Guest: Dr. Bradford Hesse and Dr. David Ahern
Presenter: Neal Howard
Guest Bio: Doctor David Ahern is the Director of the Program in Behavioral Informatics and eHealth within the Department of Psychiatry at the Brigham & Women’s Hospital and Assistant Professor of Psychology (Psychiatry) at Harvard Medical School. His specialty is focused on the intersection of informatics and behavioral science to improve health and healthcare. David was National Program Director for the Health e-Technologies Initiative of the Robert Wood Johnson Foundation from 2002-2009 where he managed a technology research portfolio of 26 grants promoting the use of technology for health behavior change and chronic disease management. In 2013, David began an IPA detail to the National Cancer Institute whereby he serves as a special advisor on health information technology (HIT) to the Healthcare Delivery Research Program (HDRP) within the Division of Cancer Control and Population Sciences.
Dr. Bradford (Brad) Hesse is Chief of the National Cancer Institute’s Health Communication and Informatics Research Branch. Dr. Hesse received his degree in social psychology from the University of Utah in 1988 with an accompanying internship in the nascent field of medical informatics. After completing his degree, he served as a member of the Committee for Social Science Research on Computing at Carnegie Mellon University, and then went on to co-found the Center for Research on Technology at the American Institutes for Research in Palo Alto, California. For almost three decades since that time, he has been conducting research in the interdisciplinary fields of social cognition, communication, health informatics.
Segment overview: Dr. Bradford Hesse and Dr. David Ahern of the National Cancer Institute, discuss how oncology informatics work to give us new insight into cancer, its causes, and its individual solutions and how it can alter the course of treatment for a patient.
Health Professional Radio – Improved Patient Outcomes
Neal Howard: Hello and welcome to the program, I’m your host Neal Howard. Thank you for joining us here on Health Professional Radio. Cancer information has not been readily shared over the past several years up until just a couple of years ago, most hospitals and treatment centers didn’t share information about their cancer patients. But at the forefront of an information sharing revolution is our guest in studio today Dr. Bradford Hesse and Dr. David Ahern, both of which are with the National Cancer Institute and also authors of the book, Oncology Informatics: Using Health Information Technology to Improve Processes and Outcomes in Cancer. Welcome to the program doctors.
Dr. Bradford Hesse: Thank you, it’s our pleasure.
Dr. David Ahern: Thank you.
N: Dr. Hesse as co-author of this new book, tell our listeners what oncology informatics actually is.
H: So the notion of informatics is the use of health information technology to improve the way that we deliver care in medicine and very particularly how we transport information around the system of medicine to support patients. So the book on Oncology Informatics deals very specifically with all the issues that we care about when it comes to cancer and that includes how to prevent cancers from happening in the first place and we’ve refer it to as preventive oncology – how we can help patients detect their cancers early, how we can help them during a course of treatment when we know patients may end up seeing like 7 to 13 different specialists and then how to help them to survive after they get over that treatment phase and they’re now back working with their primary carer and all the other aspects of their lives. So oncology informatics, we see as the technology for the communication needed to be able to bring all those facets together to help serve cancer patients.
N: When it comes to cancer, it seems as though in the past not up until just a couple of years ago in the past – the information at one facility to prevent cancer or the cause of cancer was going to be different than someone would get the information center down the street. But now everyone’s gonna be on the same page, it seems like preventing cancer we all get the same message say in commercials. Why weren’t we on the same page before?
A: There are variety of reasons as to why there isn’t a consistency in approach or what we call variation in care or care quality from one center to another or from one hospital or practice to another. And part of it is the complexity of cancer, it’s a very complex set of diseases, it’s not a single disease, it’s part of what is exciting about the opportunity to improve cancer detection and treatment and care over time now is because we’re doing a better job of understanding the nature, the biology of cancers. And that sort of part of what we’re taking advantage of with our work is just a rapidly expanding evidence base about the underlying genomics and genetics of cancers. With that, that has also created an enormous demand for information and ability to collect and store and share information in order to better understand the unique profile of cancer types and each person may have a particularly unique type that requires a particular approach and a procedural approach and the informatics aspect is that technology can enable that kind of more tailored physician care and in order to do that consistently back to this variation problem which is seen in health care not just in cancer is that we need to be able to share that kind of information so that there’s greater ability to provide those precision treatment. That sort of part of the story as to why now and what has been the problem that we talked a bit about the need for electronic records and the ability to have basic structured data but then that’s only a start. You have to be able to move that data to the appropriate place, the appropriate practice group, to the appropriate provider in a particular point in time for that particular patient with that particular profile. So there’s a bit of that kind of coordination that now is doable with informatics that weren’t really doable even 5 years ago.
