Cancer Treatment Centers of America’s Precision Medicine Journey

Dec. 7, 2016
At the New York eHealth Collaborative's (NYeC) Digital Health Conference, Susan Zook, an executive leader at Cancer Treatment Centers of America, discussed the organization's efforts to more effectively share aggregated cancer genomics data.

At the New York eHealth Collaborative's (NYeC) Digital Health Conference on Tuesday, Susan Zook, senior vice president, precision medicine, Cancer Treatment Centers of America, shared the organization’s precision medicine oncology journey with a focus on sharing aggregated cancer genomics data.

Cancer Treatment Centers of America Global, Inc. (CTCA), headquartered in Boca Raton, Fla., is a national network of five hospitals serving adult cancer patients. The five hospitals serve 8,000 to 10,000 new patients a year, according to Zook. And, during the NYeC Digital Health Conference at the New World Stages in New York City, Zook discussed how the CTCA started its precision medicine journey in 2012 by offering comprehensive molecular profiling, next generation sequencing and large panel testing for cancer patients. The network of hospitals sequences 2,000 to 3,000 patients a year, Zook said.

“It’s been a learning journey over the past four years, and despite what we know, we know there’s a lot that we don’t know,” she said. “We believe that precision medicine is the cancer care of the future, and there are so many benefits to patients. Through precision medicine we can contribute to the development of more information and data and get started on the foundation to build this into the standard of care sooner rather than later.”

Four years ago, the organization’s leaders realized that while the organization had an advanced electronic health record (EHR) system with “tens of thousands of patients worth of data and hundreds of thousands of encounters worth of data,” CTCA’s analytics capabilities were not as sophisticated as they needed to be, Zook said. “Trying to find certain data was like looking for a needle in a haystack. What defines a precision medicine program is the patients and the analytics around that,” she said.

Zook continued, “We started a journey to segment that population of our data out so we could really start to mine it and understand it, and turn it into better clinical practices for patients. And we saw many limitations with EHRs; that’s not what our EHR is built for. Precision medicine is an important critical component of our future and, as such, we needed a dedicated bucket, so we did a due diligence process to find a partner to help us.”

Working with Palo Alto-based software vendor Syapse, CTCA deployed a data-driven precision oncology platform to enable clinical and genomic data integration and decision support with the overall goal of providing clinicians with cancer genomics data at the point of care.

“If you’ve ever seen a large panel test result, it’s 16 to 19 pages. And if you want to understand the evidence between the recommendations you have to look through page after page, and there’s blue hyperlinks, which you can’t click on because it’s on paper. There’s a lot of information that teases you and you can’t dig into it more,” Zook said. “We needed to find a way to make that electronic for doctors, make it easier for them to access those recommended potential clinical trials, and to understand the drugs and interactions and recommendations from a molecular perspective.”

While there have been significant advances in genomic testing and molecular medicine, getting that data, such as test results, into doctors’ hands at the point of care has been a challenge and an ongoing barrier to improving cancer care. Zook said health IT has played a critical role integrating this data into oncologists’ workflow.

“When your 19-page report comes in on paper and everything else that you’re doing in your workflow is online, that’s a source of frustration and it challenging from a workflow perspective. Integrating that into electronic form has been a huge win for us and for the doctors,” Zook said.

The use of a precision oncology software platform has enabled doctors within the CTCA network to “connect the dots” between patients and cases. “We have three hospitals in three time zones, so our EHR is really segmented,” Zook said. “As we dug into this project, we found that we have patients and physicians that have been leveraging molecular medicine, genomic medicine and precision medicine from a targeted therapy perspective for years. Through this application, we have been able to connect the dots from similar patients. So our doctors not only learn from published evidence and but also from what’s happening inside the walls of our five hospitals.”

Zook continued, “It’s amazing to me that we have similar patients being treated by two doctors under the same roof, such as the Phoenix doctors where you have two doctors that are a clinic away from each other, but there’s been no way before to connect the dots and learn from each other right inside our own hospital. It’s been an amazing journey to learn from ourselves, and we want to be able to take that information and present it to others because that’s what we’re all trying to do—change the paradigm of cancer care.”

Additionally, CTCA also populates that information into the patient portal so patients have access to test results and other health data. Zook contends that precision medicine efforts ultimately improve the patient experience and helps to advance more patient-centered care.

“We’re more patient-centered today than we have ever been, even with declining reimbursement. With our focus on the patient, both in oncology and acute care, I think we’re in a different place today. And, I’ll add, the oncology patients are the smartest patients and they are hungry for information,” she said.

Traditionally, oncology has been challenged with effective tracking of outcomes on an individual basis, according to Zook, and precision medicine efforts utilizing health IT are now enabling oncologists to improve their ability to measure and track patient outcomes.

Right now, health data analytics and health genomics data are trending, and the old fashioned saying, ‘you have to measure to manage,’ is as true today as it was a decade ago. And, having the ability to data mine in EHRs is a much more significant challenge than it’s ever been,” Zook said. “The numbers are going to change the future, especially with oncology standards of care, guidelines and pathways, so you have to have the information in order to make the changes. We’ve got to be able to pull the analytics, track trends and be able to use that information and get that information into our doctors’ hands every single day so they can make a more positive impact on patients sitting in front of them at the moment.”

Further, Zook contends that better data sharing will the key to transforming cancer care.

“Health systems are uniquely positioned; we have the diagnostics, therapeutics and quality of life data, so we’re sitting on a gold mine of information. And, we can significantly impact the future of cancer care for patients by sharing the information with people who can learn from it and add to it. No health system can do it alone and there is power in numbers. We have a significant opportunity to make a huge impact on oncology patients by pulling information together and enabling doctors to make smart decisions,” she said.