Digitally Enabled Access

To drive equitable patient access to cancer care and clinical trials, your health system can leverage digital health solutions to:

Expedite Time to Diagnosis & Treatment
Expand the Care Footprint
Extend Clinical Trial Opportunities
Bridge the Digital Divide

Objective 1: Expedite Time to Diagnosis & Treatment

Digital Solution Value Proposition: AI-Enabled Screening & Diagnosis Solutions to Expedite Time to Treatment

AI-enabled screening processes can expedite time to diagnosis and treatment and have resulted in overall cost savings to health systems and patients.

How to deploy: Approaches to AI/ML Deployment

Natural language processing algorithms can be used to scrub structured and unstructured EHR data to flag at-risk patients eligible for screening.

More here for a technical basis to support this approach.

FDA-cleared deep learning algorithms can be used to support cancer imaging and improve detection and characterization.

Next-generation sequencing can be used to digitize pathology workflows and guide pathologist review.

Digital Solution Value Proposition: EHR-Embedded Solutions To Expedite Time to Treatment

EHR-embedded solutions can address inefficiencies and breakdowns in the specialist referral process. They also act as clinical decision support for providers in developing treatment plans to enable equitable access to guidance-concordant precision care.

How to deploy: Approaches to EHR- Embedded Solution Deployment

Automated referral solutions are portable and can be launched directly from the EHR.

They support referral coordinators by extracting relevant patient and referring provider data and tracking patient encounters.

Traditional approaches to clinical practice guideline deployment results in approximately half of all patients not receiving recommended care.

CDS solutions have shown promise in predicting therapeutic response and have proven effective in replicating multidisciplinary cancer team treatment decisions. More here for an example of an off-the-shelf EHR-embedded clinical

Objective 2: Expand the Care Footprint

Digital Solution Value Proposition: Virtual Care to Expand the Care Footprint

Virtual care platforms facilitate access to care outside of the health system footprint, widening the health system catchment and meeting patient preferences for care that integrates with life.

How to deploy: Approaches to Virtual Care Deployment

This approach facilitates remote expert reviews of cancer cases. It also supports the development of treatment plans by a specialist provider to be executed by a general oncologist closer to the patient’s home

Telehealth programming is especially beneficial for patients in rural communities, who are disproportionately impacted by the indirect costs of cancer care, due to reduced need for travel.

City of Hope Case Study: AccessHope and Expanding the Care Footprint To Extend the Survival Advantage

Case Study: City of Hope

AccessHope and Expanding the Care Footprint To Extend the Survival Advantage

The Challenge: There is a significant survival advantage for the 20% of cancer patients treated at NCI-designated comprehensive care centers.

The Approach
Program Workflow
Resource Commitments
The Results

AccessHope provides remote expert case reviews for complex cancers automatically via claims data, or by member request, as well as ongoing connection to knowledge and support throughout a patient’s cancer journey.

Staff Requirements

Measurements of Effectiveness

Technology Requirements

Other Considerations

Clinical improvements

Cost Savings

Objective 3: Extend Clinical Trial Opportunities

Digital Solution Value Proposition: Patient-Centric Digital Solutions to Extend Clinical Trial Opportunities

Direct-to-patient solutions, AI/ML algorithms, and remote patient monitoring can be used to:

How to deploy: Approaches to Patient-Centric Solution Deployment

The use of natural language processing software for automated trial matching is nascent but promising for increasing the number of patients screened and connected with clinical trial opportunities.

Systems can leverage end-to-end DCT platforms to support remote patient monitoring and at-home clinical trial participation.

This can reduce barriers to participation, expand the number of clinical trials opened, and expedite trial conduct. There are several DCTs platforms available on the market – check our solutions catalog for more information.

Patients and caregivers consistently report gaps in provider awareness and their own knowledge of clinical trial opportunities.

