Flatiron Well being, which has constructed up an oncology-focused EHR community and a de-identified database with greater than 4 million affected person data, just lately introduced a milestone of over 1,000 analysis publications utilizing its EHR-derived real-world knowledge. Neal Meropol, M.D., the corporate’s vp of analysis oncology, just lately spoke with Healthcare Innovation concerning the enlargement of the kinds of analysis being accomplished with its knowledge.

Based in 2012, Flatiron is an impartial affiliate of the Roche Group. It collaborates with companions in educational establishments, coverage teams, regulators, and biopharmaceutical corporations. 

A medical oncologist, scientific investigator, and outcomes researcher, Meropol oversees Flatiron’s scientific groups supporting retrospective and potential proof era. 

Healthcare Innovation: At Healthcare Innovation, we deal with writing concerning the healthcare supplier facet and never a lot about life science corporations or drug improvement. However clearly the 2 worlds are linked collectively, and Flatiron’s work is likely one of the locations the place that occurs. You have been at Flatiron for seven years. What are among the important modifications you have seen when it comes to the corporate’s capabilities?

Meropol: In a whole lot of methods, it has been exceptional, however all throughout the context of a constant mission, which has been to enhance and prolong lives by studying from the expertise of each individual with most cancers. The best way we do that has largely remained unchanged over this time, and that is by means of offering software program and providers to working towards oncologists, the place we’re an EHR vendor, but additionally by curating knowledge largely derived from digital well being data that is collected throughout routine care to achieve insights that assist deal with care high quality and coverage, and that assist speed up drug improvement 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 knowledge had been mostly used for market monitoring — how are new remedies being adopted? So the shoppers, in a method, had been business arms in biopharma. However we have advanced to have a wider scope of analysis areas that our knowledge at the moment are utilized to. That features academia, authorities, NCI and regulators, nonprofits just like the American Most cancers Society and Pals of Most cancers Analysis. Having a broader array of shoppers of Flatiron real-world knowledge opens up avenues to all several types of of purposes. Additionally, we’re now now not simply depending on the information within the digital well being file; we now have linkages to different exterior sources of information, like mortality databases, claims knowledge, digital pictures, genomic knowledge. That actually opened the door to numerous several types of insights that we’re capable of glean.

HCI: Does broadening out the kinds of analysis embrace issues like taking a look at well being fairness, at how individuals are receiving care in numerous several types of settings?

Meropol: Precisely. The purposes of our knowledge at the moment not solely embrace 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 scientific trial. 

We have accomplished work with what are referred to as pure experiments — wanting on the influence of drug shortages on healthcare supply and the outcomes of sufferers, and in addition taking a look at nationwide insurance policies — for instance, enlargement of Medicaid and the way that impacts most cancers care. We measure high quality with Flatiron knowledge, taking a look at how individuals 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 educational setting or group setting, impacts the care you obtain. The information are simply very wealthy when it comes to what is feasible.

HCI: Has the variety of oncology practices or educational 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 group oncology and in academia continues to develop. When it comes to new options in OncoEMR, one thing that is actually notable is we’ve over the previous a number of years developed resolution help instruments. We’ve got an software referred to as Flatiron Help, which helps information the suitable number of remedy 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: Often, we hear from educational medical facilities that creating and updating scientific resolution help guidelines is a posh governance process. So is that one thing that it’s a must to get enter from the community on?

Meropol: Two issues: One facet is that out of the field, the Flatiron Help answer is constructed on Nationwide Complete Most cancers Community scientific follow tips. The second characteristic 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 need to go in that course, completely.

Additionally, one of many new areas which is de facto crucial is that so as to leverage knowledge on the entire 4 million most cancers sufferers we observe, we’ve to search 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 will increase the variety of sufferers that we’re capable of have significant details about.

HCI: Might the ambient AI instrument develop into sensible sufficient to determine what to place within the structured knowledge and what to place within the narrative?

Meropol: There’s a whole lot of dialogue occurring about what the digital well being file of the longer term will appear to be. Traditionally digital well being data weren’t constructed for analysis, but when there are instruments that allow higher seize of data on the level of care in structured or usable format or purposes that embrace scientific care billing, but additionally analysis purposes, that will be good for everybody and really enabling when it comes to advancing the standard of most cancers care. So I feel everyone is wanting in direction of a future the place that turns into extra potential, 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 targeted on workflows and guaranteeing that we’re serving to clinicians present probably the most environment friendly and high-quality care potential. And there is all the time a danger that implementation of latest applied sciences causes elevated clicks on the laptop, and ends in extra burnout and has unintended penalties. 

HCI: Are the shoppers who’re working in group oncology practices completely different from the folks working within the educational medical facilities so far as the toolsets they need or want? 

Meropol: The frequent drivers in group oncology settings and educational 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 educational setting is skilled development. They is perhaps extra all for participating in analysis and publishing outcomes, however I ought to notice that Flatiron’s group oncology community has many practices in it that conduct scientific trials analysis and are closely motivated to take action. So the incentives and the needs to have the ability to present innovative care within the type of scientific trials exists each in the neighborhood and within the educational middle. And one of many issues that that we have actually constructed out over the previous a number of years is the availability of software program and providers to group oncologists to higher allow them to participate in scientific trials. That features serving to with scientific trial recruitment affected person matching, but additionally with the switch of information from the digital well being file to check databases. So we’ve a instrument referred to as Medical Pipe that could be a knowledge switch instrument for scientific trials, which reduces website burden and permits extra websites to take part in additional research than they may in any other case have been capable of do. 

HCI: I keep in mind that there was an announcement of a Flatiron partnership with the Affiliation of Most cancers Care Facilities to work on broadening entry to that instrument.

Meropol: Group oncologists, the truth is, are sometimes very all for constructing out their scientific analysis capabilities, however the investments in scientific analysis in an educational middle 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 scientific research with scientific care, and in doing so, make it extra of a routine strategy to how sufferers are cared for.

HCI: Do you need to speak a bit about your scientific trial community?

Meropol: On the highest stage, we understand that knowledge collected in routine care — what we think about retrospective real-world knowledge — 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 scientific trials’ potential knowledge assortment, ideally for research which are pragmatically designed and extremely aligned with routine care. 

So we’re constructing out the capabilities for conducting scientific research throughout the group setting. That features working with sponsors on the design of research, utilizing Flatiron knowledge 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’ve a chance to lower the complexity of scientific trials that exist at the moment by means of pragmatic examine design, but additionally pragmatic operational design that can broaden accessibility to scientific trials for most cancers sufferers.