How HealthIT Can Change the Clinical Trial Landscape

April 17, 2017
Moe Alsumidaie

The adoption of electronic health records by hospitals and providers has increased engagement in Health Information Technology (HealthIT) activities. Nora Belcher of the Texas eHealth Alliance speaks on how HealthIT will change the pharma landscape for drug development.

There has been a lot of activity in the healthcare sector, as hospitals and healthcare providers are adopting electronic health records (EHR), and are increasingly engaging in HealthIT initiatives. With this changing infrastructure, biopharmaceutical enterprises can leverage these innovations in order to execute studies more efficiently, widen patient access, and enhance patient centricity. Nora Belcher, executive director at the Texas eHealth Alliance, recently spoke at eXl’s CROWN Congress on how Health Information Technology (HealthIT) will change the clinical trials landscape. In this interview, Nora will elaborate.

Moe Alsumidaie: What forces are driving HealthIT adoption?

Nora Belcher: There are three major forces. The first is the transformation of our access to technology. Patients want to do everything on their cell phones, even seeing their doctors. We have moved away from paper in many ways and yet, in the healthcare system, we still make people fill out paper forms on clipboards at every visit. Patients are frustrated with this, especially when it’s combined with the inefficiencies of the system, like having to spend three hours waiting in a doctor’s office for a visit. There is a lot of progress that can be made using HealthIT to improve the patient experience.

Secondly, we are all set to complete hospital adoption of electronic medical records, as 80-90% of hospitals and their physicians that take Medicare and Medicaid are using those tools now. The providers have had to move towards digital tools, and are starting to understand how that works to support the move towards value-based purchasing.

The third piece is the payer piece. Payers do not want to just know how many of something they bought, they want to know if it was any good or of any value to the patient. You cannot do value-based purchasing without HealthIT because you need to have data and infrastructure. This pressure from one side, and the consumer demand pressure from the other side, has made HealthIT a hot initiative in the last few years.

MA: Who will be benefiting from the use of HealthIT?NB: In a perfect world, everybody is winning when HealthIT is working. An Institute of Medicine study a few years ago looked at the billions of dollars that we waste in the healthcare system every year, and how HealthIT tools can help close these gaps and address some of those inefficiencies. We need to ask if we are using the technology to best improve the health care system for patients. We are not all the way there, but we are making great strides in being able to share data and deliver services in patients’ homes.

People don't think about healthcare until they are sick. By the time you realize you have the flu, for example, it is oftentimes too late to seek a cure or prevent it from happening. With tools, such as HealthIT, patients will be able to not only know whether they received a flu vaccination, bualso be able to stay at home with remote visits with their physician and prevent further spread of the disease. In a few years, telemedicine will be just known as medicine, and patient outcomes will be improved through delivering preventative services in an more automated fashion. That is when you will know that HealthIT has been fully integrated into the ecosystem.

Some payers worry that some of these tools are going to increase utilization without delivering meaningful results. The HealthIT community has to be mindful that, when talking about the benefits, we are careful not to overuse things and that our tools are being used in a way that makes sense for the patients and the providers. Another important facet to be considered is having one platform for doctors to use, because they don’t have time to look at eight different platforms to get an overview of their patient’s health.

MA: How can bringing HealthIT improve the clinical trial process?

NB: The ability to share patient records, deliver healthcare virtually and collect data remotely, whether it is telemedicine or using integrated clinical records, will help improve the process. One of the challenges of clinical trials is getting patients to the trial site. At MD Anderson in Houston, we have been using telemedicine for a long time to support survivorship. There are concerns about putting cancer patients in a car for 3 hours to take them to a clinical trial site. One of the pieces of the future of clinical trials is the ability for the patient to stay with their home provider and not have to travel to the clinical trial site, and using telemedicine and wearable technology to collect vitals which can be used for ongoing monitoring. The patient could go to their local general practitioner or request a remote nurse if they need a study visit blood draw. Technology will make it easier to recruit patients into the trials, and we will have more data to match patients to the trials. The more we automate data sharing for clinical trials both inside and between the EHRs, the easier it will be for providers to participate without worrying about the added workflow burden. Automation, virtual technology and big data are all going to play a role in the future of clinical trials.

When it comes to data access and data quality, HealthIT can have a tremendous impact on potential trial sites. For example, paper charts have many issues; you cannot read them, they tend to be inaccessible, and they have missing information. In the HealthIT industry, we are building networks between digital platforms There are two majorinitiatives, one called Carequality and another called CommonWell that are connecting different EHR systems to share patient data. It will be relatively transparent to the providers, and it will offer a standard way for a hospital’s system to talk to a physician’s system. Having immediate access and standardized ways of communicating patient information is going to be very important in clinical trials, because you want your source data to be consistent no matter where the patient is interacting in the system.

MA: What will a future clinical trial look like?NB: The clinical trial of the future will bring studies to patients who cannot or do not want to leave their home towns or even their homes. Someone who has a brain tumormay currently have to travel a couple of hours back and forth to participate in the clinical trial. Soon, video conference equipment will be in the home, the physician visits will be virtual and the peripherals needed to take measurements may even be taken in virtual reality. Medications may be delivered by drones. The cata will be a part of an ultra large scale system using pattern recognition to move faster through the data. Future trials are going to use technology and data to become optimized to the patient, and feel familiar in terms of the patients’ regular behaviors. That is going to increase participation and decrease the burden on the patients participating in the trial because they will be closer to home and be more comfortable. Once we are able to digitize healthcare, we will be able to run studies more efficiently because we will have better data access.

Moe Alsumidaie, MBA, MSF is Chief Data Scientist at Annex Clinical, and Editorial Advisory Board member for and regular contributor to Applied Clinical Trials.

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