Digital Health Bridges Gaps for Community Oncology Practices in the Age of COVID-19

Debra A. Patt, MD, PhD, MBA, discussed the use of digital health systems, particularly at Texas Oncology locations, and how it can help patients and providers strengthen their relationships.

While the COVID-19 pandemic strained in-person relationships formed between patients and providers, many healthcare professionals turned to the world of digital health tools to help adapt to the new normal.

Digital health solutions offer advanced remote communication between patients and the experts working with them. With COVID-19, these tools have been brought to the forefront, and have been adopted by many healthcare providers. However, barriers to adequate utilization remain.

To further understand and accommodate patients faced with digital divides, patients across our 220 sites of service were examined. Investigators aimed to understand how and why the use of digital health systems may be limited among certain patient populations.

In the study, a total of 7,347 diverse patients were involved with 651,004 digital encounters. According to Debra A. Patt, MD, PhD, MBA, some of the main goals of the study were to assess digital tools, including an electronic patient-reported outcomes program, a patient portal for health records, and digital education for patients.

A total of 9,938 patients engaged in electronic patient-reported outcomes, 49,771 patients in a patient portal, and 12,044 patients in digital education. Findings showed that across all digital health solutions, engagement was high in patients who were aged younger than 65 (72.7%, 79.67%, 54.7%). However, the electronic patient-reported outcomes completion rate for patients aged 65 years and older was higher at 59.0% vs 55.6%. No significant difference was observed in either the patient portal login activity of the digital education read rate.

English patients were significantly more engaged at 68% vs 54% in regard to electronic patient-reported outcomes, 80% vs 62% for those who engaged using a patient portal, and 57% vs 37% for those who used digital education. Additionally, English patients had higher completion of digital utilization than Spanish patients across the digital health solutions (7.31% vs 53.23%, 7.48 vs 7.14, 96.2% vs 90.8%).

Patients living in rural areas made up 25% of the population and participated across tools in a similar fashion to those living in non-rural areas (67% vs 69%, 79% vs 79%, 56.9% vs 56.8%). Overall, while engagement was observed based on age, language, and rural status across the portfolio, patients within these populations continue to utilize the digital health solutions. In order to further understand and explore enhancements of digital health systems, these tools remain under investigation for optimization in regard to patient-specific barriers to care.

In an interview with Targeted OncologyTM, Patt, a practicing oncologist and the executive vice president of Texas Oncology, further discussed the use of digital health systems, particularly at Texas Oncology locations, and how it can help patients and providers strengthen their relationships.

Targeted Oncology: Can you explain the purpose of implementing digital health solutions in cancer care? What information has been revealed regarding the topic?

Patt: I was really excited at ASCO to see all of the innovation in digital healthcare. We talked about our experience with our investments in digital health care across the practice, and how we have used that to serve patients. We've implemented several different digital solutions. What we discussed was how those solutions can close gaps in care delivery by understanding how our patients are using them.

Texas Oncology is a big practice. We have 220 sites of service across Texas, and we are urban or rural and we are in all parts of the state. By understanding utilization trends, it helps us better understand how we can pivot this technology to enhance patient care.

What does this technology currently look like and consist of?

We looked at the utilization trends for four different tools that we use that provide digital health care to patients. One of them is a nurse triage system, which is care management. That's if you have a cancer patient that calls in with a symptom. They get triage to a nurse and the nurse is using triage pathways to manage patient symptoms. The second is an electronic patient reported outcomes instrument, so that is an electronic mechanism or a web-based platform that does a symptom assessment. Again, that symptom assessment if it hits certain triggers of severity, it pushes information to a nurse to intervene. The third is the patient portal, which is a way in which patients can log in to personalized healthcare information about their cancer, their labs, their medication, their diagnosis, and that way they can get information about their health care. The fourth is digital health care education, and that's a patient's specific cancer information or specific treatment information that we're pushing out to them on the portal so they can learn and improve their health literacy.

We have rolled these digital healthcare tools out in collaboration with a partner named navigating cancer. They're a vendor of digital health solutions to help patients navigate their cancer journey. We reported on 300,000 patient touches of digital healthcare to try to understand how patients engaged with the platforms given their different ages, races, gender, distance from clinic and primary language.

What demographics did you look at when examining patients throughout these 220 sites of service?

