History of Oncology Research at Intermountain Healthcare

Transcription

1 History of Oncology Research at Intermountain Healthcare Elizabeth Hale Hammond, MD, FACP Consulltant Pathologist, Intermountain Healthcare, Professor of Pathology, University of Utah School of Medicine; Salt Lake City, Utah Objectives: Identify oncology program developments of significance in Intermountain List the key success factors in oncology and program successes

2 History of Oncology in Intermountain Elizabeth H Hammond MD

3 In two landmark reports on Quality and Information Technology, the Institute of Medicine described a 21st century healthcare delivery system that would improve the quality of care while reducing its costs. To achieve the improvements envisioned in these reports, it is necessary to increase the efficiency and effectiveness of the clinical decision support that is delivered to clinicians through electronic health records at the point of care.* This 21 st Century healthcare delivery system started in Utah at Intermountain In the 1960 s! *Jones et al. BMC Medical Informatics and Decision Making 2013, 13: /13/47

4 We cannot solve our problems with the same thinking we used when we created them Albert Einstein

5 Innovative Care Changes are Woven into the Fabric of Intermountain Clarence Wonnacott attracted Homer Warner to LDS Hospital to create a cardiac catheterization laboratory and ultimately, the HELP system was born Brent Goates attracted Henry Plenk to LDS Hospital and Radiation Oncology was solidified in Utah Stanley Altman, persuaded Charles Smart to come to LDS Hospital and Cancer Surgery was added Don Nelson and the medical staff established an ongoing foundation to support medical research

6 HELP System is Developed Beginning with cardiac catherization data, Warner and colleagues built a decision support system that underpins every clinical program. Institutional support was consistent and foundational Healthcare workers embraced the technology and made the changes in process to allow it to flourish at the bedside

7 Radiation Oncology comes to Utah Henry Plenk was recruited to LDS Hospital in the 1960 s and quickly established a cancer treatment program and residency In 1968, he joined the newly established Radiation Therapy Oncology Group LDS Hospital became an important player in these trials

8 Oncology Defined in 1970 s Charles Smart becomes first cancer surgeon in the state working in the Intermountain Regional Medical Program Thru IRMP, the tumor registry was computerized in 1973 and cancer became a reportable disease in Utah Using tumor registry data, cancer care could be better followed and improved. What cancers are prominent in Utah? What is the death rate from those cancers? How can care be improved?

9 Charles Smart used Data to Improve Oncology An early adopter of computerized technology, Smart promoted its use He advocated and promoted research involving the tumor registry data and was its strongest supporter to keep cancer reporting unified throughout the state

10 1980 s Brought New Talent and Fruitful Collaborations Talented medical specialists were recruited to Intermountain Fruitful research collaborations evolved HELP system continued to expand Tumor registry data was used to understand cancer care LDS Hospital developed an oncology unit and bone marrow transplant unit still operative today Expertise in imaging and pathology expanded to support patient cancer diagnosis and treatment Research funds allowed small projects to generate meaningful patient improvements

11 LDS Hospital became key player in Cancer Care in s Physicians and staff at LDS Hospital were supportive of clinical trials and made significant contributions to RTOG/COG group studies Early studies in hyperthermia, intraoperative radiation therapy, and childhood cancer radiation evaluated utility and defined best uses Physicians at Intermountain became key cancer players in RTOG/COG in 1980s 1990s and expanded clinical care in Intermountain William Sause and John Thomson were key players Elizabeth Hammond led pathology studies and tissue banking Michael Collins and Dirk Noyes played leadership roles in surgery William Rees, Regina Rosenthal, Bret Parkinson refined breast cancer services

12 RTOG Changed Cancer Care in the USA Completed 460 protocols which improved cancer care involving 90,000 patients over 40 years Landmark trials in brain, prostate/bladder, GI/pancreatic, head and neck, and lung cancers 300 leading cancer hospitals including 90% of cancer centers in the USA 800 published papers Intermountain was a major player in these trials and in writing grants to support the group

13 Intermountain Pursues Integration in the 1990 s to Improve Care Intermountain established a health plan and a medical group Data and collaboration fostered further improvements Brent James taught and optimized improvement work and tools and spread learning system wide Research improvements could be systematically spread through the system and monitored regularly

14 Oncology Clinical Program is Established in 1990 s Oncology Clinical Program established with William Sause as the clinical leader System wide goals were established Data mart for oncology was developed Tools like synoptic pathology reports and statistical process control charts made monitoring a reality 5500 patients are treated annually and 94% of those have adequate staging information to plan treatment

15 Oncology Data Warehouse Integrated Research and Analysis Claims& Eligibility EDW Financial Data Clinical Data A single source for complex data analysis and reporting

16 Breast Preservation Rate

17 Sentinel Node Rate System

18 Breast Synoptic Reporting Elements Became National Standard Intermountain synoptic breast cancer checklist elements paved the way for national adoption American College of Surgeons for cancer hospital accreditation National Quality Forum as breast cancer quality measures CMS has also adopted them for pay for performance Synoptic elements enable uniform understanding and avoid missing information in reports

19 Intermountain Huntsman Oncology Collaboration in 2000 s Enabled data sharing and further research using Utah Population Data Base, LDS Church genealogical records, and clinical data from Intermountain Led to more patients being enrolled on clinical trials and enabled research collaborations

20 Oncology Standardization, Data Access, Outcomes Research in 2016 Research collaborations with Stanford Medicine in molecular oncology (precision medicine) Membership in NW NCI Community Oncology Research Program, the largest collaborative involved in community based outcomes research ASCO CancerLinQ HIT platform early adopter institution. providing data on cancer care to compare with others across the country for purposes of improvement

21 New Programs Providing Excellence Intermountain Precision Genomics Next Gen sequencing for genetic mutations 80% of which are actionable by specific targeted therapy Enhanced genetic counseling services to direct appropriate testing and dedicated counseling services Intermountain Biorepository with qualified cancer tissue specimens dating back to 1980 s in all cancer sites Biorepository supports 20 biomarker and molecular studies at the present time

22 The Future is Bright William Sause has set a high standard for leadership Innovative health care professionals will continue to pursue creative changes in care delivery Research, supported strongly by Intermountain and involving national organizations, will drive ever better oncology care

23 Unicorn tapestry, Metropolitan Museum of Art 1495