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We’re joined by Andrew Norden, a physician executive, to dive into the world of digital transformation in oncology. We explore why oncology has been slower to adopt digital innovations compared to other health care fields, debunking myths about technology use among older adults, and the challenges of measuring success in this space. Discover how virtual care options can enhance problem identification, improve the quality of life for cancer patients, and expand access to care.

Andrew Norden is a physician executive.

He discusses the KevinMD article, “Why oncology is ripe for digital innovation.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Andrew Norden. He is a neuro-oncologist and a physician executive. Today’s KevinMD article is titled “Why oncology is ripe for digital innovation.” Andrew, welcome to the show.

Andrew Norden: Thank you. Good to be here.

Kevin Pho: We’ll get into the article in a little bit. First off, briefly share your story and journey.

Andrew Norden: Sure. I started my career in a traditional capacity, like many academic oncologists. After my fellowship in neuro-oncology, I took a job on the faculty at Dana-Farber Cancer Institute here in Boston, where I live, and I ended up spending more than 10 years there at Dana-Farber. But early on, I would say I was frustrated with the pace of progress and with the limited impact that I felt I was having seeing patients one at a time. I was interested in how I could expand my impact and perhaps change the systems of care that we have in place for people with cancer.

That’s how I first transitioned into an administrative role at Dana-Farber, where I became the physician leader for Dana-Farber’s expanding community network. It was in the context of that work that I realized something that, in retrospect, should have been obvious: IT systems have a huge impact on the extent to which we provide the kind of care that we think patients deserve. After thinking that way for a number of years, and implementing a clinical decision support system across the Dana-Farber enterprise with many other colleagues involved, I decided that it was time to try my hand in IT directly.

I went to IBM Watson Health in the early years of IBM Watson Health’s existence. My experience there is probably a story for another time, but the long and short of it is that I was disappointed with the products that were available at the time. Soon after joining, I left IBM to become chief medical officer of an oncology-focused data and analytics company called Cota that was doing some really great work in real-world data and evidence. I had a nice stint there for about three years and then joined OncoHealth, which is where I’ve been for going on four years now. OncoHealth is a company that provides services to payers, exclusively in oncology. We are involved in a host of utilization management-type activities, improving the quality and outcomes of cancer care, and we have a digital health offering in oncology that I’m really excited about.

Kevin Pho: So one of the reasons you said you made that transition into a chief medical officer, physician executive role is that you wanted to make a difference on a more macro level rather than seeing patients one-on-one. Have you done that?

Andrew Norden: It’s a good question. It’s hard to answer that question with a simple yes, in the sense that we have lots of opportunity to continue to improve. But that said, I do think that I’ve been really meaningfully involved in helping improve the landscape of cancer care. One of the things that led me to write the article on your platform is that I think technology represents an enormous opportunity to improve the experience of cancer care for patients in this country and beyond. We and others, other entrepreneurs and cancer programs around the country, are working on systems that enable us to do that. So I find that work really meaningful and satisfying. There are still lots of problems to be solved in order to achieve the full potential impact, but I do think I’m moving in the right direction.

Kevin Pho: All right, so let’s jump right into the article. I’m interested in hearing what you have to say about that intersection between oncology and the various digital, innovative tools that we have available. Your article is titled “Why oncology is ripe for digital innovation.” How did this article come together?

Andrew Norden: Well, my sense is that not many people know that digital innovation is happening in oncology just yet. People are familiar with the various digital health offerings that are focused on obesity, diabetes, hypertension, and musculoskeletal problems, but oncology is somewhat new to the digital health world. I thought that it would be important to help people understand what kinds of opportunities we see in the world and how patients might benefit. What’s more, I thought that it would be a great way to showcase the reality that I see technology in cancer care as a way not just to make things better for patients, but also to improve quality of care generally and to help manage cost, too.

Kevin Pho: So give us an example of some of these digital tools that you’re talking about.

Andrew Norden: Yes. For example, our offering is called Iris, which is a technology-enabled service that people with cancer can access through an app or a website. First and foremost, it allows them to connect with expert humans, which is really important. They can engage with oncology nurses 24/7 by text, audio, or video. They can engage with oncology-expert mental health professionals by video or audio, and they can engage with oncology-focused nutritionists as well. Then there is tooling inside the application that lets them keep track of their symptoms and alert our team should a symptom warrant intervention. They also can access a whole host of personalized, really high-quality, vetted content that’s been put together by experts on our team and that’s relevant to their particular experience with cancer.

