Cancer is a highly complex disease but technology should ideally make caring for cancer patients simpler. 

That's sometimes easier said than done, however. Kathy Dalton Ford, chief product and strategy officer at Ronin, which develops clinical oncology software, very much believes virtual care and other technologies can help providers improve their cancer care. But the tools have to be properly calibrated.

Healthcare IT News spoke with Ford to discuss what it is about cancer care that lends itself well to telemedicine, how integrating electronic-reported outcomes with the electronic health record helps the whole virtual oncology effort, and much more.

Q. At Ronin, you work toward enabling better cancer treatment through virtual care tools. What is it about oncology that makes it a good fit for telemedicine?

A. Cancer is one of the few diseases where we must make patients sicker to get them better.

Telemedicine is best applied in low-acuity situations – cases where being on video or engaged in a live video chat or discussion is not inconvenient.

But when you are very nauseous, incredibly lethargic, tired and suffering from several adverse events, you may want to find a secure and reliable way to connect with your clinical team – but not necessarily in a synchronous manner.

Thus, systems that offer reliable, asynchronous communication methods and provide relevant education are ideal for cancer patients. This way, patients can report side effects following treatment and ask their care teams if this is something that is to be expected.

A natural complement to traditional telehealth, electronic-reported outcomes elevate at-home care by providing specificity and context to symptoms that allow clinicians to take precise action. It may take a few minutes or hours to get a response from their care team, but it can be reassuring to get a response about the side effects they are experiencing – what they mean and the next steps for managing reported symptoms.

"Having this kind of tool built into the clinicians' workflow by being embedded within the EHR is another level of convenience that is becoming table stakes at this stage."

Kathy Dalton Ford, Ronin

Meanwhile, this form of communication provides the clinical team with a way to triage and view the patient's complete history. This allows the clinical team to prioritize patients with higher severity levels, which will help them prevent adverse events and reduce unnecessary emergency department visits.

Q. What elements of cancer care can physicians and nurses tend to with telemedicine along the cancer care journey?

A. Telemedicine is viewed as a synchronous connection with an agreed-upon time for two parties to meet, versus an asynchronous communication system that does not require the care team and the patient to be simultaneously available to communicate.

So, suppose your nurse or physician is with another patient. In that case, they can treat that patient and be in the moment – as you would want them to be with you – and then immediately be able to address the messages that have come in virtually based on severity.

The portal is the other alternative. While a portal is asynchronous, it's also incredibly inefficient – often functioning as a catch-all for patient questions. It must be filtered, allocated, sorted and distributed, which often burdens a clinician more.

These tools aim to minimize clinician burden, reduce their time spent within the EHR, and answer patients after hours. Electronic-reported outcomes provide straightforward, efficient and contextualized treatment-specific information in an asynchronous, direct and safe manner – back and forth with the patient – serving the care team and the patient much more effectively.

Q. How can integrating electronic-reported outcomes with the electronic health record help the whole cancer care virtual care effort?

A. Integration is critical because no clinician wants to log into separate applications or use a nonsecure, non-HIPAA-compliant tool like FaceTime, Zoom or something else on their phone. They certainly want to keep their personal phone number private.

So, having this kind of tool built into the clinicians' workflow by being embedded within the EHR is another level of convenience that is becoming table stakes at this stage.

Having patient-reported symptoms automatically written back from the electronic-reported outcomes patient app to the EHR is essential. There shouldn't need to be any intervention required on the part of the clinical team.

Q. In October 2022, Providence St. John's Health System implemented your company's multiphase cancer intelligence platform. How have the electronic-reported outcomes components of this implementation been coming along?

A. Whether it's Providence, or any of our clients, the ability to stay connected with a patient throughout their treatment to manage expectations and anxiety while going through this extraordinarily complex disease and treatment pathway has been significant to their patient population.

Depending on what is happening with the patient, the information provided by the electronic-reported outcomes system could allow clinicians to preempt adverse events, avoid unnecessary office visits or provide clear directions for the patient to go to the emergency department because of their reported symptoms.

So, the ability to promptly intervene and do so conveniently for the clinician and the patient is essential to patient safety, outcomes and satisfaction.

And if you look at the geographical location of St. John's in Santa Monica, Southern California, the traffic can be a real hindrance. Living 20 miles from St. John's could easily be a 90-minute commute to the hospital – it’s an incredible gift and improved patient experience to offer an application that's easy to use and can prevent unnecessary trips.

Communication between patient and clinician is critical during this journey. The application guides the patient to document all the information relevant to clinical decision-making and opens the door for productive communication.

Providers can ask additional questions and send educational material based on the patient's responses. It's highly personalized to each patient and their situation, so they feel connected and heard. Again, the design of these tools can help prevent avoidable trips to the emergency department, manage patient expectations, and ensure clinicians have the real-time data to make confident and informed clinical decisions to improve patient outcomes.

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