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The article offers an update on the health information technology platform Cancer Learning Intelligence Network for Quality (CancerLinQ) implemented by the American Society of Clinical Oncology (ASCO) in oncology practices in the U.S. Topics covered include CancerLinQ's aggregation of data from electronic health records (EHRs), the call by the Institute of Medicine for the creation of a rapid-learning health care system, and the aim to improve patient care quality through CancerLinQ.

The article discusses the certification of electronic health records (EHRs) as well as its impact in the practice of oncology in the U.S. It notes the high purchase and implementation risk of health information technology (HIT) for small and medium-sized physician practices which often lack the resources to engage consultants or to navigate a landscape of products of their own. It also highlights the founding of the Certification Commission for Health Information Technology (CCHIT) as an independent, limited liability company (LLC) in 2004. The author cites the three associations that sponsored the founding of CCHIT,which include the American Health Information Management Association. It also outlines the reduction of risks in investing in HIT as one of the missions of CCHIT in 2011.

PURPOSE: Because of expanding interoperability requirements, structured patient data are increasingly available in electronic health records. Many oncology data elements (eg, staging, biomarkers, documentation of adverse events and cancer outcomes) remain challenging. The Minimal Common Oncology Data Elements (mCODE) project is a consensus data standard created to facilitate transmission of data of patients with cancer. METHODS: In 2018, mCODE was developed through a work group convened by ASCO, including oncologists, informaticians, researchers, and experts in terminologies and standards. The mCODE specification is organized by 6 high-level domains: patient, laboratory/vital, disease, genomics, treatment, and outcome. In total, 23 mCODE profiles are composed of 90 data elements. RESULTS: A conceptual model was published for public comment in January 2019 and, after additional refinement, the first public version of the mCODE (version 0.9.1) Fast Healthcare Interoperability Resources (FHIR) implementation guide (IG) was presented at the ASCO Annual Meeting in June 2019. The specification was approved for balloting by Health Level 7 International (HL7) in August 2019. mCODE passed the HL7 ballot in September 2019 with 86.5% approval. The mCODE IG authors worked with HL7 reviewers to resolve all negative comments, leading to a modest expansion in the number of data elements and tighter alignment with FHIR and other HL7 conventions. The mCODE version 1.0 FHIR IG Standard for Trial Use was formally published on March 18, 2020. CONCLUSION: The mCODE project has the potential to offer tremendous benefits to cancer care delivery and research by creating an infrastructure to better share patient data. mCODE is available free from www.mCODEinitiative.org. Pilot implementations are underway, and a robust community of stakeholders has been assembled across the oncology ecosystem. [ABSTRACT FROM AUTHOR]

PURPOSE: To evaluate the completeness of information for research and quality assessment through a linkage between cancer registry data and electronic health record (EHR) data refined by ASCO's health technology platform CancerLinQ. METHODS: A probabilistic data linkage between Iowa Cancer Registry (ICR) and an Iowa oncology clinic through CancerLinQ data was conducted for cases diagnosed between 2009 and 2018. Demographic, cancer, and treatment variables were compared between data sources for the same patients, all of whom were diagnosed with one primary cancer. Treatment data and compliance with quality measures were compared among those with breast or prostate cancer; SEER-Medicare data served as a comparison. Variables captured only in CancerLinQ data (smoking, pain, and height/weight) were evaluated for completeness. RESULTS: There were 6,175 patients whose data were linked between ICR and CancerLinQ data sets. Of those, 4,291 (70%) were diagnosed with one primary cancer and were included in analyses. Demographic variables were comparable between data sets. Proportions of people receiving hormone therapy (30% v 26%, P <.0001) or immunotherapy (22% v 12%, P <.0001) were significantly higher in CancerLinQ data compared with ICR data. ICR data contained more complete TNM stage, human epidermal growth factor receptor 2 testing, and Gleason score information. Compliance with quality measures was generally highest in SEER-Medicare data followed by the combined ICR-CancerLinQ data. CancerLinQ data contained smoking, pain, and height/weight information within one month of diagnosis for 88%, 52%, and 76% of patients, respectively. CONCLUSION: Linking CancerLinQ EHR data with cancer registry data led to more complete data for each source respectively, as registry data provides definitive diagnosis and more complete stage information and laboratory results, whereas EHR data provide more detailed treatment data and additional variables not captured by registries. [ABSTRACT FROM AUTHOR]

