As cancer prevalence continues to rise in the United States, demand increases for highly coordinated oncology networks that provide the best possible patient care closest to home. A Kurt Salmon study conducted in the fall of 2010 found that although all regional oncology networks surveyed are in the process of increasing coordination of services and resources, most networks remain at a low or intermediate level of development.
Because many networks remain underdeveloped in certain key areas, investing resources in enhancing the network now can create an opportunity for growth and value in the future.
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The study was conducted to better understand current levels of development and best practices in 3 areas: organization and governance, systems and resources, and clinical care coordination. Examined together, these areas create a broad picture of the maturity of oncology networks. Table 1 lists some of the best practices in each area.
- Organization and governance. The most advanced oncology networks have governance administered through a central oncology network leadership council consisting of key administrative, physician, and nursing leadership. This body has defined authority over network resources across all sites and is coordinated with other governance structures (CEOs of individual sites).
- Systems and resources. Leading networks have developed highly coordinated centralized systems and resources supporting the network. The network has a central administrator and staff who lead, coordinate, direct, and support network development. Leading oncology networks are distinguished by their increased dedication to developing electronic health records (EHRs) and common information technology (IT) systems across network sites. Network planning and budgeting are completed across multiyear cycles.
- Clinical care coordination. This area represents the most underdeveloped aspect of the oncology networks studied. The best practices are implementation of common clinical care protocol sets across all sites, instantaneous access to patient records at any point of care, and demonstration of improved clinical outcomes. All participants envision this as their future state, even though few have achieved it in practice.
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Strengthening Clinical Care Coordination
The study also identified 8 lessons about the interplay between the 3 areas studied and potential priorities for future development (Table 2). Oncology networks interested in strengthening their clinical care coordination can take 3 actions to prepare for future models of care:
1. Ensure the network has a strong central leadership body that is able to prioritize initiatives and secure resources across sites. The ability of the network to conduct coordinated planning and multiyear budgeting is essential to advancing EHR and clinical care initiatives as well as balancing oncology priorities with alternate service line investments within hospitals and systems.
2. Evaluate current EHR resources and plans to understand how they support or hinder clinical care coordination and quality treatment delivery regardless of where the patient accesses care. The free flow of clinical information among providers is the key differentiating feature of leading oncology networks. This may be accomplished in a number of ways (eg, single oncology EHR or multiple interfaced systems); however, greater integration of clinical information will be required for future success.
3. Create staff roles that support current clinical information needs. The realities of living in a largely paper-based care environment can be greatly improved by defining functional support roles, such as tumor registrars, clinical coordinators, and tumor board coordinators. These functional staff members provide expertise to smooth clinical information flow and ensure providers have access to all necessary care records.
Over the past decade, the major focus of oncology networks has been on forming the organization and developing basic resources. To date, little progress has been made in coordinating clinical care protocols and standardizing treatment processes across the network. Leading networks see advancing clinical care coordination as the next important area for network development and are creating multiyear plans and budgets to support this goal.
We expect many networks to address the key challenges and barriers to coordinating care over the next few years by engaging physicians; developing dedicated staff assignment; and investing in information technology systems, interfaces, and health information exchange. Achievement of clinical care coordination will significantly improve the network’s value and prepare the organization for the future healthcare environment.
For more information, please refer to the Kurt Salmon white paper at www.kurtsalmon.com/oncology.
Gerard M. Nussbaum and Laura Rehfeld have more than 30 years of experience advising hospital and health system leaders. Kurt Salmon offers strategic planning for clinical programs; developing cutting-edge, operationally efficient facilities; and designing agile information management environments.