The Health Information Advantage

In the face of market and regulatory pressures, oncology practices are embracing technology as a solution to enhance efficiencies, increase profitability, and improve patient care. From adopting comprehensive electronic health record (EHR) platforms to providing patients with medical record access and the ability to engage with their providers through online portals, oncology practices are working to improve the quality of patient care. Opportunities for powerful insights into the oncology market are also on the rise.

Challenges facing the community oncology practice include increasingly complex clinical decisions, larger patient loads, declining reimbursement, and increased costs. With the growth of targeted therapies and companion diagnostics, as well as the proliferation of new therapies available for several types of cancers, physicians are turning to technology to assist in treatment selection. Targeted therapies have fueled most of the recent growth in the oncology market and "will dominate the top 20 cancer therapies by 2017," according to a report from GBI Research. These market trends will require clinical systems that support physicians in selecting the most appropriate treatments.

Another issue is declining revenue since the passage of the Medicare Modernization Act in 2003, as reimbursement shifted to average sales price plus six percent for Medicare patients. According to ASCO, "Medicare patients make up 61 percent of new cancer cases in the United States today and that proportion is expected to rise to 70 percent by 2030" leading to further erosion of practice profitability stemming from lower reimbursement rates for Medicare. Drug costs are also on the rise; many cancer treatments approved in the last two years came with a price tag north of $100,000; often, multiple therapies are concurrently prescribed, compounding the cost of treatment. These dynamics will erode practice profitability, increasing the need for practices to effectively capture charges, reduce drug loss, and maintain optimal inventory levels.

Finally, health reform will increase patient loads in a specialty that is already short of physicians: "An aging and growing population, increasing numbers of cancer survivors, and slower growth in the supply of oncologists will result in a shortage of 2,550 to 4,080 oncologists by 2020," according to ASCOs Journal of Oncology Practice, 2007. Physicians will have to turn to technology to support the increased patient demand and maintain optimal levels of patient satisfaction and outcomes.

IT boosters

Adoption of health information technology will lead to improved efficiencies and assist with the challenges facing the community oncologist. According to Information Week, "spending on electronic health records [will] grow from $2 billion in 2009 to $6 billion in 2015." The acceleration is the result of federal programs created to support technology adoption with a goal to drive down the cost of care and improve patient outcomes. The Health Information Technology for Economic and Clinical Health (HITECH) act that is part of the American Reinvestment & Recovery Act provides up to $44,000 per provider for the adoption and "meaningful use" of a certified EHR system. The first stage of the program launched in 2011 and the subsequent stages two and three are set to launch in 2014 and 2016, respectively. The goal of the HITECH Meaningful Use program is to "promote the spread of electronic health records to improve healthcare in the United States," according to HealthIT.gov. The primary benefits include complete and accurate health information regardless of the setting, better access to health information to improve outcomes, and boosting patient engagement.

Supporting patient treatment

Technology must support the most critical function of the oncology clinic: providing high quality care for patients. This process is supported by a number of systems, including the EHR, inventory management system (IMS), practice management system (PMS), and financial reporting system (FRS). These systems are connected by interfaces that facilitate the transfer of data to support the patient treatment process from diagnosis, to treatment decision making, to claim submission and financial review, ensuring efficiencies to increase revenue, decrease costs, and improve patient care. The patient demographic information is entered into the PMS by the practice staff and is sent to all practice systems via the interface. The ability for the PMS to send important data elements impacts the quality of the information that is generated from all other systems in the practice. This information can then be extracted to provide insight into the patients' clinical and financial data.

Before treating the patient, the oncologist enters diagnosis and staging information along with any other relevant clinical data required to create the treatment plan in the EHR. McKesson Specialty Health's iKnowMed EHR presents the physician with the appropriate treatment regimens based on the patient's clinical factors. McKesson's collaboration with the National Comprehensive Cancer Network to launch value pathways will allow oncologists to assess treatment options against evidence-based standards at the point of care, enhancing the physician's ability to support increasingly complex clinical decisions. The EHR captures rich clinical data that can also be used by brand managers to develop effective, targeted educational and marketing efforts. Finally, this data can answer comparative effectiveness and other outcomes questions that support the overall value proposition of brands within the marketplace.

Once the patient's order is reviewed and approved by the physician in the EHR, the order is sent to the IMS. McKesson Specialty Health's Lynx Mobile, allows the user to match the EHR order with the item(s) pulled from the Lynx Mobile cabinet reducing errors to optimize charge capture and practice revenue. In a study conducted in 2011, physician revenue from charge capture was improved by $70,000 per physician annually after the implementation of Lynx Mobile. The system also provides a mechanism for auto replenishment of drug and supplies, ensuring optimal inventory levels and reducing the capital required to run the business, which is critical in the high drug cost, low reimbursement environment. The data captured in Lynx Mobile can be leveraged to create intelligence for pharmaceutical-biotech companies, payers, and other healthcare stakeholders around product utilization patterns providing insight into how their drugs are being prescribed and used.

Patient engagement

After the patient treatment information is signed off by the provider in the EHR, the treatment information is made available to the patient in the portal. According to Deloitte's Center for Health Solutions, 10 percent of Americans currently use patient portals, but that number is predicted to rise as patients begin to expect access to their clinical information online. Patient engagement is a top priority for the government through the HITECH Meaningful Use program. Stage one of the Meaningful Use program required physicians to provide patients timely access to their health records. Stage two increased the patient engagement mandate requiring physicians to provide secure messaging between patient-physician, enabling patients to view, download, and transmit their health information and educating patients on their conditions and treatments. McKesson Specialty Health's My Care Plus patient portal's connection to the iKnowMed EHR provides real-time access for patients to view their health records. My Care Plus enrolled over 25,000 patients in the first year alone, an example of the strong demand for online health record information. My Care Plus also provides a new way for pharmaceutical-biotech companies, payers, and other healthcare stakeholders to engage patients in a HIPAA compliant way, through prescribed content, surveys, virtual advisory boards, and focus groups.

Tracking financial health

After the treatment plan is completed, it is sent to the practice's management system, to the clearinghouse, and ultimately the payer. The claim and remittance data can be extracted from the PMS and imported to a FRS. A big challenge for the oncology practice is generating analytics that provide a view into the financial health of the practice. Understanding reimbursement challenges, denial rates and reasons, and cash flow is critically important for these small businesses in this tough economic environment. McKesson Specialty Health's Lynx TotalView solution provides the ability for practices to glean financial intelligence that offers greater insight into critical financial metrics. The system also provides benchmarks at the regional or national level, providing insight into reimbursement rates across those areas.

Better health 2020: the outlook

Oncology practices are facing tough headwinds, but the oncology market continues to present strong opportunities, and health information technology will provide efficiencies needed to survive and thrive in the marketplace. Spending on health information technology will continue to accelerate as providers look to improve operational efficiencies and meet government regulations. Community oncology clinics have a number of tools available, including EHRs, IMSs, FRSs, and provider and patient portals. These solutions also provide invaluable information and insight for pharmaceutical-biotech companies, payers, and other healthcare stakeholders into the oncology market around product utilization, segmentation and targeting, comparative effectiveness, and reimbursement challenges. Equipped with the right insight, brand managers can better provide assistance and education to providers and patients. We have only scratched the surface on the intelligence that we can collect from these systems; as health information technology products become more pervasive, the quantity and quality of data will continue to improve, providing powerful insights to the user.

Dan Lodder is Vice President, Technology, Sales, Service, and Portals at McKesson Specialty Health. He can be reached at dan.lodder@mckesson.com.