The face of American health care is changing dramatically as a result of the growing use of health information technology (HIT) and electronic health applications, according to researchers at the Johns Hopkins Bloomberg School of Public Health and The Commonwealth Fund. Their study, published in the November 2013 issue of Health Affairs, suggests that the demand for oncologists will be significantly different over the next decade, and the oncologist’s role will evolve as a result. For instance, many of them may only be seeing patients in-person after the patients have already gone through several layers of e-health management.1
“Every clinician’s job will get easier and it will [change]. It will be easier to communicate and share all the same charts in real-time, and that is the way of the future,” said the study’s lead author Jonathan Weiner, DrPH, professor of health policy and management at the Johns Hopkins Bloomberg School and Director of the Center for Population Health Information Technology in Baltimore, MD. “The computer will be better than a human on the technical side, but the human will do better in the compassionate side, and with cancer, the compassionate side is very important.”
Dr. Weiner and his colleagues have been analyzing HIT trends and they believe they have performed the most comprehensive review of the literature to date. It includes previously published systematic reviews and relevant individual studies, with a focus on the impact of HIT on the future demand for physician services. Interestingly, the current communications revolution in medicine is occurring at the same time as new targeted therapies are significantly changing how many patients with cancer are being treated. Finding information about new advances involving molecular mutations/targets/drugs is now much more streamlined thanks to the involvement of electronic health tools.
Impact of e-Health Tools on the Cancer Treatment Landscape
According to Weiner, it is now estimated that more than 70% of office-based physicians are making use of electronic health records (EHRs). However, only a decade ago, that number was closer to 10%. Fueling these changes in clinicians’ offices are educated and tech-savvy consumers, who are increasingly making use of the Internet and mobile phones to manage their health. Many individuals may prefer an electronic consult over a face-to-face office visit with a physician.
“Health care is changing dramatically [in this digital age] and we don’t know how it is going to come out,” Dr. Weiner said in an interview with ChemotherapyAdvisor.com. “All care will have better documentation and better digital decision support. The science will make it into the computer more rapidly…that will affect how [patients with] cancer are managed.”
Dr. Weiner and his colleagues estimate that health care professionals could meet the demands of about 4% to 9% more patients than they currently do if just 30% of community-based physicians’ offices fully implemented EHRs and other electronic health systems.1 The researchers theorize that digital delegation of care to nurse practitioners and physician assistants will reduce the future US demand for physicians by an additional 4% to 7%. In addition, through electronic referral systems, there could be a reduction in the national demand for specialists.
Oncologists Adopting Internet Health Tools
Eric Chen, MD, PhD, and some of his colleagues at the Group Health Physicians in Seattle, WA are using new electronic medical systems to provide care and manage patients receiving chemotherapy. Dr. Chen and his colleagues are practicing a significant amount of “virtual medicine” and trying to maximize their EHRs to coordinate care. He described the standard of care in the past as a trip to the oncologist’s office if a primary care physician (PCP) diagnosed a new cancer. Now, for him, the new standard is a virtual consult: the PCP sends an e-mail to the oncologist with his or her findings, and then the PCP and oncologists look at the chart and consult with each other about the best treatment approach for that particular patient.
Dr. Chen indicated PCPs are able to order scans and blood tests in advance, and the entire work-up can sometimes be conducted ahead of a visit to the oncologist. “This helps speed up the evaluation and work-up even prior to the patient being seen by the oncologist. There are times when the PCP actually needs to send the patient to a different specialist first, and this makes care better coordinated,” Dr. Chen told ChemotherapyAdvisor.com. He noted that all “virtual recommendations” are documented in the chart so all members of the health care team can see what has transpired.
Dr. Chen predicts that there will be a shortage of oncologists in the future. However, delivery of care is now being transformed by digitalization and that needs to be considered by policymakers and stakeholders. As electronic health “apps” proliferate, it is highly likely that the majority of patient interaction with health care programs will be digitally mediated. Subsequently, some oncologists may be able to postpone their retirement if they can telecommute part-time and perform virtual consults.
How fast all this technology will be adopted nationwide may be partially determined by what percentage of consumers want face-to-face treatment. Many patients may prefer interaction via e-mail. “It is clear that this technology is here to stay. Both patients and caregivers feel more comfortable with ‘apps’ within their everyday lives. Therefore, electronic health apps will likely be an easy transition,” said tech-savvy oncologist Steven Nurkin, MD, assistant professor of oncology at the Roswell Park Cancer Institute in Buffalo, NY.
According to Dr. Nurkin, preliminary data suggest that EHRs can help practices be more efficient and may reduce medical errors and adverse events. In addition, he noted that they can be critical tools for data collection and extraction. “However, we also need to be aware of its limitations,” Dr. Nurkin told ChemotherapyAdvisor.com. In addition, he cautioned that there are things that cannot be addressed by text message alerts, automated emails, or push notifications. Building trust in the doctor/patient relationship and defining individual patient goals are critical to cancer care. As Dr. Nurkin notes, “This is an important time in cancer care. We will continue to learn more about cancer biology through genomic sequencing and personalized medicine. Combining this with HIT, we hope to improve the quality and value of cancer care.”
- Weiner JP, Yeh S, Blumenthal D. The impact of health information technology and e-health on the future demand for physician services. Health Aff (Millwood). 2013;32(11):1998-2004.