Personalized medicine firm Proventys and the National Comprehensive Cancer Network said last week that they are partnering to develop the Proventys CDS Oncology system, a web-based platform that brings together standard oncology clinical guidelines and informatics technologies to help cancer clinicians make the best treatment decisions for their patients.
Proventys CDS Oncology, which will be launched in the fourth quarter, “was designed to automate the NCCN guidelines in oncology in a…structured fashion according to individual patient characteristics,” the company said.
The software is intended to be an interactive alternative to the static versions of the clinical guidelines available on NCCN’s website. Using the NCCN guidelines and patient information entered by clinicians, the system provides information on appropriate lab and imaging tests, cancer staging, and highlights the most relevant treatment regiment for patients.
Surya Singh, chief medical officer and vice president of clinical development at Proventys, told BioInform that the collaboration came out of a series “of usability and human factor studies” on the company’s febrile neutropina diagnostic, or FN PDx, predictive test product, which is currently under review by the US Food and Drug Administration as a medical device.
While developing the product, “we heard over and over again from practicing community oncologists that there was a real need for better decision-support tools in their practices,” he said.
He noted that about 80 percent of community oncology practices "don’t currently have an electronic medical record or computerized physician order-entry system,” to support decision-making.
Armed with that information, as well as the knowledge that oncologists often rely solely on NCCN’s paper-based guidelines, Singh said that Proventys worked with NCCN to “conceptualize and formulate an agreement” to create a system that “involves the dynamic rendering or automation of their guidelines into a workflow-friendly decision-support tool.”
Singh added that at the end of this process the clinician gets a tool that "walks them through each node on the decision trees that are contained within the current guidelines. “What we are doing is taking each one of those decision trees and digesting it down to its component parts so each decision tree has several nodes and branch points off those nodes,” he said. “We are taking each one of those [nodes] and creating a discrete item in a rules engine.”
The system also links the concepts represented by the nodes to medical terminology from sources such as Unified Medical Language System hosted by the National Institutes of Health. This includes terms used to describe things like symptoms, diagnoses, and therapeutic options.
Singh said the end result is a system that guides clinicians through several decisions such as disease staging, diagnostic test ordering, chemotherapy selection, supportive care medication selection, disease restaging, and monitoring.
He added that the system is designed to incorporate a variety of data types including demographics, laboratory data, imaging results, genomic data, and medications.
“Clinician users can make notes within the system, but clinical document management is not currently the primary purpose of the system,” he noted.
For its initial release, the platform will incorporate NCCN’s guidelines for breast, colon, and non-small cell lung cancers as well as Hodgkin lymphoma.
Singh said that NCCN is responsible for “the content that’s embedded in their guidelines and, by proxy, the expertise of their panel members," while Proventys is bringing its "clinical informatics expertise and technology” to the partnership.
'The Next Logical Step'
Bill McGivney, CEO of NCCN, told BioInform that converting the paper-based guidelines into “an electronic format that will be integratable with an electronic health record” is the “next logical step” for the organization.
NCCN, which is a consortium of 21 not-for-profit hospitals and institutions across the US, publishes 110 oncology guidelines that are “recognized and applied as the standard of care in the United States” and are viewed by over 1 million unique visitors per year.
According to surveys of oncologists conducted by NCCN and other groups, around 90 percent of oncologists in the US report that they use the NCCN guidelines in their practice frequently or very frequently.
And, according to NCCN, between 80 percent and 85 percent of cancer patients in the United States are treated by community oncologists, who are the primary target market for the Proventys CDS Oncology system.
McGivney said that while an oncologist in a medical center might specialize in a particular area of cancer, a community oncologist might treat multiple types of cancer and would have to keep up with advances in a number of areas, such as molecular tests, genotype profiles, and protein factor profiles for each cancer type.
“Clearly, their need for information is much more serious and in higher demand than a doctor that just every day treats breast cancer patients and can follow that literature a little bit better,” he said.
[ pagebreak ]
Joan McClure, senior vice president of clinical information and publications at NCCN, told BioInform that the guidelines are developed by multi-disciplinary teams of physicians from member institutions.
“A typical disease-related panel will have a pathologist or two, several medical oncologic surgeons, radiation oncologists, and other specialties as needed for that particular disease type, “she said. “We have also made an effort to have the patient advocacy community represented on some of our panels; they provide a unique perspective to it.”
She said the guidelines follow “step-by-step clinical decision-making pathways” that physicians would typically use to treat their patients from the time of “suspicion of cancer to the point at which the patient completes palliative care or dies.”
She said the steps typically include diagnosis of the cancer, screening, primary therapy, adjuvant therapy if needed, surveillance following treatment, treating recurrence, and palliative care.
The guidelines are updated at least once a year to reflect changing data and, according to McClure, may be updated up to three or four times in a year.
McClure said that NCCN had considered several different informatics partners over the last several years, but was “very impressed” by Proventys’ product prototype.
“It was very clear that [Proventys] had input from oncologists who really understood data, and that was very attractive to us,” she said.
McGivney declined to mention any of the companies that NCCN had considered but he did say that in choosing Proventys, NCCN is working “with a company that has demonstrated expertise, experience, and acuity in developing these systems.”
In terms of the market for the product, Singh said that there are about 7,000 community oncologists. He believes that the tool will primarily be of interest to the 80 percent of community oncologists who don’t have access to EMRs and other electronic tools, though he noted that the company’s focus on integrating data will make it more useful for the 20 percent of oncologists who do have access to those tools.
Rick Morello, vice president of strategy and development at Proventys, agreed. “We think the overall demand for a point-of-care tool that brings these guidelines dynamically to [community oncologists] and makes them relevant at the point of care for clinical decision-making support is absolutely a large market for this,” he said.
While the early adopters of the tool will likely be community oncologists, McGivney believes there will be opportunities for oncologists in academic settings to use the tool as well.
Neither partner divulged specific details of the exclusive agreement, citing confidentiality reasons. But Morello did say that it’s a “long-term arrangement to work collaboratively to build products” and that “the exclusivity refers to building this specific type of decision-support product and delivering it at the point of care.”
Neither Singh nor Morello said how much the system would cost but Morello did say that it will be priced significantly lower than the costs associated with implementing EMRs.
He also said that the system will be sold under a subscription model, but clinicians will also be able to use it through payer-sponsored quality programs.