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History of Oncology Research at Intermountain Healthcare
Elizabeth Hale Hammond, MD, FACP
Consulltant Pathologist, Intermountain Healthcare, Professor of Pathology, University of Utah School of Medicine; Salt Lake City, Utah
Objectives: • Identify oncology program developments of significance in
Intermountain • List the key success factors in oncology and program successes
History of Oncology in IntermountainElizabeth H Hammond MD
In two landmark reports on Quality and Information Technology, the Institute of Medicine described a 21st century healthcare delivery system that would improve the quality of care while reducing its costs. To achieve the improvements envisioned in these reports, it is necessary to increase the efficiency and effectiveness of the clinical decision support that is delivered to clinicians through electronic health records at the point of care.*
*Jones et al. BMC Medical Informatics and Decision Making 2013, 13:47http://www.biomedcentral.com/1472‐6947/13/47
This 21st Century healthcare delivery system started in Utah at Intermountain In the 1960’s!
We cannot solve our problemswith the same thinking we used when we createdthemAlbert Einstein
Clarence Wonnacott attracted Homer Warner to LDS Hospital to create a cardiac catheterization laboratory and ultimately, the HELP system was bornBrent Goates attracted Henry Plenk to LDS Hospital and Radiation Oncology was solidified in UtahStanley Altman, persuaded Charles Smart to come to LDS Hospital and Cancer Surgery was addedDon Nelson and the medical staff established an ongoing foundation to support medical research
Innovative Care Changes are Woven into the Fabric of Intermountain
HELP System is Developed
Beginning with cardiac catherization data, Warner and colleagues built a decision support system that underpins every clinical program.
Institutional support was consistent and foundational
Healthcare workers embraced the technology and made the changes in process to allow it to flourish at the bedside
Henry Plenk was recruited to LDS Hospital in the 1960’s and quickly established a cancer treatment program and residencyIn 1968, he joined the newly established Radiation Therapy Oncology Group LDS Hospital became an important player in these trials
Radiation Oncology comes to Utah
Charles Smart becomes first cancer surgeon in the state working in the Intermountain Regional Medical ProgramThru IRMP, the tumor registry was computerized in 1973 and cancer became a reportable disease in Utah
Using tumor registry data, cancer care could be better followed and improved.
What cancers are prominent in Utah?What is the death rate from those cancers?How can care be improved?
Oncology Defined in 1970’s
An early adopter of computerized technology, Smart promoted its useHe advocated and promoted research involving the tumor registry data and was its strongest supporter to keep cancer reporting unified throughout the state
Charles Smart used Data to Improve Oncology
Talented medical specialists were recruited to IntermountainFruitful research collaborations evolved
HELP system continued to expand Tumor registry data was used to understand cancer care LDS Hospital developed an oncology unit and bone marrow
transplant unit still operative today Expertise in imaging and pathology expanded to support
patient cancer diagnosis and treatment Research funds allowed small projects to generate
meaningful patient improvements
1980’s Brought New Talent and Fruitful Collaborations
LDS Hospital became key player in Cancer Care in 1980‐1990’s
Physicians and staff at LDS Hospital were supportive of clinical trials and made significant contributions to RTOG/COG group studies
Early studies in hyperthermia, intraoperative radiation therapy, and childhood cancer radiation evaluated utility and defined best uses
Physicians at Intermountain became key cancer players in RTOG/COG in 1980s 1990s and expanded clinical care in Intermountain
William Sause and John Thomson were key playersElizabeth Hammond led pathology studies and tissue banking Michael Collins and Dirk Noyes played leadership roles in surgeryWilliam Rees, Regina Rosenthal, Bret Parkinson refined breast cancer services
Completed 460 protocols which improved cancer care involving 90,000 patients over 40 years Landmark trials in brain, prostate/bladder, GI/pancreatic,
head and neck, and lung cancers 300 leading cancer hospitals including 90% of cancer
centers in the USA 800 published papers Intermountain was a major player in these trials and in
writing grants to support the group
RTOG Changed Cancer Care in the USA
Intermountain established a health plan and a medical groupData and collaboration fostered further improvementsBrent James taught and optimized improvement work and tools and spread learning system wideResearch improvements could be systematically spread through the system and monitored regularly
Intermountain Pursues Integration in the 1990’s to Improve Care
Oncology Clinical Program established with William Sause as the clinical leader System wide goals were established Data mart for oncology was developed Tools like synoptic pathology reports and statistical
process control charts made monitoring a reality 5500 patients are treated annually and 94% of those
have adequate staging information to plan treatment
Oncology Clinical Program is Established in 1990’s
Oncology Data Warehouse
EDWFinancialData
Clinical Data
Claims&Eligibility
Integrated Research and Analysis
A single source for complex data analysis and reporting
Breast Preservation Rate
Sentinel Node Rate – System
Breast Synoptic Reporting Elements Became National Standard
Intermountain synoptic breast cancer checklist elements paved the way for national adoption
American College of Surgeons for cancer hospital accreditationNational Quality Forum as breast cancer quality measuresCMS has also adopted them for pay for performance
Synoptic elements enable uniform understanding and avoid missing information in reports
Enabled data sharing and further research using Utah Population Data Base, LDS Church genealogical records, and clinical data from Intermountain
Led to more patients being enrolled on clinical trials and enabled research collaborations
Intermountain Huntsman Oncology Collaboration in 2000’s
Research collaborations with Stanford Medicine in molecular oncology (precision medicine)Membership in NW NCI Community Oncology Research Program, the largest collaborative involved in community based outcomes research ASCO CancerLinQ HIT platform early adopter institution. providing data on cancer care to compare with others across the country for purposes of improvement
Oncology Standardization, Data Access, Outcomes Research in 2016
Intermountain Precision Genomics Next Gen sequencing for genetic mutations 80% of
which are actionable by specific targeted therapy Enhanced genetic counseling services to direct appropriate testing and dedicated counseling services
Intermountain Biorepository with qualified cancer tissue specimens dating back to 1980’s in all cancer sites Biorepository supports 20 biomarker and molecular
studies at the present time
New Programs Providing Excellence
William Sause has set a high standard for leadership
Innovative health care professionals will continue to pursue creative changes in care delivery
Research, supported strongly by Intermountain and involving national organizations, will drive ever better oncology care
The Future is Bright
Unicorn tapestry, Metropolitan Museum of Art 1495