I was most interested in the age question because whenever we advocate for digital healthcare solutions, we frequently get the concern that older patients won't engage with digital health platforms because they may not be technologically savvy. But what we found is that the 65-80-year-old group were the most engaged in our digital health platforms, which is representative of our patient population as that is the most common age group with cancer in an adult cancer population. That was incredibly reassuring to see those patients, even those who were older, used the platform, so age was my greatest concern.

We also looked amongst ethnicities, gender, distance from clinic, and I would say that in general, everyone engaged with the platform. The other particular concern that I had was around distance from the clinic. I was concerned our rural patients may not have the same access to digital health care because sometimes in rural areas, they may not have the same broadband access that patients do in urban areas. We found that, in fact, they engage more with the digital platforms, particularly the patient portal, so that was really fascinating. There were some differences in utilization of different platforms by primary language, by gender, but broadly, all ages, whether you are a primary English speaker or not, regardless of your ethnicity, or gender, regardless of how far you were from the clinic, people were engaging with the platform. I think that was reassuring. This is a reasonable way to deliver care to patients across our patient population, both for urban and rural Texas.

What were the full findings and how did they influence the way digital health tools are currently being used?

Our full results were looking at the 4 different digital platforms and the 300,000 digital patient touches to understand those characteristics. What it told us was that older patients do engage with all the platforms. We probably do not need additional modification for older patients and they seem to be using them well. Primary Spanish speakers did not engage with some of the platforms in the same way or at the same rate that primary English speakers did. It would probably be useful to have some modifications for Spanish speaking patients. They did have high utilization of the platform, just not as high as primary English speakers.

Women were more likely to use care management platforms than men, and the electronic patient reported outcomes instrument, as opposed to men and women, were as likely to engage in the portal and digital health education. As we think about how we allow digital healthcare to close gaps in care delivery, we appreciate today that it does. It does a good job of improving health literacy, engaging people in their healthcare journey, interacting with the clinical team, and there are some pivots that we can make, particularly around language, to make sure that it's more culturally competent care.

How did the COVID-19 pandemic bring these tools to the forefront?

Before we knew anything about a pandemic, we had already planned to implement these digital healthcare tools. I can remember having a conversation about should we hold our implementation because we didn't know what was going to happen with COVID and we were interested in studying implementation, so [we thought] should we delay it? We elected not to delay it and to move forward. Thank goodness, because the pandemic was longer than any of us had thought that it would be.

There was some other research at ASCO in our cancer meeting that showed that digital healthcare tools were used a bit more during the pandemic because people felt more comfortable interacting with their clinics that way. It helped to close some of the challenges. They were having an interaction with their clinical team during the pandemic, so I thought that was useful. Then, this study that we presented at ASCO looked at utilization, but we have done other work that has shown that using these digital tools and these care pathways reduce time to patient responsiveness, so patients get answers faster. We think that's helpful because it keeps them out of the emergency room and in the hospital because it gets answers to the questions that they need.

As we continue to make pivots to improve upon the platform, we continue to see that those improvements reduce time to patient responses. We want patients to have responses right away. I think that these are all positive changes, and it makes me happy to see the investments in care delivery. I would say more broadly, Texas oncology in the US oncology network has made tremendous amounts of investments in care delivery because we are part of the oncology care model, which is CMIs alternative payment model contract. We've had a lot of different ways that we think about navigating patients through their health care journey. I think that's been helpful for patients and enhances their care. As cancer care becomes more complex, these tools are needed to help patients.

What advancements do you expect to see next in this space? What excites you the most?

I'm so excited about the innovation in this space. At this year's ASCO meeting, there was more on digital healthcare than I've ever seen before. While there are so many bad things that happened out of the pandemic, the good thing is that people engaged with digital health care in a way they hadn't previously. I think it's here to stay. Just like people will work remotely more often, I think they will access their health care more remotely and depend upon digital tools. I think it will grow in general. I think that our suite of services will continue to expand. I meet with other vendors all the time that offer a different suite of services through digital healthcare, and I'm excited as we continue to grow and have more offerings.

Patt DA, Patel AM, Hudson KE, et al. Analyzing patient engagement with digital health tools to facilitate equity across a large statewide community oncology practice. J Clin Oncol. 2022; 40 (16):1575-1575. doi:10.1200/JCO.2022.40.16_suppl.1575
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