Can Real-World Evidence Improve Clinical Pathways?

At the 2022 Oncology Clinical Pathway Congress, Session 1 “Pathways Strategies to Decision-Making and Data Management” kicked off in earnest with Rebecca Miksad, MD, MPH, Flatiron Health; and Carole Tremonti, RN, MBA, Three Mountains LLC, co-presenting “Can Real World Evidence be Used to Improve Clinical Pathways?”

Tremonti spoke on the question of whether real-world data can be used to drive decision-making. The short answer, she said, is “yes,” but there are barriers to overcome. There are the “haves” and the “have nots.” And there is a shared pain among content generators, clinicians, payers, and the pharmaceutical industry when it comes to trying to establish pathways.

Real-word data, Tremonti said, is data pertaining to patient health status or the delivery of health care, collected from sources such as electronic health record, claims and billing activities, product and disease registries, patient-generated data including in-home use settings, and other sources that can inform on health status.

“The common barrier we all share is a giant data gap, but the data is all there,” Tremonti said. “Data really is the new oil, it’s the thing we all need.”

But data can be unstructured, there is a lack of data standards, embargoes on data-sharing, mistrust, and ownership issues that complicate the creation of data-driven pathways.

The solution, Tremonti poses, is to incorporate real-world data into pathways decision-making.

What needs to be included in the data to determine pathways include genomics, social determinants of health, spatial biology, computational biology, and population comparisons (eg, clinical outcomes, cost considerations). The way to get there is through clinical informatics, annotation, natural language processing, machine learning, and collaboration.

Miksad spoke on the process of “flipping the script” with Flatiron Assist’s technology, data, and services. Their mission, Miksad said, is to build a world where technology and science can close the gap between care and research, and thus improve and extend the lives of patients with cancer.

Miksad noted that more effective and efficient processes must be developed to facilitate compliance and consistency with cancer treatment guidelines. The need is to find the proper treatment for each patient at the right time, while overcoming barriers such as lack of access to pathways products, time-consuming tools, inability to measure pathway adherence, lack of integration into the EHR, and clinician reluctance. The challenge is to find and achieve conformity with evidence-based expert guidelines.

Embedding the proper tool to gather the data for clinical pathways into an EHR is feasible, Miksad said. This will provide decision support in the form of custom pathways, incorporate NCCN guideline updates, will be based on the specific patient case, and will track compliance. The tool will also provide research and administrative support.

In a pilot for 11 community practices, the EHR-embedded pathway tool was associated with 92% NSCLC documented treatment concordance. Clinicians used the tool for 67% of orders at 2 months, 79% at 6 months and 82% at one year for patients with non-small cell lung cancer. Flatiron Assist also showed significant time efficiencies.

As a result, Flatiron Assist was shown to have helped standardize care, decreased insurance denials, and improved billing workflow.

In conclusion, population-level data provides specificity and creates value in regards to aiding decision-making. Numerous industry members are leading the way in demonstrating the impact to value-based care arrangements for both providers and payers.