Decision Support Through Structured Data

Mary M. Ichiuji, MD, oncologist at Kaiser Permanente (KP) and National Physician Lead, Beacon Oncology, presented “Opportunities for Decision Support Through Structured Data” during Session 1 at the 2022 Oncology Clinical Pathways Congress.

After describing the Kaiser Permanente network—which consists of eight regions with 12.6 million members (including more than 24,000 physicians, 64,000 nurses, and 217,000 employees at 39 hospitals), Ichiuji explained how the KP Beacon Oncology Module – EPIC electronic health record (EHR) offers nearly 1,200 protocols developed through the collection of data.

“With the rapidly changing therapeutic landscape, it’s difficult for physicians to keep up with the landscape,” Ichiuji said.

In 2018, the KP National Oncology Drug Treatment Pathways was agreed upon, with the intent to develop internal oncology treatment pathways at KP, “...to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve,” according to the KP mission statement.

Developed with 11 subspecialty teams, a Regional Subspecialty team creates the pathway draft, and consensus is reached by a second Regional team, then approved by a governance group comprised of InterRegional Chiefs. The pathway is then loaded onto the National Clinical Library and is integrated with Beacon EHR. This has resulted in pathways for a multitude of organ systems including breast, cutaneous, CNS, colorectal, and gastrointestinal.

EHR integration is viewable from KP Health Connect or the KP Intranet for physicians, or orderable from the Patient Chart in the EHR, with multiple options and menus intended to provide specific pathways for specific individuals.

When deployed in 2020, initial use among network physicians was 16%, now that number is up to 93%. In January 2021, about 20% of treatment plans utilized pathways; as of June 2022, 78% of treatment plans now use pathways.

“The rapid adoption for the use of pathways is because we feel physicians trust the information; it was made by their peers,” Ichiuji said.

The system provides usage reports that can be utilized to update pathways rapidly. Subspecialty groups can evaluate the percentage of preferred vs alternative treatment options to determine the most appropriate pathway. These groups will also evaluate whether new protocols and pathways should be added.

Ichiuji closed per presentation by discussing the future vision of the program. It will be patient-centered, personalized, and technology-supported, offering screenings (as 42% of all cancers are preventable), guided diagnoses involving doctors and patients, expert- and evidence-driven treatments, and survivorship in which no one falls through the cracks, and healthy lifestyles are promoted and taught.