By Robert Daly, MD
This is the second post in my series on five innovations to look for in 2019 in oncology care delivery. In this piece, I examine the platforms oncologists are using for information sharing. Cancer care has become increasingly complex. Last year the FDA approved 19 applications for new cancer drugs and biologics as well as 38 supplemental indications and four biosimilars. With the increasing pace of discovery in cancer care, clinicians are looking for guidance and expertise into how to integrate these new antineoplastic agents into their practice. In the past, this knowledge sharing was achieved through informal networks and discussions with colleagues. However, ASCO’s State of Cancer Care in America, 2018 finds that most oncology practices remain small with 76% of practices employing only 1-5 oncologists, and there are increasing demands on oncologists’ time with payer and documentation pressures that limit their ability to engage in informal discussions. New platforms have emerged to help foster this knowledge sharing. One such platform is theMednet.org, which has raised over $2.5MM in funding and was co-founded by siblings Nadine Housri, a radiation oncologist at Yale, and Samir Housri, a software engineer. I sat down with Dr. Housri at the ASCO annual meeting to discuss with her how theMednet is serving as a platform for oncologists to ask questions and share expertise about the care of their patients.
The origin story for theMednet came when the Housris’ father was diagnosed with cancer. Nadine reached out to her network and colleagues to find information on the optimal treatment. This experience revealed to her how much medical knowledge is not retrievable and the challenges with unearthing this knowledge, mainly:
The value of knowledge exchanged depends on strength of network.
Valuable experiential knowledge from strong networks are not documented and shared with the community.
theMednet codifies this informal knowledge into a searchable platform to help oncologists answer clinical questions. The questions asked on theMednet are not case-based. In my discussion with Nadine, she emphasized that case based questions help only the physician asking the question but are not beneficial to the greater community. Questions must meet three criteria: 1) there is no clear answer in textbooks, guidelines, or UptoDate; 2) questions must be able to elicit answers that are helpful to the community, and not only the question asker; and, 3) questions must be clinical and have some kind of answer (no “food for thought”). Recent questions on lung cancer include: do you recommend holding a tyrosine kinase inhibitor when treating brain metastases with SRS/WBRT? and How do you approach adjuvant chemotherapy for high grade large cell neuroendocrine lung cancers? There are over 9,600 medical, radiation, and gynecologic oncologists on theMednet with over 700 experts providing answers to these questions. Only physicians are invited to participate to promote a relaxed, empowering environment for clinicians where they can feel comfortable debating controversial issues. In responding to the questions, theMednet is hoping these clinicians can engage in the type of conversations that used to occur in hospital and clinic hallways. theMednet has adopted many of the practices used by social media sites and the platform is designed to be social where peers are able to agree, comment, share, and vote on the helpfulness of answers. Nadine reports that experts enjoy participating because it meets their academic mission, it allows them to disseminate their research and have a broader impact, and it helps them to formulate their own thoughts on a topic and learn from their colleagues.
In speaking with Nadine, she does not feel that theMednet will replace peer-reviewed journal articles as the source of practice changing findings in oncology. Rather the platform will serve to disseminate those findings more broadly. theMednet could, however, influence how journals think about presenting information making findings more digestible to clinicians at the point of care – drilling down to the “so what”, “how does this effect my clinic” of any publication. We have already started to see this effect with shorter more parsimonious abstracts and tweets accompanying academic publications. theMednet has partnered with the American Society of Clinical Oncology on a JCO journal club. The future of how oncologists synthesize and integrate new discoveries may be less through journals and more through digital platforms like theMednet that make those findings relevant to the clinician at the bedside.
theMednet has dreams of the future including expanding beyond oncology to other disease areas. As Nadine indicated there is nothing particular about the model that lends itself exclusively to the field of oncology and they have already branched into gynecologic oncology. The platform also received a grant from NSF to use their platform to match physician search on clinical questions to relevant clinical trials with the goal of increasing awareness of trials in the community. They have also started to build a sustainable business model with sponsored topics and have the backing of Y Combinator and other investors with deep experience in Silicon Valley. It will be interesting to see how this platform grows between now and ASCO 2020. After all, next year’s theme is “Unite and Conquer: Accelerating Progress Together” and platforms such as theMednet are poised to deliver on that goal of bringing oncology practitioners together.
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