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Report identifies IT upgrades needed to enhance cancer care

August 18, 2017 | Dagny Stuart

A group of nationally recognized medical information and data management experts has recommended the development of new knowledge software applications that work alongside electronic health record systems (EHRs) to help practicing oncologists access and use the latest genomic information to assist in the treatment of cancer patients.

The recommendations were unveiled in a new report published in the Journal of Clinical Oncology. The lead author is Jeremy Warner, M.D., M.S., assistant professor of Medicine and Biomedical Informatics and medical director of the Vanderbilt Cancer Registry.

Jeremy Warner, M.D., M.S.

Clinical oncologists, whether at large academic institutions or small community practices, are increasingly expected to deliver precision medicine with treatments tailored to the genomic changes that occur in a tumor as the cancer advances. The promise of precision medicine is to deliver targeted therapies to patients with specific tumor molecular alterations and to spare patients without those alterations from the side effects and expense of therapies that are unlikely to work.

But the pace of scientific discovery in the field has been so rapid that the authors note “our ability to identify genomic aberrations has outstripped our ability to take advantage of such information for the benefit of the patient.”

The ability to characterize cancers into smaller and smaller subgroups has been spurred by next-generation gene sequencing. However, clinicians who order these tests often receive a report that is 20 to 30 pages, with hundreds of literature references, and the reports can be quickly outdated.

Then there is the issue of standard language to describe genomic alterations, which “are often named differently by different laboratories and researchers.”

This deluge of information makes it hard for a practicing oncologist to keep up with new discoveries and treatment options, especially if the clinician isn’t a genomic specialist.

To address these issues, the American Society of Clinical Oncology (ASCO) convened the Omics and Precision Oncology Workshop in October 2016.

Omics refers to the technologies used to explore the relationships and actions of various molecules within cells.

The goal of the workshop was to address the complexity and rapidly changing nature of genomic information which existing EHRs are not designed to manage.

The authors of the new report noted “there is a need for genomic tools that constantly update, supplement and provide useful clinical decision support (CDS). It would be ideal to have this CDS resource available from all electronic health records used by oncologists.”

“One of the issues our group identified is that there is no “universal language” that laboratories and EHRs have to speak with each other; as a result, many of these extremely modern lab tests are coming to clinicians as faxed PDFs,” Warner explained.

Recognizing that a complete solution will take years, the group determined that some progress is possible “using existing Health-IT approaches sometimes referred to as sidecar applications [apps].”

Like a motorcycle sidecar, these apps would work alongside and in tandem with existing EHRs.

Warner said “some exciting technologies developed in the past few years, such as SMART on FHIR, got a real boost from the recently passed 21st Century Cures Act. This law requires that EHRs “expose” some of their data through patient-friendly application programming interfaces (APIs), on demand. While the initial scope of 21st Century Cures does not include genomic data, complementary efforts such as Sync for Genes are leading the way to the much-needed “universal language” of clinical genomics.”

The authors also recommended the creation of a “meta-knowledge base” of genome information, potentially developed and maintained by ASCO, which provides all possible codings for any gene-genomic abnormality combination.

The investigators noted that “a functional app allowing data to be entered just once and allowing the viewing of the information from multiple knowledge bases would help oncologists practice better genomic medicine and would help ASCO and oncologists better understand the process of app development.”

Other authors include Kevin Hughes, Massachusetts General Hospital, Harvard Medical School; Edward Ambinder, Icahn School of Medicine at Mount Sinai; Gregory Hess, Symphony Health Solutions; Peter Paul Yu, Hartford Healthcare Cancer Institute; Elmer Bernstam, University of Texas Health Science Center; Mark Routbort, MD Anderson Cancer Center; Jean Rene Clemenceau, Hospital Angeles Del Pedregal; John Hamm, Norton Healthcare; Phillip Febbo, Genomic Health; Susan Domchek, University of Pennsylvania; and James Chen, Ohio State University.