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 Oncology Informatics.
Health Professional Radio – Oncology Informatics
Neal Howard: Hello and welcome to Health Professional Radio, I’m your host Neal Howard. Thank you for joining us on the program today. Up until just the last couple of years hospitals, treatment centers and scientific hubs and research projects – they didn’t share information with each other readily about their cancer patients. Well things are changing and our guess in studio today is Drs. Brad Hesse and David Ahern, they’re both with the National Cancer Institute and they’re here today to talk with us about oncology informatics. They both have written a book, Oncology Informatics and we welcome them to Health Professional Radio. Hello Doctors.
Dr. Bradford Hesse: Hello, thank you Neal.
Dr. David Ahern: Hello, thanks Neal.
N: Thank you for taking time out and coming and talking with us today. Oncology Informatics, as I said there was a time when nobody shared information. How is that changing and how are you at the forefront of this change?
H: Why don’t I go ahead and start. This is Brad Hesse and where we’re at right now it’s an interesting set of times. A couple of events have happened over the past I guess about 5 or 6 years, one was the High Tech Act that was published I think it was in 2009 that it was passed by congress and that’s the health information technology for economic and clinical health act. That’s what really provided incentives for hospitals to start adopting other information technology, so when that happened all of a sudden for better for worst a lot of hospitals start to picking up electronic health record systems and started growing their own electronic nervous system – so that’s a very good important time so that happened. Then as we’re proceeding forward, there are changes occurring on the side of oncology where we can start aiming ourselves in what the President has refer to as a Moonshot that if we can just collect our data together we can accelerate the way that we’re treating patients and we can accelerate the way that we’re learning about cancers so that’s happening simultaneously and as this is going on, we looked at this at the National Cancer Institute Dr. Ahern and I and we said ‘You know what I think this is a really great time to reach out to some of the best experts in the field to find out where the bright spots are on how doctors are sharing information with each other and then to create a blueprint as we continue to move forward on how to do that better for the service of patients across their cancer journey.’ So that’s what I would add to that and maybe Dr. Ahern can add something as well.
N: Well Dr. Hern now that things are moving in a much better direction and it’s taken quite some time, what were some of the obstacles that were preventing this sharing of information?
A: That is a great question Neal. A host of issues, historically information collective in health care system hospitals, doctor practices was largely collective on paper. There were paper charts and paper records, so really there wasn’t any computerized system in place in most practices and most hospitals. As Dr. Hesse mentioned the High Tech Act and the incentives to meaningful use program that was put in place by the CMS to incentivize doctors and hospitals to implement electronic health record systems has really changed that situation, that landscape so that a majority of hospitals and practices and physicians have access to electronic health records now so information has now in more structured formats and now available to be extracted electronically. However many of the systems that have been implemented are largely not interoperable as the technical term used meaning that the information is basically is locked in those individual practices or hospitals and not able to flow across systems or to hospitals and practices. So the goal now is to take advantage of the investment in these sort electronic systems and find ways to collect the information into build the structures that offer data sharing for the ability for data to move and flow and it’s a very good part of the Moonshot Approach that we… rapidly share information and there’s a bit of culture issue to not just the technical technology issue but historically hospitals and practices conventionally sort of looked at their own patients in the way that they do their work as different in another center across the street in terms of methods or approaches. I think… recognition now we need to share information to actually improve quality, improve health care outcomes in that… that we’d be less controlling if you will of the data so by that’s a bit of a culture change, we need to make sure that the expectations are that data sharing will occur.
N: Some of these practices and facilities being located in rural areas, do you find that being a factor and is that being addressed as part of the cultural issue?
A: Certainly if you don’t reside in an area, an urban area or there’s no access to an academic health system or a large hospital system or a hospital at all it may be difficult to receive the full range of care that you might need for chronic illness or acute condition. There’s a movement called telemedicine or telehealth which is part of this informatics area that we’re talking about that is growing as well where the ability of, where geography shouldn’t preclude the ability for patient have access to high quality care. And so we see that telehealth and telemedicine movement which is sort of parallel to this data liquidity, data flow using electronic record systems in operable systems that combination could improve care for all citizens of the United States if not in the world where geography isn’t a barrier as it has been. So we think some of these barriers – cultural, technological, geographical – can be minimized and overcome through the use of technology and informatics.
N: Now talk about the book that you’ve written, it’s called Oncology Informatics. How does this book help physicians and patients understand? Often times you right to a physician from a physician and leave the patient out as far as understanding it. It may be a great, great step forward but is this book aimed mainly toward other health care professionals, specialists or can we as patients get some insight into this new if sharing of information as well?
H: Yeah, I’m glad you mentioned that because one of the first things that we did when we decided to create this book is that we said ‘Okay there’s been a lot of books developed for very technical audiences before’ and that wasn’t our purpose. Our purpose was to help the different stakeholders in care kind of get onto the same page as to what the potential is here and what the possibility might be of a really connected health care system. So the very first thing that we did is using some patients that Dr. Beckjord who wasn’t able to be on the call today but was the third editor of the book, some patients that she connected to is that Dr. Ahern and Dr. Beckjord create or did a focus groups with a lot of patients asking them ‘How are you using technology in other aspects of your life? What are you doing when it comes to banking and what are you doing when it comes to entertainment and consuming? And then how can we kind of apply those principles over to the world of what we want to do in caring for you as cancer patients in clinical care?’ And we cited those patients repeatedly and almost most of the chapters throughout the book because that became a starting point for us as we went through here. We also reached out, we have a several places where we’ve embedded the comments directly of others who read the book and gave us comments on that. There’s a patient her name is Janet Freeman-Daily she also helped us with something we’ll discuss in the later on perhaps and a panel that’s giving recommendations to present and non-connected health and she has a whole section where she talks a little bit about her care coordination story where the problems were and what her hopes might be for how a connected system help give her better connected services and a better continuity in what she does.
N: Where can our listeners go and get a copy of this new book Oncology Informatics using health information technology to improve processes and outcomes in cancer?
H: I think the two places that I would make the most sense could be either to go to the Elsevier site so if you were to Google our publisher which is Elsevier and find there connection you’d be able to get a look at the book itself or even amazon.com has a copy of it you can look at.
N: Great. You’ve been listening to Health Professional Radio, I’m your host Neal Howard in studio with Drs. Brad Hesse and David Ahern both with the National Cancer Institute and they’ve been here talking about Oncology Informatics. Transcripts and audio of this program are available at healthprofessionalradio.com.au, you can subscribe to this podcast on iTunes and also at hpr.fm. Thank you doctors for joining us today.
A: You’re welcome.