The Obama administration is pushing for universal EMR adoption. Sounds like a good idea. But are EMRs ready for prime time?
Practice & Policy
In this issue of Oncology, Dr. Kilbridge details the incorporation of nontraditional outcome measures in the evaluation of cancer therapies—the importance of which is underscored by the passage of the sweeping healthcare reform bill that will alter the landscape of healthcare delivery for years to come.
Recently, the American Recovery and Reinvestment Act (ARRA) set aside $1.1 billion for comparative effectiveness research (CER) to investigate what healthcare strategies and interventions offer the greatest benefits to individual patients and the population as a whole. The Institute of Medicine has identified CER in cancer care as a high priority research focus for ARRA funding. The ability to measure quality of life will be central to CER in oncology because survival and disease-free survival do not adequately capture outcomes important to policy makers, physicians, and patients. There are two ways to measure quality of life: descriptive health status and patient preference weights (utilities). However, only patient preference weights can be incorporated into the economic analysis of medical resources and be used in the calculation of quality-adjusted life-years (QALYs). Some of the advantages and limitations inherent in measuring quality of life with descriptive health status and patient preference weights are discussed. Both types of measurements face health literacy barriers to their application in underserved populations, an important concern for CER in all medical fields.
Kilbridge correctly points out that comparative effectiveness research (CER) does not require cost data. It should also be pointed out, however, that the composition of the quality-adjusted life-year (QALY) gain of one intervention over another—whether the QALY gain is achieved mainly in the dimension of longevity or in the dimension of quality of life—has real consequences in terms of comparative costs of the interventions. Basically, a longevity increase entails additional consumption costs and additional labor earnings, essentially negative costs, during the extended life that should be included in the “cost” of an intervention.[1-3] Because labor earnings tend to be negligible relative to consumption costs toward the end of one’s life, due to sickness or retirement, failure to incorporate consumption costs and labor earnings into the comparative costs of two interventions generates a bias in favor of the intervention with the larger longevity effect.
US Oncology, Inc, announced the launch of iKnowMed—an oncology-specific electronic health record (EHR) system designed by oncologists for oncologists—to the open market.
Eliminating cancer disparities—not only for racial/minority groups but for all underserved populations—must be a priority for those involved in cancer care. For individual practitioners, the first step in addressing disparities is accomplished through understanding the possibility that disparities exist in varying depth and complexity for each racial or ethnic minority patient.
Two cancer-related issues-evidence-based cancer screening and
pain control in advanced cancer-are among 20 priority areas
that an Institute of Medicine (IOM) committee has urged public
and private organizations to focus on as a way of transforming health
care in the United States. Goals regarding screening, especially for
colorectal and cervical cancer, the report said, are "to increase the
number of people who receive screenings and to provide timely followup."
Regarding pain control in patients with advanced cancer, the
committee urged efforts to "emphasize cooperation in protocols across
care settings, advance planning for changes in settings, as well as
heightened pain, and public education regarding the merits of opioid
medications in this area."
Confronted with essentially stagnant budgets in coming years, the
National Cancer Institute (NCI) is initiating an unprecedented
effort to solicit the views of the cancer community about setting
its future research priorities. NCI wants greater input from its own staff and
advisory groups, cancer researchers and clinicians, advocates, and other
groups that fund cancer research as it decides where to focus its future
efforts, according to a briefing document provided to the National Cancer
Advisory Board (NCAB) subcommittee on budget and planning.