A new article, “CancerLinQ: Cutting the Gordian Knot of Interoperability”, in the Journal of Oncology Practice (JOP) looks at how ASCO’s commitment to CancerLinQ® can lead to improvements in the interoperability of electronic health records (EHRs). The article, by Wendy S. Rubinstein, MD, PhD, FACP, FACMG, and Deputy Medical Director of CancerLinQ LLC, highlights the major obstacles the field currently faces and shows the importance of properly leveraging practice data to improve quality of care and reduce costs.

ASCO’s most recent State of Oncology Practice in America: 2018, affirmed that practices face a major source of pressure in their need to electronically integrate patient information from other practices and providers. Only 15% of oncology practices reported full interoperability, and 40% were unable to accept any patient information from other practices.

ASCO has long embraced the goals of interoperability through its commitment to the CancerLinQ® platform aimed at discovering meaningful information to improve clinical care by analyzing longitudinal data from large groups of cancer patients.

To date, CancerLinQ® has established data flows among practices using seven different EHR types. While these EHR systems do not readily exchange data with each other, the CancerLinQ initiative has worked beyond the many barriers of interoperability and synthesized a data commons accessible to all participating practices. In doing so, the CancerLinQ team has learned significant lessons regarding best practices and developed valuable insights, which Dr. Rubinstein shares in JOP.

Some of the main hindrances to interoperability include:

• Ecosystem pressures—Changes in the organizational structure of practices including closures, openings, mergers, and/or sales is on the rise.
• “Intra-interoperability”— EHR customization works against a need for standardization across other critical players in the health care space.
• Backward compatibility—Practice migrations to new EHR systems can lead to the loss of a practice’s historical data.
• Unreasonable charges—Some EHR vendors and document archiving services charge physicians substantial fees to access and exchange their own EHR data.
• Attitudes—There are mistaken perceptions that single, though large, hospital systems or research collaborations are achieving the goals of interoperability.
• Silos of genomic and phenotypic data—Most EHRs have no framework to accommodate even basic genomic data.
• No lingua franca for oncology data—Oncology data are not represented consistently within EHRs, which drives errors, inhibits interoperability, and increases the cost of the advancement of science.

CancerLinQ® has developed ideas and solutions to help the oncology field overcome these problems. For example, under CancerLinQ®, ASCO is currently developing a set of “Minimal Common Oncology Data Elements” (M-CODE); this set of data elements is envisioned by ASCO to form the basis of an initial set of necessary data that should populate all EHRs serving patients with cancer. These data elements would greatly streamline the exchange of basic needed data in oncology.

The editorial is part of the State of Cancer Care in America article series, which features original research, editorials, and commentaries from ASCO leaders and invited stakeholders that explore the current challenges, opportunities, and trends in the delivery of high-quality cancer care. The articles are featured as a special series in the JOP.

Read the full article and visit ASCO in Action for the latest updates on interoperability.

For more information on CancerLinQ® and how to join please visit CancerLinQ.org.