User Story: Surgical Oncology
Ordering Provider
Byrne Lee, MD, Clinical Professor, Surgical Oncology
How did you hear about the informatics consult program?
One of my colleagues, Andy Shelton, advised me to look into the services being provided to answer clinical questions being proposed.
What is your primary area of interest?
I spend about 75% of my time in clinical care and the rest in research and administrative functions. I specialize in the surgical treatment of peritoneal metastasis and HIPEC, which is generally only offered at large academic medical centers. As a result, many patients do not have access to this treatment – this type of health disparity is one of the things I spend my administrative and research time studying.
Our cancer center is looking to expand geographically and beyond just serving the most severe patients in our region. To do so, we need to understand the needs of the other 90% of people in the Bay Area that don’t have easy access to Stanford.
As someone of Chinese descent, I’m especially interested in learning more about how we can better serve the large Asian population here through expanded access to translators, multilingual providers, and better data on utilization of services like palliative care and hospice that tend to vary across demographic groups.
What question(s) did you ask the Atropos informatics consult service?
Do factors such as treatment with chemotherapy or radiation affect the 5-year survival in patients diagnosed with malignancies of the soft tissue and abdomen?
For patients with malignant bowel obstruction who get treated surgically vs conservative management is there a difference in outcomes?
For patients with malignant bowel obstruction who get treated surgically vs conservative management is there a difference in the number of ED visits within one year?
Why were those interesting to you?
One of the conditions I commonly treat is malignant bowel obstruction. These can occur in late-stage cancer of many types, not just colon cancers, so patients present to us from multiple places. Because of this, it is extremely difficult to develop useful algorithms on how best to treat the condition. The more data we have on these patients and their outcomes, the closer we’ll be to more granular pathways.
If we can isolate the drivers in variation across cost, length of stay, and other outcomes for the roughly 5000 malignant bowel obstruction patients we treated over the last few years, we can dramatically improve the lives of countless future patients.
What would you have used to answer this type of question in the past (before the informatics consult service was available)?
As clinicians, getting access to the right data through Epic or other hospital administrative processes can be extremely difficult.
We have to use tools like REDcap and work with data support teams that don’t have the incentive to meet with us to support our work – they have dozens of other projects in their queues.
Now that everything has moved to Epic, I can’t just go to the medical records department to have them pull 500 charts on a certain type of patient. The process is obviously more secure, but it limits the research we can do.
How was the experience different with Atropos?
The turnaround time being days instead of months is a major improvement. And more than just the speed, Atropos data allows me to line up a discussion with key stakeholders before I’ve even gotten broader buy-in for my projects. It also helps me define questions more concretely for formal research and quality project proposals.
Using data that Atropos was able to provide, our group has submitted two grants for further study!
Any closing thoughts?
The service has been very helpful in terms of interrogating questions that we all have as clinicians – to test out whether it’s worth spending a month investigating a hypothesis or to improve the likelihood of success for a research project.
Byrne Lee, MD, Clinical Professor, Surgical Oncology
