data sets and are clinically and statistically sound.
Tempus and Concerto HealthAI are the data assemblers. They clean up the data for us and bring analytic expertise where we have gaps.
Looking Ahead
What is on the horizon for CancerLinQ in the near future?
From a business standpoint, we want to be on break-even sustainability over the next few years. We want to sustain a modest growth within our organization to continue to build on applications for our practices. We don’t want to rely on philanthropic donations alone. We have to find revenue streams to sustain and continue to expand CancerLinQ. Those revenue streams will come from the value-added applications I mentioned previously.
Some of the applications in discussion include the use of molecular data to capture key precision medicine endpoints and tumor registry data. We are exploring what information physicians actually need to improve patient care and track real-time quality performance and how we can provide that technology to clinicians in both rural communities with few large health-care system resources and academic institutions.
We are at a pivotal point in the expansion and execution of CancerLinQ and are quickly building on its core quality improvement platform….— Cory Wiegert
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Our secondary focus is to build the number of QOPI-related measures in the QOPI library. Currently, there are around 180 measures in the QOPI program, which I think of as ink cartridges in a printer; CancerLinQ is a technology printer that the QOPI measures can plug into to provide a comprehensive view of the patient experience and to help practices meet their reporting needs.
The final area that is important for us to expand is the idea of self-service onboarding, in which there is self-service measure management and activation; this way, practices can accelerate their onboarding time and utilize the tools available. These efforts are the underpinnings of our investment initiatives over the next 2 to 3 years.
I’m excited to tell you that we will be announcing details about CancerLinQ’s new quality initiative and quality platform during the 2019 ASCO Annual Meeting in Chicago. More details will be made available at the meeting, but the initiative includes a quality management framework to allow eligible oncology practices to submit their oncology measures for CMS’ Quality Payment Program for MIPS or Advanced Alternative Payment Models automatically through CancerLinQ.
We are at a pivotal point in the expansion and execution of CancerLinQ and are quickly building on its core quality improvement platform to help oncologists and the whole cancer community deliver effective care for patients and, most important, improve patient outcomes. ■
DISCLOSURE: Mr. Wiegert owns stock and has other ownership interests in IBM and has received travel/accommodations/-expenses from IBM.
