On June 1 in Chicago, at the annual meeting of the American Society of Clinical Oncology, a mobile computer application under development at Vanderbilt University Medical Center, called SMART Precision Cancer Medicine (PCM), was featured in a demonstration of improved cancer care coordination through clinical data interoperability and electronic clinical information sharing.
SMART (Substitutable Medical Apps and Reusable Technology) is a computing platform designed to allow apps to work with all manner of medical record systems. The idea behind this type of technology is that clinical data should flow through the health care system as easily as account data flow through the financial system. Perhaps only as that occurs will automated clinical decision support and evidence-based medicine truly come into their own.
SMART PCM runs on smartphones and tablet computers and is intended one day to help cancer patients and their doctors understand and act on genetic test results. It communicates with medical records systems using a new interoperability language called FHIR, for Fast Healthcare Interoperability Resources.
Genotyping is becoming common for at least some types and some stages of cancer, and according to the expert who leads development of SMART PCM, Jeremy Warner, M.D., MS, assistant professor of Medicine and Biomedical Informatics, there are several hundred genetic variants (and counting) with known implications for cancer treatment and prognosis.
“The question of what patients understand, and, for that matter, what clinicians understand, is an open one as we get into a really complicated space with clinical genetics and cancer. So that’s an area for research.
“The sky is the limit,” Warner said of the potential benefits of clinical data interoperability and apps like SMART PCM.
As work on the app continues at VUMC, Warner said the team is building in survival prediction, and linking the app to additional cancer clinical decision support knowledge bases.
“Patients want to know obviously what kind of cancer they have and what that means, but they also really want to know how they can expect to do, and it turns out that survival is affected by the mutation status as well as more conventional indicators,” Warner said.
The demonstration in Chicago highlighted the advantages of data interoperability by following a hypothetical colon cancer patient through risk assessment in the clinic, genomic testing, surgery, chemotherapy administration and home care.