Mark Hulse, CIO, Moffitt Cancer Center, Chapter 1

If you think most hospital CIOs have a lot on their plates, you’d be absolutely right. And if you also think cancer center CIOs have even more, you’d win another prize. That’s because not only must they sate the clinical side of the house, but a voracious need for data on the research side constitutes a thirst that never gets quenched.  As such, Mark Hulse, CIO at Moffitt Cancer Center, is a busy man. In this interview, he talks about the center’s march toward ever greater degrees of automation, and how every step marks an advantage in research that means hope for cancer patients.

Chapter 1

• About Moffitt
• The TCC initiative
• Finding candidates for research studies
• Bringing personalized medicine to cancer care
• Building a vendor team to match Moffitt’s vision

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What it means at the practical level is that we have both clinicians and researchers who are organized and work together as part of the specific programs; so we really have clinicians and researchers sitting across the table from each other.

So we’re still not quite at a point of total electronic interchange, but it’s definitely on our radar screen. It’s really where we want to go.

We put together a lot of functional requirements and asked vendors, “Can you do this or not?”

Gamble:  Hi, Mark. Thank you so much for taking the time to speak with us today about the work you’re doing at Moffitt Cancer Center.

Hulse: Sure, it’s my pleasure, Kate.

Gamble: To start off, why don’t you give our readers and listeners some basic information about Moffitt – in terms of the size of the organization and some of the affiliates, things like that.

Hulse: Moffitt is based in Tampa, Fla., and for folks who may not be familiar with that, we’re at the center of Florida on the west coast, on the Gulf of Mexico side; and we are a National Cancer Institute-designated Comprehensive Cancer Center; actually we’re the only NCI designated Comprehensive Cancer Center in the state of Florida, so it’s kind of a unique distinction for us.

What that comprehensive status means is that not only do we really treat patients with all types of disease and we have clinical expertise on many types of cancer diseases, but we also have a very rich research program with a lot of breadth and depth that supports clinical care.

In terms of size, Moffitt is a little over 200 beds, I think, we’re about 206 inpatient beds, but most care and oncology is provided on the outpatient side; so we do see about, I think, a little over 300,000 outpatients a year.

Moffitt has about 4,000 employees today, and we actually have close to 180 new employees in IT.

Gamble: One of the things I really wanted to talk a lot about today was the research component and, specifically, what you’re doing with the Total Cancer Care initiative. Why don’t you give some background about the program.

Hulse:  I’d be happy to; so Total Cancer Care actually encompasses several different things at Moffitt. I’ll just abbreviate it as TCC or you may refer to it that way. At the conceptual level, TCC is really a comprehensive approach to cancer treatment and prevention that enables researchers and clinicians really identify the overall needs of the patient and their family.

What it means at the practical level is that we have both clinicians and researchers who are organized and work together as part of the specific programs; so we really have clinicians and researchers sitting across the table from each other, if you will, taking a look at not only how to treat this specific patient’s disease, for example, but what our research really needs to get to the next level.

TCC is also being characterized, I think, as Moffitt’s approach to personalized or what is sometimes called precision medicine. Just give a little bit of background on that for folks who may not be familiar — so under the current paradigm of medicine, patients are provided with what’s considered standard care for their disease. If the patient doesn’t show progress, they try a different or second round of therapy, etc. Under personalized medicine, the goal is really to try to understand how to treat them based on their specific profile, based on what’s worked and what hasn’t for patients with similar profiles. We’re very much, across the board, at the early stages of this, so that’s the best general idea of what we mean by personalized medicine.

In terms of how we organize TCC at Moffitt for research, we actually developed a consortium of 18 hospitals, 17 other hospital in addition to Moffitt in about 10 different states. As part of the TCC research protocol, we ask them three questions: one is, can we follow you for life because it’s really important for us to understand cancer as a life-long disease, it’s important to understand the various stages of remission and exacerbation of different disease and to learn how our patients are responding, based on the treatment and other data information.

The second thing we ask is this: if they’re having surgery and if there’s tissue, if we could take a sample of that tissue and biobank it so we can do general work and have regular study on that tissue later on.

Then the third question we ask is: if there’s a particular discovery that we think is pertinent to that patient, for example, if there is a clinical trial that they may have some benefit from, can they be contacted in the future.

