In Absentia

Tags

cancer, digital media, integrated medicine, integrative oncology, Just Oncology, oncology, richard just md, social media

By Gregg A. Masters, MPH

When I first approached Dr. Just on his potential interest in the emergence of social media in healthcare in general and medicine in particular, we engaged in conversations that generally tethered to a contribution to a ‘legacy’ theme.

Reflecting on a now 40 year career in community based medical oncology he was thinking about winding down his participation in a full time practice while passing on the deep wisdom and insights developed over the decades.

Considering the explosion of digital media platforms and capabilities, and the low hurdle rate to participate via this medium this consideration was rather timely.

The first order of business was to brand that voice and craft a social media ‘presence’.

As I reflected on his last name ‘Just’, and saw a double entendre opportunity to conflate ‘just’ with ‘oncology’ – I thought how perfect! Lets brand you as ‘JustOncology.com’. Since in this context ‘just‘ could mean ‘Dr Just’, or solely focused on oncology, or even just in the sense of ‘equity’ or fairness in oncology care. In all cases, the branding expression and focus was clean and consistent with his interest to write, speak and counsel others on the journey.

So we created the blog JustOncology and twitter handle @JustOncology (though he principally tweets via @chemosabe1) and shortly thereafter launched the radio show ‘this week in oncology’.

As noted in the masthead above Dr. Just writings would reflect on ‘health, illness & evidence based medicine’. An intentionally broad brush tapestry that included everything from his personal health encounter with heart surgery, the move into value based pricing for oncology services, oncology ACOs, seemingly interminable encounters with EHRs that actually work for the practice, practice mergers, partner relations and the most recent shift into ‘integrative oncology’ which has literally taken him offline for almost a year – at least as a principal contributor to this blog.

So as his partner, de-facto editor and co-contributor, let this post call attention to two projects that fit squarely into the ‘legacy’ theme and Dr. Just’s valuation of and advocacy for truly ‘patient centered care’.

Meet @TumorBoard aka TumorBoard (dot) com and CancerCenter (dot) TV – both projects in the incubator of ideas in search of funding support.

A little history on @TumorBoard includes the following introduction from our concept paper.

Context

A centerpiece of the American College of Surgeons’ Commission on Cancer (COC) standards to accredit hospital based cancer programs is a multidisciplinary conference (aka ‘tumor board’) of doctors and other cancer specialists, who meet on a regular basis to collaborate in the diagnosis and recommend treatment options for cancer patients. An active and vibrant tumor board is an essential consideration in the accreditation process. For further context see the Commission on Cancer’s ‘Cancer Program Standards 2012, Version 1.1: Ensuring Patient-Centered Care.’

As defined by the National Cancer Institute (NCI), a ‘tumor board’ is:

A treatment planning approach in which a number of doctors who are experts in different specialties (disciplines) review and discuss the medical condition and treatment options of a patient. In cancer treatment, a tumor board review may include that of a medical oncologist (who provides cancer treatment with drugs), a surgical oncologist (who provides cancer treatment with surgery), and a radiation oncologist (who provides cancer treatment with radiation). Also called multidisciplinary opinion.

Once a popular collegial if not ‘social’ venue to network and learn from one’s peers, periodically present or consult on cases, possibly earn CME credit, if not grab an occasional meal, tumor board has unfortunately lost some of its attraction and ‘gravitas’.

Increased practice complexity, misaligned financial incentives, declining reimbursement and growing demands on physician time, are some of the obstacles resulting in declining physician participation in traditional hospital based tumor boards. Yet few other comparable multidisciplinary, peer based clinical forums outside of mature integrated delivery systems or academic medical centers have the potential to enable the integrated practice of collaborative, coordinated and evidence based community cancer care.

