By: Dr. Anand Kuruvilla

Treating cancer has always been challenging from a therapeutic standpoint, but advances and innovation in oncology have made treatment more tolerable and helped to improve care and outcomes. Yet the delivery of care is becoming more complex, and multiple factors make healthcare data overload a growing challenge in oncology.

One factor is the increased amount of data generated over the course of treatment. In many cases, accurate staging and subtyping require additional testing. A growing number of cancer therapies are indicated for specific genetic mutations, necessitating companion diagnostic tests. Treatment plans are also increasing in complexity, comprising radiation therapy, chemotherapy, immunotherapy and surgery, and involving multiple care providers across different departments and, in some cases, institutions. Scheduling and coordinating multiple tests, treatment sessions, physician visits and follow up appointments also adds to the overload of data.

Collecting, annotating and archiving patient data and chart notes places significant burdens on providers’ time, reducing the amount of time available for delivering patient care and limiting their ability to see patients in a timely manner. This is a particular challenge within our practice, as our policy is that any patient referred to our center for consult is seen within a maximum of two days from the time of referral. This type of timely care is difficult to provide when physicians and office staff are drowning in administrative activities, and overcoming the data overload challenge is essential to giving patients the time and focus they need.

Technology: It isn’t just for patient care
Providers and care centers typically embrace new treatment and diagnostic technologies as tools for improving outcomes, yet may be more reticent to invest in technologies that improve the administrative aspects of patient care and institutional operations. However, these investments are critical for improving the quality and cost of care and providing patients with an optimal care experience.

For example, an electronic medical record (EMR) can allow for data sharing within a health system by putting information online rather than in a physical chart. Care management software solutions allow patient data to be collected and accessed in a single system from diagnosis, to treatment, to follow-up. Importantly, voice recognition and automation technologies can significantly streamline data collection and management. The ability to generate a chart note by voice during a patient visit simplifies and modernizes the clinical documentation process and, in some systems, can automate data collection from previous notes, which reduces the amount of data that needs to be collected during each visit. These technologies reduce cognitive load on physicians, and increase the time available for face-to-face patient care.

Technology solution case studies
For 25 years, the Cancer Center of Putnam has been providing cancer diagnosis, treatment and care in Northeast Florida. It is a member of the HCA Healthcare network and offers state-of-the-art radiation oncology services, including image-guided radiation therapy, stereotactic radiosurgery, brachytherapy and PET/CT imaging. As the sole radiation oncologist, I see 50-80 patients each week and act as coordinator of care provided by multiple physicians and facilities.

In response to the growing challenge of patient data overload, we decided to transition to a paperless workflow environment in 2017. Elekta’s MOSAIQ oncology care management software solution was selected because it readily enabled the aggregation of multiple patient data points in a single system. These include radiation oncology data, radiation therapy treatment plans, treatment outcomes, and tracking and scheduling of tests and office visits. Automated aggregation of these data reduces data entry errors. The system also enables rapid and efficient sharing of data among our staff, ensuring effective coordination and delivery of care.

After hearing a colleague rave about Palabra, a voice-based clinical documentation system that was developed for use with MOSAIQ, I adopted this solution for all of my documentation. Palabra seamlessly integrates speech recognition software into MOSAIQ with sophisticated voice-driven dictation. It fully automates the document creation process and streamlines patient documentation. Importantly, personalized templates automatically pull patient data from MOSAIQ into the note for each office visit, which streamlines the documentation process. It also enables tests to be ordered directly from the dictation and provides specific detail to other staff about how the test should be conducted.

Case study #1
Recently, the Center received a referral for a male patient who needed evaluation for a newly diagnosed locally advanced throat cancer. He was advised curative concomitant chemo and radiation therapy. He sought a second opinion at Mayo, which affirmed that recommendation. Prior to the patient arriving in the office, data from his primary care provider were uploaded to MOSAIQ, including his initial imaging, operative note and pathology reports. Upon his arrival in the office, staff collected personal and health history data and entered it into MOSAIQ. The personalized Palabra template pulled selected data from the MOSAIQ record into the note for the office visit and automatically incorporated my comments as I examined the patient using cutting-edge voice recognition technology. The updated note and a recommended action plan were available immediately upon conclusion of the office visit and the plan of care was shared with the referring primary care physician and other concerned providers less than 24 hours after the referral was made.

Case study #2
A patient with high-grade prostate cancer came to the Center to evaluate potential treatment options, surgery and/or radiation therapy. I recommended radiation therapy, given that it would be needed even if surgery were chosen as first-line therapy, and recommended neoadjuvant hormone therapy. MOSAIQ/Palabra automatically captured the treatment recommendations and forwarded information to the urologist, medical oncologist as well to the patient’s cardiologist, who needed to determine if there were any safety concerns about this patient’s use of hormone therapy. The patient is on track to initiate an eight-week course of hormone therapy followed by radiation therapy, and all upcoming visits and treatment sessions have already been scheduled and documented in MOSAIQ. This allows for automated reminders and notification of any pre-visit actions needed to ensure productive and efficient visits to the Cancer Center.

The patient data deluge: sink or swim
Technology and automation can be effective solutions to the deluge of patient data that pose a challenge to physicians and care centers. Investing in these technologies should be seen as an investment in patients because they can optimize care by reducing errors and maximizing effective communication and coordination among all of a patient’s care providers. New cancer technologies have historically been available only at large academic care centers, but 80% of cancer patients are treated in community care settings. Community care centers may be challenged by the capital expenditures associated with implementing cutting-edge electronic health records (EHRs) and voice recognition systems, but it is important to focus on the long-term returns that these investments provide. Community cancer centers also have recruitment issues in finding radiation oncologists to serve these areas. Coupled with the “graying of America” and increased numbers of cancer patients being diagnosed, technologies such as these, that improve efficiency and productivity, are lifesavers.

A key benefit is the potential for reducing expenses by eliminating transcription costs, reducing errors and increasing physician productivity. Another important consideration is the need for simple and accurate processes for collecting and submitting data in order to meet the requirements of the Medicaid EHR Incentive Program (formally known as “meaningful use”). MOSAIQ provides validated data that can help ensure these requirements are fulfilled, and simplify the data submission, optimizing the payments that the care center can receive under the program. Healthcare is a competitive business, and community-based care centers that invest in new technology will be better positioned to attract and retain patients who might otherwise travel to larger institutions. All of these factors highlight the value of investing in data management technology. For cancer centers drowning in patient data, technology solutions offer a lifeline that should be considered regardless of size or geographic location.

About the author: Anand Kuruvilla is the director of the Cancer Center of Putnam.