Revolutionizing the EHR Landscape Through Integra Connect`s Solution for Oncology

Mr Bessette: Hello everyone and welcome back to the Journal of Clinical Pathways podcast. My name is Zack Bessette, and I’m the associate editor of the journal, and I’m joined by my colleague Amanda Del Signore, the managing editor of the journal.

With us today is Dr Charles Saunders, MD, the chief executive officer of Integra Connect, to discuss the company’s latest EHR Solution for Oncology, the only solution designed to capture, integrate, and provide data at the point of care to help match patients with optimal treatments and manage their progress over time.

Thank you for joining us today, Dr Saunders!

To begin, can you detail Integra Connect’s EHR Solution for Oncology? How is it different from the competitor solution and what makes it the optimal technological solution for practices needing IT support for their specific workflows?

Dr Saunders: Sure. There are essentially three areas where I would call out significant differences. One of those has to do with the way that it was conceived and designed. It’s a completely modern, contemporary concept that’s designed by oncologists, for oncologists, with value-based oncology care and precision medicine as part of the design paradigm. By contrast, EHRs designed over the last decade or two were really designed for fee-for-service billing or are part of Enterprise or generic EHR suites that are only slightly customized to be able to handle the nuances of oncology. Ours is purely oncology-driven, purely modern, and incorporates value-based care and precision medicine, so that’s one significant difference.

Another differentiator is from the technology architecture standpoint. Most EHRs that are out there are either on-premise applications that you have to run in a closet somewhere on a server or hosted applications that run in a co-location center someplace, but are still client/server type applications or ASP applications. Integra Connect’s EHR is designed as a pure Cloud-based application which means it runs in the Cloud. In our case, it’s Azure which is the Microsoft cloud. But it runs in the Cloud, which means that you have no hardware that you have to buy other than a browser and you’re good to go. It also provides near infinite horizontal scalability, so that you can grow and scale without hardware that you have to maintain and update. The other advantage to Cloud is that the rapid cycle of improvements, enhancements, and new functional roll-outs can be as frequent as daily and weekly. Updates are made at the same time to everybody’s software, so everything is automatically up to date, much like your iPhone, for example.

And the other thing from a technology standpoint that is special about Integra Connect’s EHR solution is that this is not just an application. It’s a platform. It’s a platform in that it is very, very highly configurable, with new functionality and features and integrated third-party apps very easily added to it. As a result, it can grow with you as a practice and can change and shift as the industry changes and shifts, without becoming obsolete. So, those are some technology components to our EHR solution that most people may not be aware of.

And then there are some functional components that differentiate it. First of all, it is designed around a longitudinal patient view. Think about a flow sheet where you have everything that has happened historically to that patient displayed graphically and that you can work off that flow sheet and see everything that’s going on in time and in the future. Then you can do all the functions you need to right on that timeline, whether it’s scheduling chemotherapy or changing medication doses or scheduling appointments. In addition, doctors still have the traditional views like, “Chief complaint is regression illness,” and things like that.

Integra Connect’s EHR solution for oncology also is designed from the get-go with the kinds of work flows that are unique to an oncology practice, including chemotherapy administration, getting payor authorization for a drug, supporting in-office dispensing and buy and bill for insurance, and other needs that are fairly unique.

Our EHR also has integrated care pathways, whether it’s NCCN or other pathways. We provide not only the selections of pathways and the ability to customize and choose, but the ability to monitor compliance with pathways dynamically – then manage deviations from that with authorizations, if the practice requires it.

The other thing that is special about the Integra Connect EHR is it supports value-based care out of the box, so that if you’re in the Oncology Care Model program, for example, the data elements that are needed to report are captured and the team-based care plan can be generated right within the electronic health care record. It has integrated analytics for reporting things like quality measures and metric scores and other types of things like cost, utilization metrics, patient risk stratification, and eligibility for the monthly enhanced oncology service (MEOS) payments.  So, all those kinds of elements are integrated.

And I think the final thing I would just note is that our EHR is open, unlike other systems that have the data locked up and don’t really provide access to the data. We use standard-based data formats for data exchange, whether it’s exported with CCDA or imported data or exported to a data mart so you can perform analysis. All of that is open.

Mr Bessette: You touched on this a bit – can you speak more to how the EHR Solution for Oncology is designed with efficiency in mind?

Dr Saunders: Right. We have spent a lot of time with oncologists as users both with our advisory boards and in our beta environments, looking at the number of clicks that they need to do to certain things. And what we’ve tried to do is to make those as efficient as possible so that they don’t have to go through an excessive number of clicks to perform a particular task. That’s very onerous for most providers and they don’t like it, so we try and minimize those.

The other thing that we’ve tried to do is integrate financial functions directly in the Integra Connect EHR. So, things like a payment authorization for chemotherapy administration, that all occurs in the background electronically with the PM system and you don’t need to really manage that process with additional workflow.

Another capability has to do with drug regimens. If a patient is in a chemotherapy cycle and they have to change an appointment or something, it automatically resets all of the subsequent appointments. If a dose gets changed, it can automatically reset those. You don’t have to go through it one by one. It’s little things like that that we’ve worked into the software to try and make things efficient. Not only efficient from the doctor’s standpoint or the nurses for clicking the buttons, but also for the back-office staff that has to do a lot of financial work-around and manual work to set things up, get authorizations and generate bills. 