Realizing the Promise of Multidisciplinary Cancer Care

Many assume multidisciplinary care is better care, since it engages multiple minds in the care process, yet in ‘The Need for Assessment and Reassessment of the Hospital Cancer Conference‘, in the Annals of Surgical Oncology, October 2009, Frederick L. Greene, MD, identifies the traditional weakness of many hospital based tumor boards:

most of these [tumor board] conferences…are based on a “show and tell” mentality rather than serving as treatment-planning conferences utilizing the expertise of the participating multidisciplinary experts….

In other words, traditional hospital based tumor boards have not yet fulfilled the promise of better care or improved outcomes as a result of the assumed value add of multidisciplinary engagement in cancer diagnosis and treatment. Apparently, business as usual ‘silo-ed’ medicine remains embedded in the care process even in the midst of what appears to be multidisciplinary consideration.

Why @TumorBoard?

@TumorBoard intends to uniquely address the convergence of several macro trends:

• The high cost of cancer treatment and parallel shift of a greater share of the total cost burden on to a resource constrained and often health literacy challenged patient.
• A heightened awareness of the need for increased clinical integration and care coordination across an otherwise silo-ed and discontinuous portfolio of specialties.
• Formal recognition that the upside of the multi-disciplinary engagement of cancer specialists (i.e., tumor board), has neither realized nor fulfilled its collaborative promise (see: Tumor Boards (Team Huddles) Aren’t Enough to Reach the Goal).
• Emergence of an informed and engaged ‘e-patient’ (witness the launch of SmartPatients).
• A nascent yet growing pool of technology savvy, patient-centric cancer specialists who value peer based collaborative multidisciplinary care with active engagement of the patients under their care (See e-patients and the Society for Participatory Medicine).

For more information, download the TumorBoard concept paper via tumorboard_description_v1.5.

 

 

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What Is Cancer?

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accountable care, best practices, evidence based care, health, innovation, jay walker, mind the gap, oncology, stephen wilkins, tedmed, wellness

By Gregg A. Masters, MPH

It’s been a while since Dr. Just has been able to put pen to pad and update you on his journey (and their is lots to tell from group mergers to a continuing drama with EHR implementation) into social media and a ‘transition’ to full to part time practice in a multi-site community oncology practice. More soon from Dr. J aka @chemosabe1 – at least I’ve been told.

Meanwhile, below is a clip producer by Jay Walker the curator of TEDMED and noted Professor of Medicine and Engineering at the University of Southern California Keck School of Medicine and Viterbi School of Engineering oncologist David B, Agus, MD well worth a view!

Also, we had a great session today on ‘this week in oncology’ chatting with Stephen Wilkins the publisher of ‘Mind The Gap’ blog. You can listen here.

 

Big Data, Government and Cancer Research: A Benefit for Patients?

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big data, cancer, clinicaltrials, dan munro, evidence based medicine, genomics, innovation, medicine, oncology, social media

By Gregg A. Masters, MPH

On the Wednesday, July 24th, 2013 broadcast of This Week in Oncology at 2PM Pacific/5PM Eastern our special guest is entrepreneur, social media thought leader and Forbes Contributor Dan Munro aka @danmunro.

Dan recently penned a piece for Forbes titled: ‘Big Government Opens Big Database For Cancer Research‘

This catchy headline caught my attention since part of our mission at This Week In Oncology is to eliminate the esoterica from ‘oncology-speak’ and to present the significance of the discoveries, trends and developments in the cancer care and dignostics in plain english for more general consumption.

Much progress has been realized in medica oncology of late with a fair amount of the promisesd upside of ‘personalized [or individualized] medicine’ often pointing to better outcomes via more targeted treatment of specific tumors based on their unique genetic signature.

So called ‘big data’ is in the news as ubiquitous technology, connectivity, the declining costs of massive data dragnets and disease specific mashups affords insights previously inaccessible to reseachers, clinicians and others interested in the diagnosis and/or treatment of oncology.

We’ll get Dan’s takes on his piece and see how he sees the confluence of these trends coming together for the benefits of patients.

To listen live or via archived replay, click here.

Tumor Board: Is There Value in Multidisciplinary Case Consideration?