Kevin Pho: Now, with this tool specifically, is this in conjunction with their regular cancer team? Do you work together with their current cancer team, or is this something in addition, a supplement?

Andrew Norden: This is a supplement to the care that they receive from their primary oncologist, but we work closely in collaboration with their primary oncologist and take great pains to ensure that our care is not confusing matters or the like. The goal is really to provide an extra layer of support, particularly around components of care that we know are important but are often inadequately available, particularly in smaller and community practice settings.

So for example, it’s been known for decades now that people who are going through cancer treatment have high rates of depression and anxiety, and it’s known that untreated depression and anxiety contribute to poor quality of life. I suppose that is obvious, but what’s also interesting is that having cancer and untreated depression or anxiety increases the likelihood of having potentially avoidable ED visits or hospitalizations. Our goal is to dramatically improve access to a community of mental health experts who can help detect, diagnose, and then treat depression and anxiety, and in that way potentially ameliorate all those downsides that I just described.

Kevin Pho: So offering a tool like this implies that legacy or traditional models of care aren’t adequately addressing the full scope of what a typical cancer patient needs. Is that correct?

Andrew Norden: I think that’s safe to say. I wouldn’t want your listeners to conclude that we at OncoHealth, or I personally, have a view that cancer programs are largely falling short. But I think the reality is that the large majority of patients in the United States get their care in settings that just aren’t able to adequately meet these needs. In substantial part, that’s been because of business model problems, which is to say that it’s not in an oncology practice’s business interest to provide mental health care to all of its patients, even though I suspect most oncologists would be quick to say that that’s a perceived need. The same is true around nutrition, and the same is true around symptom management. So while there are pockets, particularly academic and urban ones, where patients do have these various needs addressed, I think most cancer patients in the country are not having these needs adequately addressed.

Kevin Pho: Give us a sample case study or an example. It could be a hypothetical case study where a digital tool like the one you mentioned has moved the needle for that patient.

Andrew Norden: That’s a great question. I can tell you one off the top of my head, because recently we had a patient who contacted our nursing line through text early one evening on a weekend. She was experiencing some swelling in her neck and was concerned about it, very anxious about this new symptom, and was preparing to go to the emergency room. She called her physician and didn’t get a call back, and an hour or 90 minutes lapsed. Then she reached out to us, and in talking to her, we uncovered that in fact this neck swelling had been coming and going over a period of many months, and that it had been previously evaluated by her physician and deemed not serious, although the cause was not entirely clear.

So frankly, in that scenario, our intervention was reassurance. We reassured the patient that, given the history she described, we felt comfortable that things were going to be OK. We stayed in close contact with her through the text-based app through the weekend, and then on Monday we facilitated a visit with her local oncologist to ensure that all the necessary connections had been made and any additional evaluation that was warranted had been done. The long and short here is that this was not an example of a high-acuity, serious issue, but it was an example where simply failing to reach her doctor at the right time led to a high likelihood that this patient would have gone to the emergency room, and we were able to prevent that.

So in a lot of ways, I think the value that offerings delivered technologically like this provide is surveillance and availability at the right time, so that necessary assessments can be made and clinically legitimate decisions can get made without always having a patient show up in the emergency room. I think you probably know, Kevin, that when cancer patients go to the emergency room, there’s a 50-plus percent chance that they end up getting admitted to the hospital. A lot of our interventions are along these lines. We’re available at the right time to assess and then provide the reassurance that patients need, and that helps them avoid some utilization that they would rather avoid anyway.

Kevin Pho: Now, one of the common critiques when it comes to digital tools is that they appeal only to a certain demographic subset: people who are, of course, adept at digital tools, people who are adept at English, and for whom there are no cultural or socioeconomic barriers to using these tools. So what’s your comment on that, that these digital tools only appeal to a narrow subset of the population who have the capacity and socioeconomic ability to use these tools in the first place?

