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The continued delivery of high-quality cancer care and good patient outcomes relies on oncologists remaining current with efficient practice processes and knowledge of information technology. This year, the American Society of Clinical Oncology (ASCO) Annual Meeting—the premier venue for learning about cutting-edge cancer research—offers community oncologists expert, practical education through 10 sessions in the Practice Management and Information Technology track. These sessions are designed to help attendees meet the challenges of practicing in a health care environment marked by increased clinical priorities, sophisticated health technology, and decreased resources.
By addressing issues of particular concern to community oncologists, the Practice Management and Information Technology track helps fulfill the objectives of the 2007 Strategic Plan. One goal includes ensuring an “appropriate environment in which high-quality cancer care can be accessed and delivered,” with an objective toward that goal “to develop and disseminate practice management tools and materials to minimize potential risks and enhance the delivery of cost-effective, high-quality cancer care.”
This year's track includes the largest number of educational offerings since the 2003 debut of the Practice Management and Professional Issues track team within ASCO's Cancer Education Committee. Between 2004 and 2006, most of the sessions in this track were related to professional development, and a limited number of sessions were included in a separate Information Technology track. The combination of the two topics into one track allows for a greater breadth of topics. All the sessions in the track offer continuing medical education credit, and many also offer nursing and pharmacy contact hours. As an added convenience, the sessions in the track are concentrated in the first few days of the meeting, allowing community oncologists to take advantage of the sessions targeted to them with minimum amount of time away from their practices.
James L. Wade, III, MD, of Cancer Care Specialists of Central Illinois, served as the leader of the Practice Management and Information Technology track. He and the other members of the track team developed the topics for the sessions. Commenting on the practice management side of the track, Dr. Wade notes, “We had two broad themes: quality and implementation.” The result is a group of sessions led by an array of expert faculty and presented in a variety of session formats, offering different educational experiences and levels of interactivity (see sidebar). In addition, other sessions address patient safety, integration of clinical trials into practice, and advances in imaging. The information technology sessions provide information on electronic medical records and Internet resources, especially those developed by ASCO.
“There is a great divide between what we say about quality cancer care and how we actually achieve it. Several of the sessions will help address that challenge,” says Dr. Wade. Enhancing the quality of care is the backdrop for all the sessions in the track, and two sessions are devoted to measuring quality. “Good to Great: Measuring Key Practice Indicators and Improving Satisfaction from Your Practice,” focuses on the targets of clinical practice that can be measured, with a discussion of tools available to measure practice efficiencies and to assess patient satisfaction. John V. Cox, DO, of Texas Oncology PA, serves as chair of the session, which will be held on Saturday. “We will discuss the relationship between patient and referral physician satisfaction and present a model of management of efficiency in a multipractice setting,” says Dr. Cox.
Also on Saturday is “Measuring Quality of Care and Effecting Practice Improvement,” led by chair Joseph O. Jacobson, MD, of North Shore Medical Center (Peabody, MA). Dr. Jacobson was a member of the Steering Group for ASCO's Quality Oncology Practice Initiative (QOPI) and is Chair Elect of the ASCO Quality of Care Committee, established in 2007. QOPI is ASCO's oncologist-led, practice-based quality improvement program. “This is an important session,” notes Dr. Jacobson, “It will provide the framework for practicing oncologists to prepare for the coming surge of programs that will measure (and potentially reward) the care that we provide our patients.” Dr. Jacobson will present data from QOPI and provide information on participating in this project. The session also features a discussion of how ASCO clinical practice guidelines can improve the quality of care and an overview of the Physician Quality Reporting Initiative program for oncology.
“The second theme of the Practice Management and Information Technology track, implementation, addresses the nuts and bolts of how we make our practices more efficient,” says Dr. Wade. “These approaches run the gamut from the incorporation of physician extenders to industrial engineering challenges such as patient flow and financial management,” he adds. How to create and sustain a successful and efficient practice is the focus of the ASCO Practice Management Curriculum, which will be presented, in part, at an Extended Education Session on Friday. Established in 2007, the Extended Education Session provides an in-depth learning experience for Annual Meeting attendees.
The Practice Management Curriculum is a unique educational initiative developed by ASCO in 2004 (see sidebar). The curriculum provides practical strategies not only on practice efficiencies but also on adapting to changes in Medicare and in implementing health information technology. The time offered within the Extended Education Session allows for the presentation of three of the curriculum's six modules.
This 3-hour session is chaired by Douglas Blayney, MD, of the University of Michigan Comprehensive Cancer Center (Ann Arbor, Michigan). The first module, “Generating Practice Efficiencies,” emphasizes the importance of practice assessment and benchmarking. Attendees will learn how to perform a simple assessment to identify areas of cost-savings in their practice and will also learn about cost-savings and efficiency techniques to assist their practice as reimbursement models continue to change. The second module, “Health Information Technology in Practice” provides practical guidance about maximizing existing technologies as well as the decision making and implementation processes for new health information technologies.
