Oncology has emerged as a subspecialty particularly amenable to clinical pathways. As value-based care continues to gain in prominence and importance in practices across the United States, individual providers and medical groups have sought ways to best maximize value while minimizing costs. Because clinical pathways are not a one-size-fits-all operation, each practice has approached the implementation of these programs in a slightly different manner.
In that respect, Journal of Clinical Pathways spoke with Editorial Advisory Board member Ayman Elfiky, MD, MSc, MPH, about how clinical pathways are used at Dana-Farber Cancer Institute (Boston, MA), where he serves as an attending physician in medical oncology, and as a member of the prostate cancer program. Dr Elfiky described how the health care reform, consumer-driven market practices, and the move toward precision oncology have shaped the implementation of clinical pathways and other areas of value-based care. He further explained why clinical pathways and oncology have enjoyed a synergistic relationship for many years, and will continue to grow together as medical and treatment trends evolve and grow.
What inspired you to work in oncology?
Unlike with any other clinical subspecialty, I have long appreciated the intimacy of trust and dedication to the sanctity of life that can grow in oncology over the course of each provider-patient relationship. Increasing scientific knowledge and insights about the nature of cancer development and propagation has inspired new perspectives on the human experience of cancer. Indeed, the more we appreciate cancer as representing a diseased manifestation of a fundamental “loss of balance” within our system, the more we appreciate and are humbled by the complex interplay of finely balanced biochemical processes and systems that embody the amazing human enterprise.
My cross-disciplinary training gave me the tools to bring to light those forces and processes that impact at the individual and structural levels and come to manifest as adverse health outcomes. As my vision for the future of health care matured, I see the dire need for principled managers and leaders who can affect meaningful changes in their organizations and policies which dictate people’s care experiences and sustainability of health.
How does your work at Dana-Farber Cancer Institute contribute to advancements in cancer care?
Interfacing with dedicated scientists and clinical experts to rapidly translate novel scientific insights to the clinical realm to benefit patients inspires me to reason beyond usual academic bounds and work across dimensions. My particular area of work is focused on applying novel informatics/analytics technologies with the goal of knowledge development derived from the spectrum of data representing all of the clinical decisions, treatments, patient outcomes, and “value” captured across the entirety of the care delivery spectrum. As health care and society is increasingly evolving within a digital economy, there are exciting new opportunities and necessities for health care providers to usher in artificial intelligence and analytics tools as they play increasing roles in care delivery over the coming years.
How have clinical pathways begun to shape care at your facility?
Clinical pathways can represent a double-edged sword, for which reason their implementation and adaptation requires proper leadership and appreciation of the nuances of organizations and patient populations. One pathway does not fit all. More importantly, pathways are not an end solution in and of themselves. At my facility, we continue to learn from our experiences with pathways, and are better able to tailor the use of pathways in different practice settings. At the same time, our ongoing experiences have inspired our view and understanding of what pathways must be and can be to best serve our providers and patients in realizing the best value of care.
How do you envision cancer care 10 years from now?
As technology continues to drive scientific and data-driven feats of accomplishment, there will more clearly emerge the need to return to the first principles of health care and care delivery. Despite good intentions, current patterns of health care reforms, innovations and “disruption” are being fueled more so by economic drivers instead of value drivers. Such systems that do not aim to create and capture shared value for the key stakeholders will eventually stand out as being biased against value-based care delivery. However, as patients, caregivers, and society at large grow increasingly engaged in their care, motivated toward self-advocacy, and discerning in their choices within an evolving consumer-based health care market, we will see the balancing influence of competitive market forces on care delivery organizations. Along the same line of expectations, the evolving role of precision medicine (eg, tumor profiling for treatment selection, genomic profiling of patients and families to mitigate chance of disease, or nanoengineering of a treatment directed at an individual’s tumor) will necessitate a consensus stakeholder-based definition of “shared value” and the structuring of dynamic value-based management systems within care delivery organizations.
