Oncology and the Information Revolution

As clinical oncologists, we are experiencing unprecedented challenges to our research and therapeutic and practice management skills brought on by the necessity to manage the geometric increase in medical information and the striking changes in the clinical practice of oncology demanded by managed competition. The clinical oncologist must be a clinician, researcher, educator, businessperson, statistician, healthcare administrator, and “ informatician,” who must interact with the whole patient, both as a specialist and as a primary-care physician. These skills must be assimilated into our daily clinical practice and research activities, while we continue to improve our quality for a much more sophisticated consumer and payer. Information management has become the most frustrating aspect of our professional life. Cancer patients receive intricate multi-modality therapies for their complex diseases, requiring greater access to, and tracking of, detailed medical data. Disease management clinical guidelines for cancer patients are being introduced which require the micromanagement and economic awareness of patient care.1 Managed competition as well as clinical research trials demand more intense recording of medical documentation, while reimbursements and time available for each patient are curtailed. Clinical trials must not only show progression-free and overall survival benefits but now must also display cost-effectiveness and patient satisfaction.2,3 The digitalization of information, the ability to network or connect computers, and the rapid electronic interchange of information on a worldwide basis are recognized as the hallmark of a new order in society. For oncologists to master these profound changes, it is necessary to comprehend the medical tools of the Information Age. These tools include the computer, which acts as the information gateway and integrator, the electronic medical record, which is the translator and repository of our clinical information gathering, and the Internet’s World Wide Web (WWW), which coordinates interactive information resources and personal communication. Information technology and personal computers have transformed every other profession and are now revolutionizing medicine as well. Today, health-care reform in the United States requires us to reconcile the needs of 40,000,000 uninsured patients, the individual insured patients and their health-care organization in this cost-containment environment and to apply rapidly expanding molecular and genomic knowledge for an aging and mobile population with rising chronic disease rates. The delivery of patient care in the United States is disjointed, when considering the mobile society, patients who change practitioners and health plans every 3 years on average, the absence of coordination of the patient’s longitudinal medical record, and the lip service given to the screening and prevention of disease. Health-care delivery automation, with the exception of practice management, results reporting and financial software, is shamelessly underutilized despite the nonmedical world’s rapid acceptance of the tools of the Information Age. Moore’s Law first formulated in the 1950s accurately predicted the doubling of microchip technology capabilities and the halving of computer costs every 18 months. Similar changes are occurring in health-care delivery utilizing computerization, electronic medical records, and the Internet. Most exciting is the the recent merging of biomedical and silicon chip technology with the advent of the biochip, where the entire human complement of 80,000 genes will be simultaneously and inexpensively assayed for abnormalities and biologic activity. If our health-care system is to survive and thrive in a rapidly changing medical universe, all the participants—providers, patients, administrators, researchers, educators, payers, industry and the government—must understand the laws of the Information Age. They must invest the time and energy to harness the vast untapped powers of computers, electronic medical records, and the Internet. Combining the huge cost-saving potential of computerization and the Internet telecommunication technology will provide a logical framework for health-care in the next millennium. With secured and confidential electronic medical records and the acceptance of community health information networks (CHINs) that electronically link, on a regional basis, all patients, practitioners, payers, hospitals, benefit managers, commercial laboratories, and drug stores, our health-care system will become cost effective and efficient. Most of these networks also provide free home pages, secure VPNs (virtual private networks) for large physician groups, access to continuing medical education and medical journals, and hot links to e-commerce alliances. Among the key questions to be answered are: can the internet solve the major problems of today’s electronic data interchange (EDI), such as incompatible technologies and lack of standard formats? How will companies solve data security and privacy problems that are both perceived and real? Will companies’ relationships 159 ONCOLOGY AND THE INFORMATION REVOLUTION