So to date, in Total Cancer Care, we’ve consented over 80,000 patients at this point. We collected about 30,000 tumors in our biobank and 15,000 of them had been profiled, and so obviously all of this has lots of ramifications for IT.

Gamble: Yes, definitely. One of the things I want to touch on is how this data is exchanged among the consortium of 18 hospitals?

Hulse: Yes, that’s a great question. So today while we do have some hospitals that have integration of electronic medical records and we’re able to capture some of that data electronically, to date, most of it is still done by abstracting from paper records or from people abstracting from different electronic systems such as lab and radiology and pathology.

So we’re still not quite at a point of total electronic interchange, but it’s definitely on our radar screen. It’s really where we want to go.

We also talked about the research-information exchange. We’re actually in discussions about that with several different NCIs at this time; so that would be the ideal place we’d like to go to be able to pull all this data electronically, but the fact of the matter is we’re still much paper. So we abstract it and put that into a data model and that data resides within the data warehouse that we call the Health In Research Informatics Platform.

Gamble: In terms of within your own organization, I know that you’re working with some of the Oracle products, what are some of the solutions that you’re using?

Hulse: We started out with a database of information that was being collected, and we really needed to move to the next level to analyze the data that’s being collected as a part of TCC. Probably about two years ago, we started on a journey to really think about what was needed; and we created what’s called the request concept. We put together a lot of functional requirements and asked vendors, “Can you do this or not?” we took a little different approach and we engaged folks from Moffitt, key stakeholders, everyone from basic scientists to clinicians involved in translational research and we said, “What kind of system will you need five to seven years from now?”

So we created a number of different use cases, scenarios, and put that together in kind of a comprehensive vision and sent that out to about seven different vendors, all of them industry leaders and business intelligence and healthcare analytics leaders. We essentially asked them to respond how they, in partnership of the other vendors, would work with Moffitt now to help us realize this vision. In the end, we ended up creating a four-way partnership between Moffitt and three other companies: Oracle, as you mentioned, really provides the framework and the underlying technology platform to support the data warehouse. That provides the research informatics platform, what we call enterprise healthcare analytics which is a series of products, the key component of which is Oracle’s healthcare data model. The data model, as folks familiar with the database will know, is really the key structure that represents all of the rich clinical and tissue data we need to store, and so it provides us with a very high quality data model.

We’ve got many different systems in which Moffitt collects, for example, demographic data, they’ll capture it in slightly different ways, so we can form that data into a standard approach using work with our healthcare data model.

And then another vendor we work with is a company called Transmed and Transmed provides the tool that’s used by our research to identify patients. We went live with the first phase of our health and research informatics platform last October; what we released was Moffitt data — which is the Moffitt component of the data — to our own research community at Moffitt.

What it does is give them the ability to query the platform using inclusion-exclusion criteria to quickly to see how many patients fit that criteria.

Before we did this, if they were interested in a particular grant or if there was a clinical trial and they wanted to know how many patients at Moffitt would be eligible, it could take up to a month to comb through all the data try to contact patients, etc.

Now that we have all of that information in one platform, it literally takes a few minutes, so we significantly have been able to improve the trial of trying to identify the scope.

Gamble: In terms of identifying candidates for trials, I’ve heard that can be very difficult.

Hulse: Absolutely. Often you have trials looking for patients; so oftentimes, if it’s an investigator-initiated trial at Moffitt or if we’re doing it in conjunction with a pharmaceutical company, typically it’s sending communication out to physician practices or other clinics and saying, “If you have patient who fits this criteria, have them contact us,” and, as I said, it may take months or even years to find enough patients for two or three clinical trial.

It’ll still be awhile, I think, before we can pinpoint a patient specifically and say, “We have exactly, let’s say, 500 patients who fit that exact criteria. We can certainly accelerate the timeframe much more quickly though, because we can capture most of the criteria today. We may not have every bit of data that’s needed, but we have the majority of them.

The other area we’re looking at is the whole consenting process and how can you, if you will, keep open a pipeline, or enough patients to our consent and we have their information available.

So today we take the approach of a typical consenting of the patient in the clinic and describe TCC to them and ask them if they’re interested in consenting. A lot of them already do, but we know we have to extend the nature of that; so we’re actually looking at doing online consenting where patients can access all the information they need about the study and do an online check.

Chapter 2 Coming Soon …