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The Changing Role of Technology in Clinical Pathways

October 12, 2019

On the second day at OCPC, Rick Peters, MD, UT Austin Dell Medical School, and Mahek Shah, MD, Harvard Business School, gave a joint presentation on how technology can be used to enhance clinical pathways.

Drs Peters and Shah discussed a few areas in which technology could enhance pathways, including diagnostics, phenotyping, therapeutics, patient tracking, education, and communication.

Technologic innovation is needed in the diagnostics space because analytics and artificial intelligence/machine learning are accelerating faster than anticipated. This acceleration is due to “little data,” or quality data, rather than the often-heralded “big data,” Dr Peters explained. He then provided multiple examples of how, in recent years, the medical field as a whole has been disregarding evidence. Published studies have attempted to disparage or rewrite the evidence or ignore the evidence altogether.

Dr Shah then posed the argument that non-clinical data and interventions should be harnessed and combined with clinical data and conventional therapy to improve patient care. An example he gave is that a diet of fresh food should be promoted alongside therapy options to improve the patient experience.

There are a variety of missing components to support algorithmic diagnostics and therapeutic decision support, including environmental exposure (ie, workplace and travel), economic and financial profiles, family support and infrastructure, diet and nutrition, fitness and pre/post-habilitation, and transportation, Dr Shah added.

Regarding therapeutics, Dr Shah mentioned that technology should be better utilized in clinical pathways, research and clinical trials, real-time point-of-care clinical decision-support, and precision medicine. He argued that tracking will be critical to support research and measures of outcomes and quality.

Hospitals are beginning to identify less as hospital systems and more as health systems, with the focus on speed, efficiency, service, and decreased resource utilization. “If you can afford it, pathways can be incorporated into HER [electronic health record] workflows,” Dr Peters said. However, EHRs are not capable of managing the core non-traditional phenotype data needed for optimal pathways. Mobile platforms and third-party integration vendors can support rapid development of pathways at the point of care with or without digital integration with EHRs.

Dr Peters rounded out the list of areas in which technology should be built to enhance clinical pathways by stating that the biggest breakdown in clinical care, outcomes, and quality is a failure to communicate. The most important use of technology (ie, mobile, web, messaging, and video), he posited, should be to communicate, in detail, at every stage of the patient experience with clinicians and their family’s journey with their cancer.

In their concluding remarks, Drs Peters and Shah asked the audience to consider where we should be going in clinical pathways, decision-support, advanced intelligence, analytics, and machine learning. Importantly, Dr Peters stressed that we have to shift the pathways focus from a diagnostic/therapeutic retrospective view to a real-time predictive, prospective view, all while keeping the diagnostic/therapeutics record available at every point of care.

They finished with reference to a 1914 quotation from pioneering Boston surgeon Ernest Codman that simplified the theme of the session: “Every hospital should follow every patient it treats long enough to determine whether the treatment has been successful, and then to inquire ‘if not, why not’ with a view to preventing similar failures in the future.”

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