The last module addresses the question of how to determine whether a practice is healthy. “Practice Check-up: Assessing the Financial Health of Your Practice,” is designed to help attendees use their practice management system to obtain necessary numbers to produce key indicators and then use those indicators to improve the management and financial health of their practice. Dr. Blayney will close the session with a discussion of management issues, tools for running a practice, and the role of the medical director.
While enhancing practice efficiency is necessary to the health of a practice, it also is needed to help address the crucial issue of a projected shortage of oncologists in the near future. According to the findings of the ASCO Oncology Workforce Study, by the year 2020, the demand for oncology services will have increased by 48% while the supply of services provided by oncologists will have increased by only 14% (Erikson et al: J Oncol Pract 3:79-86, 2007). Developing staffing patterns that capitalize on the expertise of various members of the health care team is a critical component of practice efficiency. The use of nonphysician practitioners not only helps to reduce the responsibilities of oncologists, freeing them to see more patients, but it also helps streamline workflow, resulting in high-quality care, increased patient satisfaction, lower costs, and increased revenue.
Integrating nonphysician practitioners into practice is the focus of the Education Session, “Workforce Integration: Effectively Utilizing Non-Physician Practitioners in Oncology Practice,” chaired by Therese M. Mulvey, MD, of Commonwealth Hematology/Oncology (Quincy, Massachusetts). Joining Dr. Mulvey in the session are three presenters who will speak from experience about the benefits and pitfalls of integrating nurse practitioners and physicians assistants into the workflow. One speaker, Georgia Decker, MS, RN, 2006-2007 President of the Oncology Nursing Society, will review the certifications that are currently available to nurse practitioners in the oncology field and will explore the ongoing role of ASCO and the Oncology Nursing Society in developing continuing education for both nurse practitioners and physician assistants in the oncology setting.
The Clinical Problems in Oncology session, “Recognition and Management of Medical Errors in Oncology,” will provide an interactive setting for oncology practitioners to learn about detecting, monitoring, and measuring medical errors in the office setting. This session format provides case-based panel discussions with attendee participation through audience-response technology. Alan M. Keller, MD, of Cancer Care Associates (Tulsa, Oklahoma) serves as Chair of the session.
One focus of the session is disclosure, and the panel will use case studies to illustrate the necessity of truth-telling in oncology and to discuss the use of a systematic approach to disclosure and alternative dispute mechanisms as a model for dealing with errors. Attendees can expect distinct perspectives on the topic because of the expertise of the panel, which includes Thomas H. Gallagher, MD, of the University of Washington Medical Center, and Carole Houk, JD, of Carole Houk International. Dr. Gallagher has carried out extensive research on the disclosure of medical errors, most recently studying the attitudes of patients, physicians, and trainees about such disclosure. Ms. Houk is the principal of a conflict-resolution firm that specializes in resolving disputes regarding unexpected adverse outcomes in health care provider settings. Together, the three members of the panel will help attendees learn how to evaluate techniques to reduce the potential for errors and to explore practices and procedures that can avoid errors.
ASCO has long advocated for enhanced integration of clinical trials in community oncology practice. Yet, many oncologists struggle with ways to integrate clinical trials research into their practice. “Optimizing Your Clinical Trials Program” focuses on the common obstacles to successful accrual of clinical trials. This Meet the Professor session, offered on Monday afternoon, will be co-led by Kim Margolin, MD, FACP, of City of Hope (Duarte, California), and Deborah Bruner, PhD, RN, University of Pennsylvania School of Nursing.
The limited attendance of the Meet the Professor Session allows for a more interactive setting than typical sessions, and attendees will learn how to develop strategies to optimize accrual at all points in the life-cycle of a clinical trial, from planning the study design to troubleshooting a nonaccruing trial. Dr. Margolin adds, “It is important for community oncologists to develop and maintain an understanding of the rationale for investigational questions, the methods used, the ‘trajectory’ of patients in such trials, and the communication opportunities between themselves and the research center to which they refer their patients.”
The Practice Management and Information Technology track also offers an innovative ASCO session that provides a forum for integrating new science with clinical aspects of diagnosis and treatment. This session type, a Clinical Science Symposium, includes the presentation of selected abstracts and expert discussion of how to apply the findings in clinical practice. The 90-minute session, “Imaging for the Oncologist: What We Can See and Not See,” is designed to alert oncologists about future trends in imaging applications for cancer treatment. Three studies on advances in the use of specially labeled positron emission tomography (PET) and computed tomography (CT) will be discussed. One study explores the use of fluorine-18 flurorerythronitroimidazole PET/CT imaging to detect tumor hypoxia in non–small-cell lung cancer; one describes the use of 11C-PD153035 PET/CT for the molecular imaging of epidermal growth factor receptor in patients with non–small-cell lung cancer; and one addresses the use of FDG-PET for improved selection of patients for resection of colorectal cancer liver metastases.