Tags

digital health, evidence based medicine, health, innovation, oncology, participatory medicine, tumor board

By Gregg A. Masters, MPH

When the American College of Surgeons Commission on Cancer picked up the accreditation football and in the spirit of the then Joint Commission on Accreditation of Hospitals ‘Joint Commission‘ began the promulgation of specific standards for the accreditation of aspiring ‘cancer programs’, at the center of this consideration was the multidisciplinary cancer conference also known as ‘tumor board.’

Via these standards there were both structural and certain process considerations to meet, but the underlying assumption or zeitgeist of the value proposition – better cancer care – was that ‘multidisciplinary’ engagement of cancer specialists in the diagnosis and treatment of cancer patients would produce superior outcomes.

Then in October of 2012 Keating et al published a study titled: ‘Tumor Boards and the Quality of Cancer Care’. While somewhat dated (interval 2001-2004), and not generally representative of community oncology practices per se (the sample was sourced in the Veteran’s Health System), the conclusions are none-the-less a compelling call to objectively demonstrate long held assumptions of the benefits of tumor board ‘collaboration’.

The background context for the study was noted as follows:

Despite the widespread use of tumor boards, few data on their effects on cancer care exist. We assessed whether the presence of a tumor board, either general or cancer specific, was associated with recommended cancer care, outcomes, or use in the Veterans Affairs (VA) health system.

While Keating et al concluded as follows:

We observed little association of multidisciplinary tumor boards with measures of use, quality, or survival. This may reflect no effect or an effect that varies by structural and functional components and participants’ expertise.

Following publication a series of pieces appeared in the professional press with eye catching headlines such as:

‘Tumor Boards May Not Really Impact Cancer Care‘, and ‘Little association of multidisciplinary tumor boards with effects on cancer care‘, but the title that grabbed our attention was an opinion piece in response to the Keating study offered by Douglas W. Blayney, MD, Stanford Cancer Institute, Stanford School of Medicine, titled: ‘Tumor Boards (team Huddles) Aren’t Enough to Reach the Goal‘.

Blayney details his reasoning and observation while cautioning against the potential ‘knee jerk’ over reaction by some to the Keating conclusions and ‘market aftermath’ as follows:

Tumor boards have too long a history for them to be easily
abandoned. Much like the “hurry-up” offense changed the conduct of huddles in football, tumor boards should also adapt to the changing times and technology. In the system studied by Keating et al. (1), there are only huddles and no feedback loop. Their measurement work provides a reason to change tumor board conduct.

On ‘This Week in Oncology‘, May 22nd, 2013 at 2PM Pacific/5PM Eastern Dr. Blayney is our very special guest. We’ll dive deeper into his thought process, rationale and recommendations to tweak the tumor board formula via technology and other process adds, to perhaps better align this important multi-disciplinary experience with improved patient outcomes.

‘You Don’t Know Jack’ by Morgan Spurlock

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cancer, clinical trials, digital media, evidence based medicine, health, innovation, Intel Science Fair, jack andraka, oncology, participatory medicine

By Gregg A. Masters, MPH

But you should! Get to know him here:

Earlier today we just finished chatting with Jack Andraka on This Week In Oncology. One of my favorite lines from the conversation is quoted below, Jack refers to the high school biology class as the:

absolute stifler of innovation

From which he none-the-less associates inspiration for his scientific inquiry. Suffice it to say, Jack was neither encouraged nor challenged by the curriculum, and found other ways to engage his mind and curiousity.

@IBMwatson and the Future of Oncology Care

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cancer, digital health, FutureMed, genomics, health, IBM Watson, Marty Kohn MD, oncology, wellness

By Gregg A. Masters, MPH

Another of the highlights of FutureMed 2013 was the track on ‘the future of oncology’. In addition to the promise of favorably impacting both the early diagnosis and thus treatment outcomes for pancreatic cancer via the discovery of Jack Andraka, Ronald Levy, MD of Stanford wove a beautiful narrative of hope and promise that might best be represented by the following quote:

My dream is to get rid of chemotherapy and do it with the immune system..

