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

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

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

Healthcare Innovation: At Healthcare Innovation, we concentrate on writing concerning the healthcare supplier facet and never a lot about life science firms 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’ve got been at Flatiron for seven years. What are a few of the important adjustments you’ve got seen by way of the corporate’s capabilities?

Meropol: In loads of methods, it has been outstanding, however all inside the context of a constant mission, which has been to enhance and prolong lives by studying from the expertise of each particular person with most cancers. The way in which we do that has largely remained unchanged over this time, and that is by offering software program and providers to working towards oncologists, the place we’re an EHR vendor, but additionally by curating information largely derived from digital well being information that is collected throughout routine care to realize 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: After we first began, our information had been mostly used for market monitoring — how are new therapies being adopted? So the shoppers, in a manner, had been industrial arms in biopharma. However we have advanced to have a wider scope of analysis areas that our information are actually utilized to. That features academia, authorities, NCI and regulators, nonprofits just like the American Most cancers Society and Buddies of Most cancers Analysis. Having a broader array of shoppers of Flatiron real-world information opens up avenues to all various kinds of of purposes. Additionally, we’re now now not simply depending on the information within the digital well being document; we now have linkages to different exterior sources of information, like mortality databases, claims information, digital photos, genomic information. That basically opened the door to plenty of various kinds of insights that we’re capable of glean.

HCI: Does broadening out the varieties of analysis embody issues like well being fairness, at how individuals are receiving care in plenty of various kinds of settings?

Meropol: Precisely. The purposes of our information at present not solely embody understanding adoption of recent therapies, but additionally understanding the real-world outcomes related to completely different patterns of care, with the ability to carry out comparative effectiveness, to know variations in approaches that may not be amenable to doing a potential medical trial. 

We have executed work with what are referred to as pure experiments — wanting on the impression of drug shortages on healthcare supply and the outcomes of sufferers, and likewise nationwide insurance policies — for instance, enlargement of Medicaid and the way that impacts most cancers care. We measure high quality with Flatiron information, 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 various areas of well being fairness, together with how shortly sufferers provoke care, together with whether or not adoption of recent improvements is equal throughout completely different teams, whether or not the place you obtain care, whether or not it is a tutorial setting or group setting, impacts the care you obtain. The info are simply very wealthy by way of 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 have now over the previous a number of years developed determination assist instruments. We now have an utility referred to as Flatiron Help, which helps information the suitable choice of remedy primarily based 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 determination making.

HCI: Often, we hear from educational medical facilities that creating and updating medical determination assist guidelines is a posh governance activity. So is that one thing that it’s important to get enter from the community on?

Meropol: Two issues: One facet is that out of the field, the Flatiron Help resolution is constructed on Nationwide Complete Most cancers Community medical observe pointers. The second function is that it is extremely customizable, so practices can select to customise the suggestions of Flatiron Help primarily based on their very own observe preferences.

HCI: What about including these AI scribe instruments to the EHR as nicely? 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 admittedly crucial is that so as to leverage information on all the 4 million most cancers sufferers we observe, we have now to seek 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 are able to develop the variety of sufferers that we’re capable of have significant details about.

HCI: Might the ambient AI device turn out to be good sufficient to determine what to place within the structured information and what to place within the narrative?

Meropol: There’s loads of dialogue taking place about what the digital well being document of the long run will seem like. Traditionally digital well being information weren’t constructed for analysis, but when there are instruments that allow higher seize of knowledge on the level of care in structured or usable format or purposes that embody medical care billing, but additionally analysis purposes, that may be good for everybody and really enabling by way of advancing the standard of most cancers care. So I believe all people is wanting in the direction of a future the place that turns into extra potential, the place that turns into a actuality, however it’s not going to occur in a single day, as a result of EHR distributors like Flatiron are actually centered on workflows and guaranteeing that we’re serving to clinicians present essentially the most environment friendly and high-quality care potential. And there is all the time a danger that implementation of recent applied sciences causes elevated clicks on the pc, 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 attempting to supply the best high quality care to sufferers, however a serious driver for clinicians in a tutorial setting is skilled development. They is perhaps extra occupied with participating in analysis and publishing outcomes, however I ought to be aware that Flatiron’s group oncology community has many practices in it that conduct medical trials analysis and are closely motivated to take action. So the incentives and the wishes to have the ability to present innovative care within the type of medical 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 medical trials. That features serving to with medical trial recruitment affected person matching, but additionally with the switch of information from the digital well being document to review databases. So we have now a device referred to as Scientific Pipe that may be a information switch device for medical 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 device.

Meropol: Group oncologists, actually, are sometimes very occupied with constructing out their medical analysis capabilities, however the investments in medical analysis in a tutorial middle and in the neighborhood observe could also be very completely different. What we’re attempting to do is assist assist the infrastructure of conducting analysis in routine care settings. So we’re attempting to align medical research with medical care, and in doing so, make it extra of a routine method to how sufferers are cared for.

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

Meropol: On the highest stage, we understand that information collected in routine care — what we contemplate retrospective real-world information — can’t reply all questions in oncology. There are particular 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 are going to assist medical trials’ potential information assortment, ideally for research which are pragmatically designed and extremely aligned with routine care. 

So we’re constructing out the capabilities for conducting medical research inside the group setting. That features working with sponsors on the design of research, utilizing Flatiron information to assist inform research design, supporting affected person identification for research, after which supporting the information assortment that we have talked about. We imagine that we have now a chance to lower the complexity of medical trials that exist at present by pragmatic research design, but additionally pragmatic operational design that may broaden accessibility to medical trials for most cancers sufferers.