FEATURE · ANALYTICS/AI
ensure that it's safe for deployment vs. an application that is gaining administrative efficiencies. There are a lot of burdensome parts of our healthcare system such as prior authorization. A lot of those opportunities to relieve the administrative burden are some of the easiest and safest places to begin to start gaining efficiencies.
HCI: Is health equity in oncology another area where Flatiron has an interest? I saw one of your company’s presentation titles from the recent ISPOR conference was about using the data to highlight measures of neighborhoods, structural racism and overall survival among patients with metastatic breast cancer. Another was about racialized economic segregation and inequities and survival among patients with multiple myeloma. Are you looking at the data to see where inequities exist in the system? Adamson: Absolutely. We started by look- ing at the effect of Medicaid expansion on reducing racial inequities and timely can- cer treatment. Then Flatiron hired a lead researcher for health equity. And since then, we've had a really robust amount of incredibly rigorous research. The life sci- ence companies that we partner with are responding to new guidance from the FDA for diversity planning. One of the benefits of having access to real-world data is that there are people in the real world who use these drugs who were not represented in the trial. They can be from historically marginalized communities or lower socioeconomic sta- tus, and they didn't have access to clinical trials. Sometimes it's in a post-marketing commitment or requirement or it could even be in a clinical trial planning phase to identify sites or more proactively recruit to be able to get a representative clinical trial. But at the end of the day, we as a society want to make sure that these drugs are safe and effective for everyone in the population for whom the products are indicated. For groups that are underrepre- sented in the trial, that's where we've done a lot of research to be able to understand how safely these drugs are working.
HCI: Flatiron recently announced a partnership with Sanofi about improving clinical data trial acquisition by digitally transferring data from the EHR to the clinical trial’s electronic data capture (EDC) system. Has that
been a problem for health systems participating in clinical research for a while? Adamson: I personally worked in clinical trials for years before joining Flatiron, and one of the resource-intensive, burdensome responsibilities in conducting trials is following all of the protocol-mandated documentation. There's been a lot of unnecessary duplication of documenta- tion. A doctor might be caring for the patient on one computer, working in the EHR, recording all the information that's guiding their treatment decisions, and how well the patient is doing, and then moving to another computer and filling out everything that's needed to be collected for the clinical trial. And it's just absolutely not necessary. One of the barriers has just been the technology to be able to get rid of that duplication. Because Flatiron has EHR software that is able to document things with regulatory grade quality and curation, it gives us a huge step up in being able to develop these new products that are being deployed and used in prospective clinical trials.
HCI: Another recent
announcement was that you were offering integrated real-world evidence solutions — end to end services. How does that differ from what the company has been doing previously? Adamson: We're at an inflection point. We have this decade of experience delivering high-quality real-world datasets. Now we are expanding into delivering evidence. The first stage is curation of data and then the second stage is generating evidence and insights from it. That's really where a lot of my expertise comes into play, which is designing studies to answer research questions. Flatiron as a service now, from end to end, is offering that intellectual methodological partnership to understand the research question, support designing the study, using Flatiron’s real-world oncology data, to be able to conduct the experiment and be able to generate meaningful results. It is really fulfilling for me because as a scientist who's been generating evidence at Flatiron for years, it's not always something that we've made readily accessible to clients, even though they've been demanding it for a long time.
HCI: I write sometimes about large federated data networks like PCORnet. The researchers there are also doing real-world
data studies. Do you think that's comparable to the kinds of things that Flatiron is doing? Are there more challenges working across multiple health systems? Adamson: Well, I love PCORnet. It's a challenge to curate data with clinical depth when you're covering lots of disease areas. Flatiron has had the advantage of a decade of staying really focused on cancer, because it's hard to have both depth and breadth. We've seen this as a challenge for many other real-world data companies. One of the approaches Flatiron has taken is having oncologists on staff as part of the team designing our data models. That has allowed us to create products that are refreshed every single month, and that can be used to answer lots of different questions. I think that everyone's efforts to learn from real-world data are important, and it's really hard to do.
HCI: Well, could someone else become the Flatiron for diabetes or the Flatiron for heart disease? Or are there different challenges around those diseases that would make this approach more difficult? Adamson: There are different challenges for every different disease area. The way that you would need to approach it to be able to get complete data would be different. One of the unique things about cancer is that people are seen by oncolo- gists at cancer clinics. But it's difficult to understand people's experience who are living with HIV and cancer because they're seeing a different doctor for their HIV than for their cancer doctor. When we look at COVID, one of the reasons why the UK and Israel were much more agile ind being able to generate real-world evidence is because they have universal health care that includes primary care. If people aren’t yet sick, they have a good understanding of who that denominator is in the general population. At Flatiron, we are able to answer questions about people that we know have cancer and are getting treated. We would not be fit for purpose to answer a question like: here’s the entire U.S. population who might be about to develop cancer, because we don’t have visibility into it. For every different disease area, the care navigation is different. To become the Flatiron for heart disease or Flatiron for diabetes, you really have to be able to have visibility into where those patients are during the part of their journey that you want to get insights into. HI
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