Dr. Levy’s concluding slide outlined the visioned future for oncology:

Meanwhile one could not be but immensely inspired by the clinical decision support and powerful AI platform demonstration detailed by Marty Cohn, MD. Witness ‘IBM Watson Demo: Oncology Diagnosis and Treatment’ developed in conjunction with Memorial Sloan-Kettering Cancer Center:

A Conversation with Jeff Hall, PhD, Vice President of GenOptix

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biomarkers, cancer, genomics, GenOptix, medicine, novartis, oncology, pharma, social media

By Gregg A. Masters, MPH

On Wednesday’s broadcast of This Week in Oncology our guest Dr. Jeff Hall makes his second appearance on the show. The topic was ‘Biomarkers: their emerging clinical significance in the diagnosis and treatment of cancer’.

Dr. Hall has over 20 years of experience in the life sciences industry, and is currently the Vice President of Clinical Education at GenOptix. He holds a BA in Biology and Chemistry from UC Santa Cruz and a PhD in Biochemistry from UC Berkeley. Dr Hall was the first author on the landmark 1990 Science paper describing the location of BRCA I on chromosome 17q.

GenOptix is division of Novartis. For broader context see webcast by Novartis CEO Joseph Jimenez to the JP Morgan Healthcare conference, and for the deck click here.

To listen to archived replay of broadcast, click here.

Is It Safe?

Tags

cancer, digital media, ehr, emr, innovation, internet security, mat honan, oncology, social media

By Richard Just, MD

When I read William Goldman’s book “The Marathon Man” years ago, I recall the evil Nazi dentist with drill in hand (played by Sir Laurence Olivier in the subsequent movie) hovering over the un-anesthetized Dustin Hoffman strapped to a chair asking the question: “Is it safe?” Of course, Hoffman didn’t know. So when Olivier turned on the drill and Hoffman started screaming, everyone in the theater identified with his pain. I still get chills when thinking about it.

In previous blog post here, I’ve described the pain I experienced when we transitioned from paper charts to electronic medical records. Certainly not as intense as having dental work without anesthesia, but agony just the same. Well guess what! Now we’re transitioning to a new EMR. In many ways, our pain level has increased from 6/10 to 9/10.

I interviewed Casey Quinlan, of Might Casey Media, a very astute commentator on healthcare in general and cancer care specifically, on This Week in Oncology last Wednesday. The “Mighty Casey” made several cogent observations on EMR’s, but, we  really didn’t address the question of security. In the December 15-16, 2012 issue of the Wall Street Journal, Ellen E. Schultz  wrote an article entitled: “How Safe Are Your Medical Records?” Two pieces of legislation are cited:

The first is the Health Insurance Portability and Accountability Act (HIPAA) which “allows health-care providers to disclose medical records without a patient’s consent when the information used is for treatment, payment and ‘health-care operations.’ Providers are supposed to exchange only relevant information, but they commonly transfer a patient’s entire file, which is easier than separating the pertinent records.” In the same manner, protection can be lost for psychotherapy records if they are co mingled with other medical records.

Second is the American Recovery and Reinvestment Act of 2009 which “prohibits the unauthorized sale of medical records, requires that data be encrypted and mandates that individuals be notified of security breaches. It is too soon to say how effective these rules will be.”

Drilling down to the core problem is Mat Honan’s original article “How Apple and Amazon Security Flaws Led to My Epic Hacking” and follow-up video entitled “Mat Honan Hacked and Digitally Destroyed” he describes an “epic hack” that destroyed his entire digital life in 1 hour. Having been the victim of a phishing expedition, a minor nuisance compared to his experience, I know how it feels to have your identity stolen.  After researching how and why hacking has become more problematical, Honan concludes: “The age of the password has come to an end; we just haven’t realized it yet. And no one has figured out what will take its place.” He continues: “The ultimate problem with the password is that it’s a single point of failure, open to many avenues of attack. Two factors should be a bare minimum.” This creates the dilemma that if the password is too simple and obvious, it’s a no-brainer to crack; if it’s too complex and obscure, the password is hard to remember. And, we are advised never to write passwords down. Why am I not surprised that the most common password used is, in fact, “password”, and second is “123456”?