Andrew Norden: I think that’s a very real and fair concern, and it’s one that we keep in mind all the time. The first thing I’d say is that our experience is that a growing proportion of older Americans are using technology. We have lots of patients on our platform who are over 65 and for whom technology is comfortable and appreciated. I think about how frequently I interact digitally even with my own nearly elderly parents, and they are quite comfortable using their phones, and we see that with our cancer patients who are on the Iris platform. So that’s the first thing. And if you look at data around this, it’s clear that 70-plus percent of older Americans at least have a smartphone. Maybe they are not as savvy using it as younger cohorts, but they have phones at high rates.

All that said, not everyone does, and not everyone is comfortable, and so I think these platforms need to be made available through a variety of media. For example, on our platform we make it available not just on iPhone and Android phones but also through a web page, and for the frankly small proportion of people for whom technology is not an option at all, we offer it telephonically. I think a pure telephonic service loses some of the slickness of technology and some of the convenience, perhaps, but it still works. At the end of the day, I think the most critical component here is: Can you get the right experts in touch with the patient at the right time?

With respect to cultural, socioeconomic, and racial differences, I think it’s important that staff be representative of the populations that they’re serving, and we go to great lengths to ensure that we hire and build our team in that way, and I think others should, too. Then finally, with respect to language, it’s critical to make these services available in patients’ native languages, and we do that as well, and I think many in this space do that. It’s becoming easier than ever to translate in-app or web page content into multiple languages thanks to generative AI and other approaches. There are also really excellent health care telephonic interpretation services that we use, so to the extent that we’re serving members who speak languages that our clinical team members do not, or do not yet, we handle that with telephonic interpretation.

Kevin Pho: We’re talking to Andrew Norden. He’s a neuro-oncologist and a physician executive. Today’s KevinMD article is titled “Why oncology is ripe for digital innovation.” Andrew, what do you anticipate the path forward to be? Do you see any other care gaps, or gaps in oncology care, that could be solved with digital innovation? What does your crystal ball tell you?

Andrew Norden: Well, I think oncology, as discussed in the article, is very ripe for digital innovation around support for patients, and I won’t repeat everything I’ve said. But there are other areas in oncology, too, that I think are highly appropriate for technology. One is clinical decision support. Clearly that’s not a patient-facing technology per se, but an oncologist-facing technology. The amount of therapeutic innovation that we’ve seen in oncology in the last decade is just remarkable, with new drugs coming out monthly now. Typically those drugs are associated with unique molecular tumor signatures, and it’s just becoming harder and harder for oncologists to keep up, so I think that creates a burning platform for technology.

Even beyond that, we’re starting to see some really remarkable AI-based technology used in the drug discovery space. We think we have a rapid pace of drug development and new drug discovery now, but I think that’s going to accelerate even further thanks to AI. That’s going to serve our patients, the future cancer patients, well, but it’s also going to continuously increase that burden on the oncologist, so there will be a self-perpetuating cycle there, I suspect.

Kevin Pho: And my final question, Andrew: Tell us some of the take-home messages that you want to leave with the KevinMD audience.

Andrew Norden: Well, I would say it’s a really exciting time for technology in medicine. I could imagine somebody sitting and listening to this saying, “But God, the EMR is such a slog for me, and the level of administrative burden in my day-to-day practice is terrible.” I think those things are true, but I see a lot of exciting things happening with technology. I think we’ve had some real success stories in digital health, and we’re finally now watching those move from relatively straightforward use cases to much more complex ones, of which oncology is clearly one.

I think AI in medicine is super exciting. We all were so wowed when ChatGPT came out a year or so ago, and as that technology gets increasingly safe for prime-time use, I think it’s going to be remarkable and exciting to be a part of. I believe strongly that these technologies are going to first solve the administrative pain of practicing medicine in 2023, and I applaud that. I think we all should be rallying around that happening, because it’s going to ensure that we all can continue to be well prepared to give patients what they need and ensure that their outcomes are as good as they possibly can be.

One final point I’d make: If you’re a physician who is frustrated with clinical medicine in our current era and have any interest in technology, explore what that would be like. Come take a leap and work for one of the many exciting health care tech companies that are innovating and trying to make things better for patients and doctors every day. We need good health care minds in the health tech industry.

Kevin Pho: Andrew, thank you so much for sharing your time and insight, and thanks again for coming on the show.

Andrew Norden: Thanks for having me.