The volume of clinical information that physicians need to retain in order to help determine the best treatment options for their patients is growing to an untenable level. While the amount of data and research is growing, so too are the responsibilities of clinicians and institutions to deliver high-value care, ie, quality care that has cut out unnecessary resources, testing, and costs. Reducing inappropriate treatment variation, duplication of services, and expensive hospital readmissions are top priorities for providers in the modern regulatory and reimbursement environment. The articles and commentaries in this issue explore digital health technologies currently in use, with commentary on outcomes and reimbursement realities.
Inconsistent treatment patterns may contribute to poor clinical outcomes, reduced patient quality of life, and health care resource utilization variation. It is proposed that the use of clinical pathways and decision-support tools can help to reduce variations in treatment where appropriate and eliminate inefficiencies. In 2010, The US Oncology Network developed and implemented Level I Pathways to improve care and care value associated with gastric cancer, which was integrated into their electronic health record, iKnowMedSM. They later partnered with the National Comprehensive Cancer Network (NCCN) to develop and include Value Pathways powered by NCCN® for gastric cancer in the Clear Value PlusSM decision support tool. Scott Paulson, MD, and colleagues present their findings after assessing the gastric cancer treatment heterogeneity over successive updates of their clinical pathways, starting with creation in 2010 and following updates in 2014, 2017, and 2018 (page 55).
Similar to gastric cancer, treatment of thoracic cancers can be highly variable, with significant heterogeneity observed in treatment choice. This year, the current COVID-19 pandemic has forced collaborative efforts, such multidisciplinary tumor boards (MTB), to reimagine themselves in a socially distanced reality. Erik Stiles, MSc, and colleagues present their center’s experience transitioning from in-person to virtual MTB for the management of thoracic malignancies and lung nodules (page 65). The rapid transition to virtual MTB occurred over one month. Institutional stakeholders were interviewed, and meeting level data was collected between 2019 and 2020 for thoracic tumor and nodule board cases. Dr Stiles and coauthors detail data from interviews and data from 141 meetings between January 2, 2019 and August 5, 2020, and discuss solutions to challenges of data presentation, video-conferencing etiquette, and workflow modification.
As our last issue of 2020, let us take this moment to reflect upon the past year and what the future may hold. COVID-19 has made us reevaluate everything we do to determine if there is a more efficient way to provide quality, value-based care. Our health care system was not prepared for such an event. However, we have shown that we are nimble enough to implement change quickly when needed. The question is, what did we learn from these changes and should these changes become the standard? Even when we get past COVID-19, I would challenge that we should continue to analyze everything we do, if only to make us more accountable for the care we provide, not only to payers, but also to our patients.