As clinical oncologists, we are experiencing unprecedented challenges to our research, therapeutic and practice management skills brought on by the necessity to manage the geometric increase in medical information and the striking changes in the clinical practice of oncology. The clinical oncologist must be a clinician, researcher, educator, businessperson, statistician, healthcare administrator, and informatician, who must interact with the whole patient, both as a specialist and as a primary care physician. These skills must be assimilated into our daily clinical practice and research activities, while we continue to improve our quality for a much more sophisticated consumer and payer.

Information management has become the most frustrating aspect of our professional life. Cancer patients receive intricate multimodality therapies for their complex diseases, requiring greater access to, and tracking of, detailed medical data. Disease management clinical guidelines for cancer patients require the micromanagement and economic awareness of patient care. ¹ Clinical trials, which demand intense documentation, must not only show progression-free and overall survival benefits but now must also display cost-effectiveness and patient satisfaction. ^{2, 3}

The digitalization of information, the ability to network or connect computers, and the rapid electronic interchange of information on a worldwide basis are recognized as the hallmark of a new order in society (Figure 162-1). For oncologists to master these profound changes, it is necessary to embrace the medical tools of the Information Age. These tools include the computer, which acts as the information gateway and integrator, the Internet's World Wide Web (WWW), which coordinates interactive information resources and personal communication, and the electronic medical record, which is the translator and repository of our clinical information gathering. Information technology and personal computers have transformed every other profession and are now revolutionizing medicine as well.

Figure 162-1

The Digitalization of medicine 1985 to 2003. This figure depicts the swift chronologic evolution of the oncologist's personal, professional, and oncologic uses of information technology from 1985 through 2002 using the unprecedented improvements in computer (more...)

Our chaotic healthcare system continues to confound our nation with inadequate funding for clinical care, research, teaching, continued dominance of managed care's flawed concepts, decreased reimbursements especially for oncology, a panoply of health care players with vested interests and severe underuse of information technology. Despite all the money invested in research, little is used for the more prosaic technology needed for gathering, analyzing and making use of data from all these medical discoveries. Oncologists remain uncomfortable with the nexus of technology and medicine. We are taught by observation and textbooks and by using our diagnostic skills with continued reliance on memory and experience.

Several recent influential groups, including the Institute of Medicine, ^4–6 the President's Information Technology Advisory Committee, ⁷ and the President's Cancer Council, ⁸ have released assessments of our healthcare system that highlight its many inadequacies and the need to apply advances in information technology to improve administrative and clinical processes. The reports criticized the variation of cancer treatments by locale, the lack of using guidelines and care plans based upon best-available evidence, the absence of tools to measure and monitor quality of care using core sets of quality measures or an electronic medical record and poor patient accrual to quality clinical trials. They also found major impediments for cancer patients to obtain compassionate psychosocial and palliative care. They stress the absence of any progress in restructuring health care to address both quality and cost concerns. Despite 10,000 clinical trials that are conducted annually that provide many medical advances, we do not efficiently translate this knowledge gained from research and development into routine clinical care, sometimes taking 15 to 20 years and even then its adoption into routine clinical practice remains uneven. There is a convincing need for our healthcare system to methodically collect, analyze, and deliver medical evidence to physicians and patients.

Healthcare consumerism is an increasing fact of life that is fueled by the Internet and our economic prosperity. It is driven by individual autonomy, skepticism of the professional, governmental, managed care, and corporate dominance in healthcare, the women's health movement, complementary medicine, informed consent, increased malpractice litigation, Internet consumer information, patient-directed drug advertisements, patient support groups, and patient-directed lab and procedure ordering. Consumers do not understand healthcare quality and true cost, however, and they cannot easily navigate the complex healthcare system. Consumers are always better served when they navigate the complex healthcare system with physician assistance.

The delivery of patient care in the United States is disjointed, especially when considering the mobile society, patients who change practitioners and health plans every 3 years on average, the absence of any coordination of the patient's longitudinal medical record, and the lip service given to screening and prevention of disease. Healthcare delivery automation, with the exceptions of practice management, results reporting and financial software, is shamelessly underused despite the nonmedical world's rapid acceptance of the tools of the Information Age. Similar changes are occurring in healthcare delivery using computerization, electronic medical records, and the Internet. While the delivery of oncology care is plodding along, there has been a spectacular increase in the knowledge base of oncology. Merging recent innovations in computerization and biomedical technologies, scientists have deciphered the human genome. Soon we will be able to inexpensively determine for each individual which of their 40,000 genes are missing, damaged, or overworking. ⁹ Medical illnesses will be discussed in relation to their genomic, genetic, and proteomic findings. Our medical system will be forced to put a greater emphasis on personal cancer prevention, health-risk appraisals, and predictive oncology based on a patient's genetic data. This will translate into lower healthcare costs through earlier detection of cancer.

If our healthcare system is to thrive in a rapidly changing medical universe, all the participants—providers, patients, administrators, researchers, educators, payers, industry, and the government—must understand the laws of the Information Age. They must invest the time and energy to harness the vast untapped powers of computers, the Internet and electronic medical records. By combining the huge cost-saving potential of computerization and Internet telecommunication, technology will provide a logical framework for healthcare.

With secured and confidential electronic medical records and the acceptance of community health information networks (CHINs) that electronically link, on a regional basis, all patients, practitioners, payers, hospitals, benefit managers, commercial laboratories, and drug stores, our healthcare system could become cost-effective and efficient. Building on fundamental strengths and with a common spirit of compromise and sharing, we could look forward to a healthcare system that maintains its world leadership in the production of clinical and basic science oncologic research, and strives to achieve equivalent excellence in the delivery of oncologic healthcare and the oncologic education of healthcare providers and patients.