Health system providers can connect patients with free, third-party solutions containing information about clinical trial opportunities

Atrium Health Levine Cancer Case Study: Digital Genomics Program and Extending Access to Clinical Trials

Case Study: Atrium Health Levine Cancer

Digital Genomics Program and Extending Access to Clinical Trials

The Challenge: Lack of (or lags) in molecular testing prevent patients from receiving targeted immunotherapy or being matched to molecularly-driven trials.

The Approach
Program Workflow
Resource Commitments
The Results

The Approach: To implement clinical genomics testing across a multi-state oncology group, Atrium Levine Health provided centralized, standardized support to providers and integrated digital solutions with clinical workflows to decrease known barriers to use (e.g. lack of training, physician confidence, gaps in decision support, high workload, EHR alert fatigue, cost to patient)

The Approach: Atrium Levine Health integrated the testing program with clinical workflows, increased patient connections to financial assistance, and provided real-time decision support to clinicians by:

The Approach:

Standardizing and integrating order sets, including a financial assistance application, into clinical pathways and the EHR.
Standardizing and centralizing the workflow for obtaining specimens, sending for testing, and tracking progress of the process to ensure rapid turn-around-time and clinical implementation of test results.
Orders were automatically sent to a centralized genomics team, teams performing biopsies to obtain specimens for sequencing, and a genetics team to coordinate somatic/germline testing.
Ensuring results and reports from third-party diagnostic companies were sent electronically, imported into a custom, in-house developed app. to form summary report and merged with clinical data (e.g., diagnosis, prior treatments, lab results, etc) to provide clinical trial matches in real-time pushed to EHR.
Integrating a quick link was into the summary report, clinical pathways, and EHR so that providers could obtain Molecular Tumor Board (MTB) review with a simple mouse click during clinical care for patients.

Staff Requirements

Technology Requirements

An EHR-embedded application for treatment and trial matching to genomics results
-Developed using software typically available with minimal additional cost at most institutions : MS suite; Power Apps, Power BI, SharePoint, SQL Server, Azure, Data factory and Databricks
API/HL7/Secure File Transfer Portal /MS Data factory for data transfer
Updates of new drug approvals and clinical trial enrollment status made available in trial matching application

Improved use and ease of access to genomic testing for patients and providers

Generated substantial improvements in clinical trial accrual

Promoted equity in access to cancer treatment

Reduce patient financial toxicity

Objective 4: Bridge the Digital Divide

Increasing Solution Uptake by Bridging the Digital Divide

The Digital Divide describes unequal access to the technology used to support digitally-enabled care and is often linked with lower socioeconomic status, insurance status, and low health literacy.

Patients impacted by the digital divide, especially those with lower English proficiency, need additional health system support for digital health solution use.

How to deploy: Approaches to Bridging the Digital Divide

The use of digital health solutions in objectives 1-3 support improved access to care but is impacted by The Digital Divide.

Health systems must account for this in solution deployment.

Convene virtual health task forces to assess and address barriers to patient uptake of virtual health services. Equip these task forces with the following resources to assess and enhance patient digital health literacy and readiness.
Opt for vendors that offer materials in multiple languages and/or translation services for real-time translation during telehealth visits.
Develop outreach and training materials for patients with lower health and technology literacy who are less likely to use digital solutions.
This checklist for inclusive patient engagement can help your system ensure that all patients are supported via these materials.

These efforts might include providing one-on-one audio or visual education about how to download a mobile application, access the patient health portal, create email accounts, and engage in”practice” visits.
Ensure comprehensive access features for all deployed solutions, including audio and visual supports for those with disabilities.

Defining Success & Choosing Solutions

Key performance indicators (KPIs) can be used to measure successful digital health solution implementation. Select KPIs that:

Are measurable

Align with existing data workflows

Work within your system’s existing strategy to improve patient access

Key Examples:

Access Example Solutions

Here is a guide of existing solutions to expedite time to diagnosis and treatment; support the provision of high-quality virtual care; and extend clinical research options.