N: Are we talking informatics and this new revolution in information sharing simply here in the United States or are we talking on a global scale? Because understanding what causes cancer here by sharing information between ourselves much quicker if we can do that we can maybe understand what’s causing a cancer there that we had no clue 5 years ago as you said. Is that something that you’re considering or that in the works now?
H: I think you’re exactly right. I think a lot about what Thom Friedman I think discussed once when he was saying that the world is flat because of this communication and information technology that we have at a global scale now. With cancer, that means that we can share information across parts of the globe as we figure out what’s causing cancer and what the best treatments are. We can also eventually – and this we’re not quite there yet it’s gonna take us awhile – but eventually I think be able to follow patients who go beyond the reach of let’s say where they live currently and maybe the United States maybe they want to go and visit another country and while in that country they have a problem and immediately need to get access to their health record, wouldn’t it be wonderful if we get eventually get to the stage where we can do that with our finances but we’re having a hard time doing that with medicine but where we want to reach toward that path and we think that these are the necessary first steps to go down that path to make it a kind of a global support system.
N: Do you think that there’s a higher percentage that is resistance to change as more than access or lack thereof to the information much quicker now? Do you think that there’s just simply a maybe a mental block that is causing some of the delay?
H: Yes, sometimes that is what happens. There becomes a big cultural change and we have to do things differently and we hear this play out often in to be very honest, clinical conspiracies on whether we should share information or whether this should be something that’s market driven. There’s a lot of those kinds of discussions that are going on right now but I think what’s happening is that because of the High Tech Act now people are exposed, for better or for worst, to these new connective systems. They may complain about the fact that it’s a lot of work and we need to improve these systems for them but at the same time if we say ‘We’re gonna take that away and make it so that you can share your information’ they resists. They say ‘Now we know what it looks like. Now we definitely do want to be able to share that information’ and the patients whose records have become mobile where they weren’t before. They are also looking at that and saying ‘Don’t take that away from me.’ So there is rapid beginning of a change I think even a psychologic way on people’s willingness to be able to share that information.
N: Now in wrapping up, yes go ahead.
A: And Neal, that I’ll just add another comment, I’ll be brief but I think it’s a great point that Brad was alluding to. Actually there’s a pretty significant consumer or patient demand to have not only have his or his own health information but also to make sure that that information is available to the providers that they elect to go to for care and where they may end up with care so it’s not only is it the health system or the provider community that is needing to respond to mandates from federal mandates to share through acts and congress. There’s a major consumer demand and consumer force now to move data to where I’m at my particular point of need as opposed to requiring me to move to some place to get data. That data should follow me, sort of the philosophy that’s driving a lot of these and that’s a powerful force in providers, in provider systems and health systems to really recognizing that.
N: Now in wrapping up your book, Oncology Informatics is in its first edition, Using Health Information technology to Improve Processes and Outcomes in cancer could you tell our listeners where they can go and quickly get a copy of this book?
A: Well you can go to the Elsevier website and if you just typed in the search bar ‘Oncology Informatics’ I think it comes up as first on the list and it’s available there to the Elsevier store but it’s also available as many if not most books out today on amazon.com where you can find the book.
N: Dr. Hesse and Dr. Ahern thank you both for being here this afternoon.
H: You’re welcome, it’s our pleasure.
A: You’re welcome.
N: You’ve been listening to Health Professional Radio. Transcripts and audio of this program are available at hpr.fm and also at healthprofessionalradio.com.au and you can subscribe to this podcast on iTunes.