Honan provides a helpful Dos and Don’ts list to survive the “password apocalypse”:

“DON’T:

1. REUSE PASSWORDS. If you do, a hacker who gets just one of your accounts will own them all.
2. USE A DICTIONARY WORD AS YOUR PASSWORD. If you must, then string several together into a pass phrase.
3. USE STANDARD NUMBER SUBSTITUTIONS. Think P455wOrd is a good password? NOp3! Cracking tools now have those built in.
4. USE A SHORT PASSWORD-no matter how weird. Today’s processing speeds mean that even passwords like “h6!r$q” are quickly crackable. Your best defense is the longest possible password.

DO:

1. ENABLE TWO-FACTOR AUTHENTICATION WHEN OFFERED. When you log in from a strange location, a system like this will send you a text message with a code to confirm. Yes, that can be cracked, but it’s better than nothing.
2. GIVE BOGUS ANSWERS TO SECURITY QUESTIONS. Think of them as a secondary password. Just keep your answers memorable. My first car? Why, it was a “Camper Van Beethoven Freaking Rules.”
3. SCRUB YOUR ONLINE PRESENCE: One of the easiest ways to hack into an account is through your e-mail and billing address information. Sites like Spokeo and WhitePages.com offer opt-out mechanisms to get your information removed from their databases.
4. USE A UNIQUE, SECURE EMAIL ADDRESS FOR PASSWORD RECOVERIES. If a hacker knows where your password reset goes, that’s a line of attack. So create a special account you never use for communications. And make sure to choose a username that isn’t tied to your name-like m****n@wired.com so it can’t be easily guessed.”

So, the answer to the question: “Is it safe?” is an emphatic NO. Honan concludes that online identity verification will not be a password-based system in the future, any more than our system of personal identification will be based on photo-ID’s. But, passwords may still be involved as just one part of a multifaceted process.

Clinical Cancer Advances 2012 via @ASCO

Tags

cancer, evidence based medicine, innovation, medical education, oncology, participatory medicine, physician, social media, twitter

Now in its eighth year, Clinical Cancer Advances 2012 was developed under the guidance of an 21-person editorial board of leading oncologists, overseen by Executive Editors Nicholas J. Vogelzang, MD and Bruce J. Roth, MD.
Each year, the American Society of Clinical Oncology conducts an independent review of advances in clinical cancer research that have the greatest potential impact on patients’ lives.

This year’s report, Clinical Cancer Advances 2012: ASCO’s Annual Report on Progress Against Cancer, features 87 studies, 17 of which were designated as “major” advances by the report’s 21-person editorial board.

The large number of advances featured in this year’s Report affirms the remarkable payoff of national investments in clinical research on cancer prevention, screening, treatment and quality of life for patients with cancer.

For complete report, click here.

Get to Know ‘Chemotopia’

Tags

cancer, chemotherapy, chemotopia, evidence based medicine, integrative oncology, Just Oncology, medical education, oncology, social media, startUp health, twitter

By Gregg A. Masters, MPH

On the Wednesday, November 7th 2012 broadcast of
‘This Week in Oncology‘ we chatted with medical oncologist, integrative cancer care specialist, and ‘serial entrepreneur’ Steven Eisenberg, D.O., co-founder of StartUp Health Academy’s transformer entry ‘chemotopia‘aka @chemotopia on Twitter.

Disclosure: Dr. Eisenberg is a partner with Dr. Just in Cancer Care Associates for Research and Education (CCARE).

We spoke with Dr. Eisenberg about his most recent entrepreneurial interest known as ‘chemotopia’, where the tagline is:

getting through chemotherapy, together

To listen to the broadcast, click on the show logo below: