Rebecca Maniago, PharmD, BCOP, Flatiron Health, New York, NY, discusses AI-enabled clinical decision support and the ways in which technology is playing a large role in the current landscape of oncology care and clinical pathways.

Dr Maniago presented on this topic at the Association of Community Cancer Centers’ 49th Annual Meeting and Cancer Business Summit.

Transcript:

Rebecca Maniago, PharmD, BCOP: Hi, I'm Rebecca Maniago. I'm an oncology pharmacist. I work at Flatiron Health.

What will you be discussing during your presentation at ACCC?

Dr Maniago: So this afternoon we'll be talking about AI-enabled clinical decision support and how technology really is playing such a big role these days in oncology care. I think one of the main things that we see is the value it can add to the oncologist and helping choose the right treatment for patients. It helps them stay on top of what is the most appropriate therapy for their patient. Additionally, we are able to really capture quality data with the technology that we have. And that can be very insightful for health systems, for cancer clinics. There's a lot, especially in the pharmacy, when you look at drugs, when you understand regimens that are being ordered, really being able to understand at the provider level why certain things are being ordered can really help you drive towards that standardization of care, reducing variation, overall, increasing the quality that those patients end up receiving.

How will AI-enabled clinical decision support tools and other new technologies impact clinical pathways?

Dr Maniago: So, as a pharmacist, I can speak to there's really three key things in pathways where we are really involved. So upfront, it all starts with the regimens. And so before you will implement a pathway, it's really a great opportunity to clean up your regimen library, to understand which ones you are no longer using that you can get rid of and no longer have to maintain; to be able to identify new ones that should be built; to update ones that maybe have had changes since they were originally built. So it's really a good driver for that in the pharmacy.

And then ongoing, as being part of a pathway, you are sort of fed updates in real time and so it no longer falls on the pharmacist to have to stay on top of what is a new regimen? do we want to build this? being part of a pathway that sends you those updates. It's kind of doing that legwork for you at which point you can decide, okay, we will incorporate this regimen that can kick off your internal processes, and that's a big value add. And then lastly, again, it all comes down to the data. So as a pharmacist, to be able to understand how your providers are ordering therapies, what regimens are being ordered for what scenario and at what cadence, it can be really impactful and help the pharmacist really join that clinician team that's responsible for looking at the pathway, how they locally prefer things. Certainly a great opportunity for the pharmacist to really get involved there.

How will technology's impact on clinical pathways affect the timeliness of care?

Dr Maniago: I think this is why technology is really needed in this space, to have technology that can provide updates in real time and can disseminate that in a way that people don't have to do all the legwork on their own. As an oncologist, if you can't attend the conference and you can't spend your whole day reading through what the new thing is this week or what the new thing is that week, technology can really be there to help disseminate that and keep everybody on the same playing field.

How will technology impact cost and value-based care in oncology?

Dr Maniago: Really, as we move towards this world of value-based care, which we certainly are, having pathways where you can reduce variation and you can highlight which regimen makes the most sense, not only for safety and efficacy, but when those are seemingly equal, that's where cost can really be a factor. And so being able to surface that information to the oncologist at the point of care can really steer them towards the most value-based decision. And then on the flip side, the data that comes with using pathways in this space, they can really participate in those programs. They all basically require you to basically be able to prove that you are ordering within some kind of standard guideline and that you're in line with their value-based arrangement. And so having reporting capabilities and data that can prove that that's how your providers are ordering, really lets you be successful in those programs. And then ultimately as a practice or a health system, you reap the benefit of that.

What are some important things from a pharma perspective that you think oncologists or other providers or possibly stakeholders should know?

Dr Maniago: I think we are already seeing AI in many places as we currently treat our patients today. But I think it's understanding that there is a place for it and then there's a place where it maybe is not for it. And so always understand we will always need the physician, the human, to make that final decision, especially something as important as choosing a chemotherapy regimen for a patient. But there are areas where AI and technology really can help. And so we should let it. We're in a world where there are shortages in the workforce, everybody's in a time crunch, and perhaps being able to lean in to technology when it can help get data from point A to point B and reduce some of that data entry really can increase those standards. And I think ultimately we're still in the middle of figuring out how to make it do what it does best while giving us space to do what we do best as humans.

It's a very exciting time to be in the clinical pathway space. I think we are starting to see a shift in the mentality. Things take time, but the data is coming out and it's looking very positive in that pathways are improving the quality of care, which ultimately leads to better patient outcomes. And so I think the more that we try to make these pathways as usable as possible, as user-friendly as possible, how do they fit into the workflow? how do we not add extra time to our provider's day? The better we will get. And so I think we are on a very good path with pathways.