In her President's message in the November 2007 issue of the Journal of Oncology Practice, ASCO President Nancy Davidson, MD, noted, “While we focus on molecular technologies to advance the diagnosis and treatment of cancer, we must not lose sight of the need to harness emerging technology related to other aspects of cancer care. Just as we should become familiar with the best technology for gene testing, we should also become familiar with the optimum health information technology to enhance our practices.” Three sessions in the track will help oncologists gain a better understanding of how health information technology can enhance cancer research and patient care.
“Clinical research, in the form of multicenter clinical trials, is an enterprise at increasing risk in a time of shrinking federal dollars and increasing pressure on clinician time,” says John Crowley, PhD, of Cancer Research and Biostatistics (Seattle, Washington), and Director of the Southwest Oncology Group Statistical Center. Dr. Crowley serves as chair of the Education Session, “Integration of Electronic Medical Records into Clinical Research: Notes from Ground 0,” which will feature a discussion of the obstacles and opportunities that electronic medical records offer to clinical cancer research and strategies to help better design electronic medical records to support clinical research. “One focus of the session is to explore how we can become more efficient in the conduct of clinical trials by reusing data already gathered for other purposes rather than re-entering the same data into different systems,” says Dr. Crowley. The session will also provide an overview of ongoing initiatives for the standardization of case report forms and implementation of electronic case report forms and medical records.
The explosion in the amount of cancer-related information on the Internet has created challenges for oncologists. “The ability to be facile with finding information to care for patients is critical,” says L. Michael Glode, MD, of the University of Colorado Health Sciences Center (Denver, Colorado). Dr. Glode, who played an integral role in the initial development of ASCO's Web presence, serves as chair of the Education Session, “Using the Internet to Keep Current: From Podcasts to Virtual Meetings to RSS.”
“Patients continue to use the Web for medical information and present increasing challenges to oncologists in terms of helping them sift through the information efficiently,” Dr. Glode says. “Without being able to quickly deal with a patient's legitimate questions from the Internet, a physician risks being considered ‘out of touch,’ which indeed, he or she may well be.” The session, he adds, will help attendees learn “what is behind one of the most powerful medical search engines available, PubMed, and what other information is linked to that data. They will also learn how to find clinical trials more easily and will hear about managing a medical blog.” In addition, RSS feeds and new and ongoing offerings on ASCO's Web sites will be discussed.
ASCO's electronic resources are also the subject of the Meet the Professor Session, “ASCO Internet Resources for Your Practice,” led by Edward Ambinder, MD, of Mount Sinai School of Medicine (New York, New York). Dr. Ambinder will provide details about the broad array of ASCO resources and help attendees recognize how ASCO resources can improve information access and exchange between them and their patients. Dr. Ambinder notes, “Attendees will learn about the new personalization capabilities of ASCO.org; enhanced integration of all of ASCO's sites, including JCO, JOP, and cancer.net; and Web areas covering practice management, quality of cancer care, electronic health records, and practice guidelines.” He adds that ample time will be given for attendees to suggest ways to further enhance ASCO's Internet resources.
In summary, the Practice Management and Information Technology track at the ASCO Annual Meeting provides information on tools and strategies that are essential for delivering high-quality cancer care in a changing health care environment. Dr. Wade encourages community oncologists to take advantage of the sessions in the track, noting, “The track adds a day-to-day practical aspect to the educational experience of the Annual Meeting.”
The ASCO Practice Management Curriculum was developed in 2004 by experts in the oncology practice arena. The curriculum was designed to meet the needs of oncologists and other oncology professionals as they were forced to adapt to changes in the health care environment. ASCO makes the curriculum available to state/regional affiliates for presentation at their local meetings. Over the past 4 years, the popularity of the curriculum has grown, from three presentations in 2004 to 25 in 2007.
The original curriculum consisted of three modules, and the content has been expanded to now include six modules:
Presentation times range from 60 to 90 minutes, giving presenters ample time for interaction with attendees. The module on Medicare is updated yearly to provide practicing oncologists and practice administrators with the most current information. Because of this, the module is most effective when presented in the first quarter of the calendar year.
Oncologists who would like modules presented at their state/regional affiliate meeting should contact the ASCO Cancer Policy & Clinical Affairs Department by e-mail (email@example.com) or phone (703-299-1050).