In health care, we often find ourselves reacting to events rather than dictating them. Being cast in this undesirable position is often unavoidable when dealing with regulators and federal policy. However, the ability to foresee the need for change and thereby influence the direction of change is a mark of solid leadership.
ASCO recently surveyed volunteer members who hold leadership committee positions on what are the three greatest driving forces that will shape how oncology looks a decade from now. The three most mentioned were genomics, affordability of care (cost and value), and Health Information Technology (HIT). Some, however, questioned whether HIT is truly a driver or merely an enabler, and whether ASCO’s strategic thinking should include HIT as a central driving force for change. I would argue that HIT has become a driver for the following reasons:
- Federal health care policymakers have learned that influencing HIT can be a powerful force for resetting health care priorities and physician roles through reimbursement incentives or penalties. CMS now directly dictates the software development priorities of HIT vendors and the use of EHRs by hospitals and providers. The FDA is studying how to leverage the growing installed base of EHRs to accelerate drug evaluation and approval. As a result, how HIT is implemented will drive how health care looks. The ASCO Board recognizes the need for professional societies to be a part of this discussion and to guide both federal policy and software development. Equally transformative is the understanding among federal agencies that engaging end users of HIT is critical to the successful transformation of health care and this has created a more balanced dialogue between federal policymakers and clinicians.
- Unleashing the power of molecular data to help prevent and treat cancer will require the ability to capture complex, changing, high-volume data and to correlate molecular data with patient phenotypic and behavioral data. This was not possible before EHRs, is still not possible given current EHRs, but will be a driving force as we struggle to achieve the ideal of personalized, precision medicine.
- HIT is a competitive advantage for organizations. I hasten to add that the data have little value in this sense, absent the ability to aggregate, analyze, and act upon such data. To be able to obtain research-quality data out of routine patient care records will require organizational strength in operations, finance, and human resources on a scale that large health care delivery systems alone possess. HIT will therefore be a driver in defining the types of relationships that physicians establish as they build their networks and ecosystems.
- Consumer expectations of HIT will establish new relationships with their health care providers. These expectations will be difficult to meet, given the complexity and uniqueness of cancer care compared to not only routine health maintenance, but say, managing a social network. Nevertheless, we will be challenged to meet these expectations in ways that are novel and best serve health care needs.
Ultimately, I think that the most potent driver of change in oncology will be cost. In the United States, we have a health care delivery system that is unaffordable and at the same time we have an inefficient cancer research system that is equally unaffordable, with its own unaddressed and poorly articulated access to care problems. I would advance the concept that we need one system where clinical care and research are blended together, a system where the quality of health data improves to the point where it can be used for clinical research. This will require a system where the expectations for clinicians to follow evidence-based medicine are strengthened and where the academic community becomes more flexible in accepting a wider range of outcomes data that are more relevant to patient- and practicing physician–concerns. This transformation will only be possible through the thoughtful re-engineering of health care through HIT.