Robert J. Esterhay

Information infrastructure for consumer health: a health information exchange stakeholder study.

BACKGROUND An enabling infrastructure for population-wide health information capture and transfer is beginning to emerge in the U.S. However, the essential infrastructure component that is still missing is effective health information exchange (HIE). Health record banks (HRBs) are one of several possible approaches to achieving HIE. Is the approach viable? If so, what requirements must be satisfied in order for it to succeed? PURPOSE The research, conducted in 2007-2008, explored HRB-related interests, concerns, benefits, payment preferences, design requirements, value propositions, and challenges for 12 healthcare stakeholder groups and the consumers they serve in a U.S. metropolitan area of 1.3 million people. METHODS A mixed-methods design was developed in a community action research context. Data were gathered and analyzed through 23 focus groups, 13 web surveys, a consumer phone survey (nonstratified random sample) and follow-up meetings. Recruiting goals for leaders representing targeted groups were achieved using a multi-channel communications strategy. Key themes were identified through data triangulation. Then, requirements, value propositions and challenges were developed through iterative processes of interaction with community members. RESULTS Results include key themes, design requirements, value propositions, and challenges for 12 stakeholder groups and consumers. CONCLUSIONS The research provides a framework for developing a consumer permission-driven, financially sustainable, community HRB model. However, for such a model to flourish, it will need to be part of a nationwide network of HIEs with compatible HRB approaches able to overcome a number of challenges.

Information Infrastructure for Public Health and Health Research: Findings from a Large-Scale HIE Stakeholder Study

While the information infrastructure to support public health and health research has been dramatically improving, comprehensive, nation-wide, longitudinal, person-centered information has been generally nonexistent. Yet, having such information for large populations is essential to public health and health research. The coupling of internet access, information standards and emerging electronic health records is beginning to provide an enabling infrastructure for population-wide health information capture and transfer. However, the essential infrastructure component that is still missing is effective health information exchange (HIE) that has specific public health and health research-supporting functionality at nation-wide, state-wide and community-wide levels.To better understand the requirements for HIE at a community-wide level, our exploratory research investigated needs and attitudes of over 1200 stakeholders including members of public health, health research and consumer sectors. This paper reports on the studys finding including the functional and infrastructure recommendations of public health and health research stakeholders, and the resultant design attributes for a consumer-centric community HIE which could be linked into a nation-wide HIE network for purposes of improving care, decreasing health related costs and supporting research.

MO‐D‐I‐618‐04: A Cost‐Effectiveness Model for New Radiation Oncology Technologies

Purpose: The additional equipment and personnel costs of supplying Intensity Modulated Radiation Therapy(IMRT) technology have caused many to question if the marginal gains in patient health‐related quality of life are worth the additional cost. A novel IMRT technology, helical tomotherapy, provides the opportunity to study cost and effectiveness for patients. Method and Materials: This methodological study proposes to evaluate the cost and effectiveness of treating conventional radiotherapy versus tomotherapy IMRT patients prospectively, among several institutions. The cost of treating patients varies between institutions, depending on personnel, equipment and overhead costs; however, the nature and quality of services provided are expected to be consistent. Results: The methodology study tracks cost information at a single institution, and simultaneously as the median from multiple institutions. Effectiveness measures include both standard quality adjusted life year instruments completed by patients and performance status measures completed by institutional personnel. In addition, disease specific effectiveness measures are accommodated in the study. Each participating institution uses the same effectiveness measures to track patients with similar disease. Conclusion: The resulting cost and effectiveness data is available to investigators at any point during the study, immediately upon the completion of a trial, or when statistical acceptability is achieved.

WE‐D‐211A‐01: Future Trends in the Supply and Demand for Radiation Oncology Physicists

Significant controversy surrounds the 2012 / 2014 decision announced by the Trustees of the American Board of Radiology (ABR) in October of 2007. According to the ABR, only medical physicists who are graduates of a Commission on Accreditation of Medical Physics Education Programs, Inc. (CAMPEP) accredited academic or residency program will be admitted for examination in the years 2012 and 2013. Only graduates of a CAMPEP accredited residency program will be admitted for examination beginning in the year 2014. An essential question facing the radiation oncology physics community is an estimation of supply and demand for medical physicists through the year 2020. To that end, a Demand & Supply dynamic model was created using STELLA software. Inputs into the model include: a) projected new cancer incidence and prevalence 1990-2020; b) AAPM member ages and retirement projections 1990-2020; c) number of ABR physics diplomates 1990-2009; d) number of patients per Qualified Medical Physicist from Abt Reports I (1995), II (2002) and III (2008); e) non-CAMPEP physicists trained 1990-2009 and projected through 2014; f) CAMPEP physicists trained 1993-2008 and projected through 2014; and g) working Qualified Medical Physicists in radiation oncology in the United States (1990-2007). The model indicates that the number of qualified medical physicists working in radiation oncology required to meet demand in 2020 will be 150-175 per year. Because there is some elasticity in the workforce, a portion of the work effort might be assumed by practicing medical physicists. However, the minimum number of new radiation oncology physicists (ROPs) required for the health of the profession is estimated to be 125 per year in 2020. The radiation oncology physics community should plan to build residency programs to support these numbers for the future of the profession.

Informatics or Information Technology for Cancer Research: Which Is It?

Why am I writing a commentary on the topic of “Informatics or Information Technology for Cancer Research: Which Is It?” The short answer is that I was invited to do so by the Editor-in-Chief because I had raised some issues regarding the use of the term informatics in the title and the text of Ochs and Casagrande’s article, “Informatics for Cancer Research,” published elsewhere in this issue of Cancer Investigation (1). I questioned the use of the term informatics versus information technology or systems on two separate reviews of their original and revised manuscript and recommended revisions to make the manuscript acceptable for publication.