Web Tools Help Cancer Doctors Pick Treatment

Evidence-based clinical support tools developed by University of Pittsburgh Medical Center help doctors choose most promising and cost-effective treatments for cancer patients.
As healthcare providers adopt e-medical record systems they're also able to tap into more advanced evidence-based clinical tools to help ensure that patients are receiving the most appropriate treatments and best quality of care for their particular illnesses.

Among the latest of these advanced clinical decision support tools is an offering from Via Oncology, a subsidiary launched last year by the University of Pittsburgh Medical Center.

The Via Oncology Pathways are web-based tools consisting of clinical treatment algorithms that assist cancer doctors in choosing the most effective, least toxic and most cost-effective cancer therapies for patients based on the individual's type of malignancy, stage of disease and other factors.

The web-based tools developed by UPMC allows doctors to enter pertinent medical data about a patient, including the patient's type of cancer, state and stage of the disease, the individual's known genetic bio-markers and other traits.

The system identifies the most effective therapies for cancer patients based on the information entered by the doctor about the individual.

"Usually there is no clear winner in cancer" therapies and so several options might be available, said Kathleen Lokay, president of Via Oncology.

The system then looks at the best therapies and levels of toxicity of different treatments so that the patient is more likely to have a better quality of life while being treated, she said.

Finally, if all choices are similar, the system identifies the treatment with the lowest cost.

However, "cost is at the bottom of the chain" in considerations, said Lokay.

The Pathways, developed and maintained by disease experts, are based on a set of focused clinical algorithms for the treatment of cancer that maximize outcomes, minimizes toxicities and can help deliver more cost effective care, said Lokay.

That's because patients receiving the most appropriate, least toxic, evidence-based care earlier on are more likely to avoid complications later or experience delays in finally zeroing in on the most effective treatment for their condition.

Before launching the Via Oncology unit in 2009, UPMC spent nearly five years developing the evidence-based clinical decision support software that's currently used in dozens of UPMC's own cancer treatment sites.

Back in 2004 and 2005, UPMC cancer centers "exploded "with activity in a 250-mile market in western Pennsylvania served by 38 UPMC cancer treatment sites. Yet, "there was no way to know for sure if the same quality of care was delivered everywhere," said Lokay.

UPMC's creation of the tools helped to ensure that all UPMC cancer patients are accessing the same standards of treatments regardless of which facility they're receiving their care, said Lokay. The system also provides hyperlinks to the medical literature related to the treatments or cancers. Clinical expert panels meet quarterly to discuss new clinical findings for updates into the system.

"We poured enormous investment for IT" into the web-based system, said Lokay.

Via Oncology is the latest tech-driven subsidiary launched by UPMC, which in recent years has also funded several other start-ups to commercialize UPMC developments.

Some of those initiatives were later spun out or sold to other companies. That includes Stentor, a unit UPMC created in the late 1990s to sell digital imaging products based on technology developed at UPMC. Stentor was sold in 2005 to Philips for $280 million.

Through the new Via Oncology subsidiary, UPMC also recently began offering the Pathway tools to non-UPMC cancer centers across the U.S.

Among those non-UPMC healthcare customers using Via Oncology Pathways is the Center for Cancer and Blood Disorders in Fort Worth, Texas, an independent oncology group of 18 doctors.

The Center for Cancer and Blood Disorders has been using an e-medical record for its oncologists for about six years, so the group has been ahead of the pack in terms of an independent doctor group using digital records and other health IT tools in its practice, said the center's CEO Barry Russo.

However, last year the center also decided to begin using the Via Oncology Pathways tools to ensure that all its oncologists were delivering the same national standards for cancer care to patients, Russo said.

"There isn't a tremendous variability for the national standards" in terms of the recommended best practices being applied to most cancer patients based on their type of malignancy, stage of disease, genetics or other known biomarkers, he said.

"Eighty percent of patients fit into the process of care for the national standards," he said.

Pathways not only helps doctors zoom in on those standards of care for patients, but also provides the correct chemo regime and other pertinent recommendations "to ensure that errors are minimized," he said.

Variations from those recommendations are minimal "except when clinically appropriate," such as in cases that fall outside the 80% most common range, like patients suffering other underlying illnesses, which creates situations where drug interactions or other issues could be complicating problems, he said.

Because of health or other issues, "some patients can't withstand the standard" of chemo or other treatments recommended for most patients with the same cancers and other similar factors, he said. The Pathways system has the flexibility for clinicians to make other treatment decisions, to document why the national standard wasn't chosen, and to track that, Russo said.

For instance, if the center has a number of colon cancer patients who weren't put on the standard Pathways treatment protocols, that can be tracked.

"Doctors worry about having huge variables in treating patients" but the Via Oncology Pathways provide doctors tools to ensure that patients are receiving the most appropriate standards of care, Russo said.

Pathways is also tied to the center's EMR, which is Aria, an oncology e-medical record system from vendor Varian.

Pathways "dumps info" into the center's EMR for ordering the patient's drug regime, he said.

Also, the Pathways system has helped to reduce the number of variable treatments by helping to guide doctors on the standards of care. This is helping to reduce center costs because there are also fewer, different drugs that get purchased now, he said.

The center is "just getting started with a formal assessment" of the Pathways, but so far doctor feedback has been good, said Russo.

The market interest in the Pathway tools is "high," said Via Oncology's Lokay.

Payers are increasingly willing to share the expense for oncologists to implement the Pathways system in their offices, she said. That's because payers benefit by having more consistent and higher quality care to member patients, as well as helping to rein in costs.

Horizon Blue Cross Blue Shield of New Jersey is among payers that have recently begun offering financial and care management assistance to some cancer centers in its network using the Via Oncology Pathway tools in their selection of evidence-based treatments for patients.

While Lokay did not disclose how much Pathways costs for doctors to use, she said the tools are generally less expensive than an EMR system.

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