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"The Dish on Health IT"

Engaging discussion around Health IT with perspectives from across the healthcare landscape. This informative and entertaining rotating panel of senior health IT consultants and their guests will keep you in the know about the latest innovations, policies and industry shifts impacting healthcare and point out the opportunities that lie within.

The Dish on Health IT

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Episode 11: HL7 CodeX: Transforming Cancer Care & Research


Steve Bratt, lead of CodeX joins hosts Jocelyn Keegan and Gary Austin to discuss the integration of minimal common oncology data elements (mCODE) and leveraging FHIR API technology to accelerate significant improvements in cancer care and research. 

Gary first asks Steve to give listeners some background on CodeX. Steve credits the early conception of CodeX to the initial research his company MITRE conducted on standard health records. After recognizing the potential of their study, Steve’s group decided to focus on a more specific problem within healthcare, cancer. The goal was to develop a common language for cancer data sharing. His team worked with the American Society of Clinical Oncology to convene a group of experts across pathology, radiology, surgery, chemotherapy and other areas to identify 90 of the most important data elements needed to treat all cancer cases.  

Gary asks Jocelyn how CodeX and Da Vinci interrelate. Jocelyn explains that with FHIR, they are building communities who can pick up and use preexisting toolkits. However, it is specificity that is needed to make these powerful tools work. That’s where there is overlap. Da Vinci and CodeX use cases started to talk about where CodeX could build upon Da Vinci payer and provider frameworks. CodeX is extending the purpose by utilizing subject matter experts who know these workflows well. Jocelyn adds that she believes CodeX is amazing in many ways. It is focused on an area of healthcare that touches most all our personal lives, not just our professional lives. There is so much to be gained by unlocking and freeing this data. That is different from other accelerators.  

Gary asks Steve what types of people are engaged with CodeX. Steve says they start with the thought leaders. People like Aneesh Chopra, Dr. Monica Bertagnolli, and John HalamkaThese individuals not only have far-reaching networks who listen to them, but they also help develop the vision and unite communities.  

So how does CodeX get patients involved? Steve notes that one of the first use cases was patient clinical trial matching, which as is, is very inequitable process. CodeX works with the American Cancer Society to automate the collection of data from EHRs. The data is sent to matching services using mCODE who then send back structured clinical trials matching certain patient characteristicsPatients will then be able to search and prioritize results. 

Another use case addresses how do we conduct clinical trials out of data in the EHR. If you’re in a clinical trial, you receive high quality, structured data. Only 3-percent of cancer patients get in clinical trials, so if we get all the cancer patients’ data out of EHRS and into mCODE, now there are 100 percent of the cancer patients from which we can learn. We will have a massive amount of information from all cancer patients. When you bring the EHRs up to a higher level, not just the quality of data, but also in a standard language, this would allow the EHRs to be a source of patient data for many use cases.

Jocelyn notes that since FHIR makes data functionable and portable, there could be even more use cases developed. If we can make data move and be accessible, projects that previously could not get funded now become possibleThese accelerators bring interested people together to do the right thing.  

Gary asks how accelerators can come together to quicken the prior authorization process. Jocelyn says layering is key. The value that Steve’s team will bring to the table is to augment tools around prior authorization that have already been built. His group will look at their specific workflow, understand how it is different from a typical prior authorization and build upon that.  

Steve notes that many people affiliated with CodeX also work with Da Vinci, so they know the value it could provide if vendors adopt it. If we could share patient clinical pathways needed for prior authorization, it could speed up the process for patients who really need care. It would reduce back and forth on complex issues. There are so many promising things that can be done working with Da Vinci, provided we get the payers to table.  

Jocelyn points out that all the work we’re doing by freeing this data via APIs is meant to automate when possible. We want healthcare equity. No matter where you are physically located, you have the same access to the same type of treatment. The second piece here is transparency. There’s so much unknown when somebody is going through their initial cancer diagnosis. The ability to say, at a patient-specific level, here are what your options are and here is what your insurer will cover is game changing in helping that patient. We can make better care decisions if we can bring the two worlds of administrative and clinical together 

Gary asks what engagement we are seeing from vendors. Steve has seen a lot of interest from many different vendors. Jocelyn notes that these projects, at their core, are human-powered efforts. It’s the volunteers that get the work done. Steven has had great interest but in order to make the accelerators fully functional, it’s really about the participation of organizations 

Gary asks Steve what he would say to key decision-makers who could be involved in this work. Steve says everyone we talk to just gets it. We need to go beyond saying it’s great, let us know when it’s delivered. They need to see the value proposition in CodeX now and understand they can impact the direction it goes. You can get early insights into what is happening and work directly with vendors to let them know what your needs are. It’s all about getting the word out. We need people coming to the table.