Mr Bessette: What has been some of the early feedback from the three community oncology practices that have already implemented your EHR Solution for Oncology?

Dr Saunders: Well, usually the first adopters provide you with a lot of really valuable feedback on features and functions that they would love to see that are either unique to their practice or they think would just enhance the application overall. And so, we work with this first wave of three or four with listening in mind. We hear the feedback, we put together a list of new, cool features and functions and other things that would increase efficiency, so that’s part of what the first wave of customers is, is to provide that two-way feedback.

I would say that overall, the feedback is that this is going to be the most advanced EHR on the market. There will be nothing like it and so, there’s a lot of excitement in the customer base. When we finally do get past the first three or four customers and we finalize or have locked in all the good ideas that everybody has, that will just make this even better.

The applications are built and they’re commercially ready. But, in my view, the one that you build for the first client is going to be unique and perfect for that client and the one for the second client requires you to add a few more things so it really is unique and special for that client and the third one the same. But by the time you get three done, then you’re not seeing anything that new with the fourth and the fifth and the sixth client. So, then it becomes something that has global appeal as opposed to just unique appeal. So, we’ve got three customers now and when we get through those we shouldn’t encounter any curves and things that we haven’t anticipated.

Of course, we do rapid-release cycles. We do release cycles every couple of weeks, sometimes more frequently than that. And so, we’re always able to add new features and functions in there as people come up with interesting, new things that would be valuable for everybody as opposed to traditional development which is a waterfall type approach. We use agile development and we use rapid sprints for these cycles, so hopefully we’ll be able to rapidly build out new, cool features and functions as they come up with the practices that we see.

Mr Bessette: It seems like you’ve struck the balance between an individualized product and one that is suited for the global market. I can certainly see how this may be a unique product on the market. Are there any features in the EHR Solution for Oncology that makes for easier data and trends interpretation?

Dr Saunders: Sure. Well, first of all, what we have designed is the ability to capture the data elements that are really essential to oncology in a structured way. So, as opposed to capturing most of the information in narrative notes, we have lots of ways that it can be put into structured data fields and, or that we can tease structure out of it so that’s it’s readily accessible for analysis. And we don’t have to do some complicated natural language processing or manual chart abstraction to get at that information, so that’s one supporting feature.

Another thing that we do is that the data model is translated into a common data model based on OMOP, which is a common open source ontology of clinical terminology. So, the data is all semantically normalized and goes into our operational data stores and allows us to completely harmonize all the different types of data, whether it’s clinical data from the EHR or claims data from the payor or lab data from the lab information system or Rx data from the pharmacy. We harmonize all that data longitudinally around single-patient identities and the physicians who treat them, so that’s it amenable to rapid data analysis. And so, the benefit of that is that you can do research studies directly in the database and you can look at real-world outcomes, treatment outcomes. You can do these in real time and you can identify subjects for clinical trials, for example, and it’s based on common, standardized nomenclature and terminology based on SNOMED and terms like that.

Those are some of the things that we’ve designed that make the oncology EHR easier for data and trend interpretation. We also export the data in standard terminology form, so you can actually open up the data if you want to in your own business intelligence package, or Tableau or what have you.

Mr Bessette: In your opinion, why are customized and personalized EHRs necessary for specialty practices to achieve clinical and financial success? 

Dr Saunders: Yeah, so there are two different words there. One is customized and the other one is personalized. It is personalized for the practice and personalized for the patient. There are still a lot of differences between practices. The industry is not 100% consolidated to where everybody practices precisely and exactly the same, so you’ve got to be able to support the nuances of the practice and the programs that they’ve set up. Some practices might have their own imaging center, they might have their own radiation centers, they might have inhouse drug infusion, or they might shift that off to the hospital. They might have an inhouse dispensing pharmacy for orals. There are a lot of different nuances and differences between practices. So, the application has to be configurable for those practices and by configurable, I mean at implementation all you’re doing is throwing a couple switches on the application. You’re not actually writing new code or doing custom development. And so, it’s highly configurable to address the nuances of those practices.

The EHR also has to support the nuances of the alternative payment models. Oncology Care Model is only one. Many payors have value-based care contracts with their providers that have other requirements. They might have requirements for certain data collection and reporting for quality measures. They might have certain payment schemes, whether it’s a share of savings or performance bonuses or even capitation. So, you have to support the nuances of those models. They also vary widely across states.

And your standard enterprise packages, EHR packages like EPIC and Cerner, if you’re affiliated with a health system it can be really difficult to get those to make subtle changes because they’re massive systems just like SAP. You’re competing for their resources with virtually every other department in the hospital.

The other part of it has to do with personalization – not only to the way that a physician practices, but also to the nuances of patients.  Increasingly, as genomic information becomes available, treatment decisions and reimbursement decisions are going to be based on this concept of precision medicine where a person’s unique genetic profile will dictate what treatments will work for that patient and which treatments will not be authorized. And so, that means that you have to be able to personalize it down to the individual patient but also down to the practice level for the various regimens that they want to use for certain genetic predictors, down to the individual physician. I think that that’s going to be more the norm going forward as the number of biomarkers and genes that are associated with certain treatment types just grows geometrically.

Mr Bessette: Okay, thank you for joining us today Dr. Saunders and we hope to hear from you soon!