I'm here with Dr Ray Page of the Center for Cancer and Blood Disorders. Just to begin, Dr Page, in your experience or professional opinion, what do community practices envision when they hear the term “clinical pathway?”
Do pathways represent to them drug treatment algorithms or are they more comprehensive and interactive with granular evidence, patient prompts, EHR integration, and data collection and analysis, etc? How has the connotation associated with the phrase “clinical pathway” evolved?
Dr Page: I think the majority of the larger, progressive, more sophisticated community oncology practices that utilize clinical pathways envision them as a tool that allows them to efficiently manage the value‑based delivery of cancer care.
However, I believe that the majority of the community oncology practices that are out there still are not engaged and utilizing practice-facing pathway systems. I think many of those practices continue to have the view that pathways are being yet another administrative burden that impacts physician time and actually makes them less efficient in day‑to‑day care. Many of those community oncologists also still have the perception that pathways can actually narrow and bind their decision‑making for appropriate treatments and management of the cancer patients.
In a lot of these community oncology practices, we're all running on tighter and tighter financial margins, and many are concerned just about the return on the investment of those pathways.
You also asked about the treatment algorithms and what is that looking like currently in the day‑to‑day use. The pathways, they indeed do represent treatment algorithms. Yes, in recent years, they've been more sophisticated in the use and we are now able to utilize a lot of pathways with the associated data to our advantage. The data that's coming through the pathway systems now is much more robust and it's much more reliable than what it was 5, 6, 8, 10, 12 years ago. Now, we can use that data and it allows us to identify potential patients for clinical trials, for screening, and enrollment.
It also allows us to look at our practice patterns that give us the opportunity to make more effective and advantageous value‑based contracts with the private payers. For OCM practices, it also gives us the opportunity to improve our practice habits in a way to maximize our performance periods with OCM reimbursement.
As the pathway systems continue to evolve and become more interactive, I think we'll see a greater electronic health record integration, and this will be able to allow us to have greater efficiency for the clinicians taking care of the cancer patients day‑to‑day.
You mentioned that community practices are still sort of conflicted about developing their own pathway programs for a variety of reasons. There was a recent benchmarking survey presented at the Oncology Clinical Pathways Congress in October that found that the vast majority of pathway programs in the United States exist in the academic setting.
I want to ask you for those community practices that have begun to develop their own pathways, how crucial or how much stock do they place in the patient perspective in developing those pathways? In other words, are these pathways that are being designed truly being designed through the lens of patient‑centered care?
Dr Page: To answer the first part of that question, I think it's only been in recent years that the vast majority of pathways programs have been placed in the academic setting. For much of the last 15 years, a lot of the development of the practice-facing treatment pathway systems were done primarily through a lot of the sophisticated community oncology practices across the United States.
Historically, in years past, there's a lot of the major academic cancer centers that had developed their own homegrown pathways to meet their institutional practice standards and so forth.
I believe in recent years, we are seeing a much broader adoption of the pathway systems to where we are seeing community practices and hospital practices and academic systems all coming together and utilizing some of these similar practice-facing pathway systems. In recent years, as we see the development of these pathways amongst all these different groups, I think we're seeing the pathways become more congruent and expressing similar standards even between all the different practice environments.
In other words, an academic setting will follow a practice pathway standard that will be carried out the same in the community.
The neat thing is many of these pathways committees now have a blend of physician representation that come from all these environments. You can have co‑chairs, which one is from an academic setting and one is from a community setting. I think that creates a much more solid, robust, decision‑making platform that is definitely more patient‑centric.
We've spoken with a few different individuals who work specifically with large patient groups and whatnot. They've alluded to the possibility of social determinants of health being a major factor in pathway development or the idea that social determinants of health could lead pathway decisions.
That's one aspect of patient‑centered pathways that we've heard of being a possibility. I'm curious if you have any thoughts on that or you've seen social determinants of health beginning to make their way into pathway design?
Dr Page: Trying to strike a balance between standardized care and using other things like social determinants of care and those kind of things, I think our oncology experts representing all the various tumor types and all the nuances of care, they are up for a challenge going forward on trying to find out the best way to get the appropriate therapies to our patients.
I think we have an opportunity that is great as have ever been for our physicians to get together to work on making prudent medical decisions based on data that looks at those variables of efficacy and toxicity of cost. I also think that clinical decision‑making is going to continue to go into a broader area besides just those variables.
As we continue to collect more robust data, we start looking at real‑world evidence, and we start utilizing artificial intelligence tools, I think we can use those tools to augment our clinical decision‑making. With, for example, some of the artificial intelligence tools, it allows us to take a look at the social determinants of health and many other variables that can sometimes allow us to better optimize the care for our patients.
That's not only in just treatment pathways, but that also gets into the realm of managing patients through triage pathways where you're trying to identify high‑risk categories for patients.
By utilizing that data and looking at such things as social determinants of health and having that artificial intelligence tool crunch those numbers for you, it really gives us the opportunity to create methods to optimally manage our patients and keep them healthier in a better shape going through their journey with cancer.
We often hear of speculation of whether or not artificial intelligence can play a role in standardized care of cancer or even in clinical pathways. You've laid that out very well, not only in care pathways but also in triage pathways. I think that's very well said.