Dr. Robert S. Miller Discusses Role with ASCO’s Institute for Quality, ‘Big Data,’ and Future of Oncology Care

Dr. Robert S. Miller Discusses Role with ASCO’s Institute for Quality, ‘Big Data,’ and Future of Oncology Care

When ASCO named Robert S. Miller, MD, FACP, FASCO, medical director of the Institute for Quality (iQ) in September 2014, the appointment felt like a perfect fit.

After 23 years assisting patients in private practice and serving as assistant professor of oncology at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Dr. Miller welcomed the chance to work with a wider audience.

“It was the opportunity to do things at a level where I could help more customers,” Dr. Miller said. “Whether it’s a patient or a colleague, I could help people more than one at a time.”

Dr. Robert S. Miller
The ASCO Daily News sat down with Dr. Miller to discuss his role with iQ and the future of oncologic care.

Daily News: What is your role in facilitating the Quality Oncology Practice Initiative (QOPI®)?

Dr. Miller: My role is to tie together our content development. Generally, all of QOPI and quality starts with a clinical practice guideline. There are levels of medical evidence, and these get codified and analyzed by our content experts.

The content experts analyze the science and say what the right answer should be, but it doesn’t stop there. Then they have to create a measure, which is a question about some aspect of the care a patient received or a process that took place in the clinic.

This has to be worded in a very specific way, so my team has to be experts in the language and wording. Then they have to create the technical specifications to make sure that the question is being asked in the right way and the answer it produces truly reflects the care delivered and what happened clinically. Then they field test the measures to see how well they perform in actual patient populations, before incorporating them into some type of an assessment program, such as QOPI.

Daily News: CancerLinQ is scheduled to launch this year. Right now, data are recorded from the approximately 3% of patients with cancer who are enrolled in clinical trials. How will CancerLinQ more securely analyze millions of electronic health records (EHRs) and change cancer care?

Dr. Miller: In addition to capturing the 97% of data we are missing, I believe CancerLinQ will be an invaluable tool for practicing physicians. Most physicians are very unhappy with their current electronic tools. They are not attuned to the way a doctor’s brain works. More importantly, they are not attuned to the workflow of a practice.

We’re designing CancerLinQ to be attuned to both of these areas. We’re helping physicians gain new insights into the care of their patients.

Daily News: How has the quality of cancer care changed over the course of your career?

Dr. Miller: Science is advancing so rapidly now as part of the genomic revolution. We can now understand what really drives a cancer. So instead of just saying, ‘I’m going to give someone chemotherapy to try to kill as many cells as possible,’ now I understand many of the mechanisms that make these tumor cells grow and divide.

There’s now the ability to determine what genes are mutated or otherwise altered through sequencing. The amount of data being produced is staggering, and we are finding hundreds of thousands of alterations in the genome we never knew about before. For most of them—the vast majority, perhaps—we don’t know their meaning yet or what drugs or other therapies we might use to target the mutation. But by using clinical trials and ‘big data’ in a thoughtful and patient-centered way, we will gain these insights. The term ‘precision medicine’ gets used a lot these days, but finding the right treatment for the patient that more closely matches his or her individual characteristics is a way of improving the quality of care.

Daily News: In your opinion, what is the future of cancer care?

Dr. Miller: So many of the challenges we are facing today are tied to fundamental flaws in our health care system reimbursement. Historically, we have always just reimbursed based on episodes and quantity. The more services you deliver, the more fees you can collect, regardless of what you do within that service or patient encounter.

That’s changing, although it’s not changing as fast as we expected it to a few years ago. But there are plenty of examples of this already happening. If you’re going to be reimbursed on the quality of care you deliver, you have to be able to measure it. That’s what our QOPI program is about.

I’m sure basing reimbursement on being able to demonstrate the quality of care is only going to become more embedded in the system. We’re going to get smarter as to what the right quality measures are. As we get a little more sophisticated and have better data—and this is where CancerLinQ is going to come in—we are going to be able to measure outcomes.

Daily News: Why should doctors consider enrolling in QOPI?

Dr. Miller: It’s inevitable that doctors will be measured on their ability to meet quality metrics, so they should start preparing for that now.

Physicians better learn to adjust their practice so that they can demonstrate the quality of their care and adherence to guidelines because they can’t get away with not doing that for much longer; soon they’re not going to get reimbursed for their services without doing so.

Of course, the most important reason is that it is the right thing to do for our patients and to improve cancer care.