The compliance rate was 82% in SEER-Medicare data, which had the most complete treatment information; more instances of androgen deprivation therapy were found in the claims data compared with CancerLinQ or ICR data. Knowledge Generated Demographic data were comparable between data sets, whereas the proportion of patients receiving hormone therapy and immunotherapy data was higher in CancerLinQ data compared with cancer registry data. For researchers, the linkage would provide enhanced data on treatment and risk factors such as smoking and body mass index Furthermore, EHR data (beyond just CancerLinQ data) could add valuable information to registry data. [Extracted from the article]

JCO Clin Cancer Inform; 5: 252-253, 2021 2 Osterman TJ, Terry M, Miller RS: Improving cancer data interoperability: The promise of the Minimal Common Oncology Data Elements (mCODE) initiative. Additionally, as we note in our article, we sought to keep mCODE reductionist and parsimonious, and where a particular data element was available and well specified in another widely used terminology system, particular if not specialized for oncology, we generally chose not to include it in mCODE in an attempt to keep mCODE minimal. We thank Chen and Chiang[1] for their interest in our I JCO Clinical Cancer Informatics i article[2] about the Minimal Common Oncology Data Elements (mCODE) standard and for sharing their thoughtful perspectives about the opportunities and challenges of applying mCODE in the Asia-Pacific region. [Extracted from the article]

PURPOSE: The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requires eligible clinicians to report clinical quality measures (CQMs) in the Merit-Based Incentive Payment System (MIPS) to maximize reimbursement. To determine whether structured data in electronic health records (EHRs) were adequate to report MIPS CQMs, EHR data aggregated by ASCO's CancerLinQ platform were analyzed. MATERIALS AND METHODS: Using the CancerLinQ health technology platform, 19 Oncology MIPS (oMIPS) CQMs were evaluated to determine the presence of data elements (DEs) necessary to satisfy each CQM and the DE percent population with patient data (fill rates). At the time of this analysis, the CancerLinQ network comprised 63 active practices, representing eight different EHR vendors and containing records for more than 1.63 million unique patients with one or more malignant neoplasms (1.73 million cancer cases). RESULTS: Fill rates for the 63 oMIPS-associated DEs varied widely among the practices. The average site had at least one filled DE for 52% of the DEs. Only 35% of the DEs were populated for at least one patient record in 95% of the practices. However, the average DE fill rate of all practices was 23%. No data were found at any practice for 22% of the DEs. Since any oMIPS CQM with an unpopulated DE component resulted in an inability to compute the measure, only two (10.5%) of the 19 oMIPS CQMs were computable for more than 1% of the patients. CONCLUSION: Although EHR systems had relatively high DE fill rates for some DEs, underfilling and inconsistency of DEs in EHRs render automated oncology MIPS CQM calculations impractical. [ABSTRACT FROM AUTHOR]

The goals of this study were to evaluate the efficacy of the mini VIDAS automated immunoassay chemistry system to detect Campylobacter spp. from retail broiler meat enriched in Bolton broth supplemented with lysed blood (B+B) or without blood (B-B), and to detect positive samples at 24 versus 48 h after enrichment. Retail broiler meat was enriched and tested for Campylobacter spp. with the mini VIDAS and with an agar plate. Isolates were speciated with a multiplex PCR and typed with pulsed-field gel electrophoresis (PFGE) to evaluate relatedness of isolates collected from subsamples enriched in B+B or B-B. The number of Campylobacter-positive samples by mini VIDAS was similar (P > 0.05) to the results found with traditional plating media for naturally contaminated broiler meat, regardless of whether the comparison was made between B+B and B-B, or among different meat products (breast, tenders, and thighs). More positive samples were found at 48 h of enrichment than at 24 h of enrichment (P < 0.05). A Campylobacter jejuni:Campylobacter coli ratio of 4:1 was found in this study. Most of the isolates from both subsamples (B+B and B-B) were similar or identical by PFGE analysis, except for a few samples in which the PFGE profiles of the isolates from the subsamples were different. Mini VIDAS allowed for the detection of Campylobacter spp. within 48 h after enrichment. However, the sensitivity is similar to plate media, and retail broiler samples need to be enriched for 48 h to avoid false negatives. [ABSTRACT FROM AUTHOR]

The efficacy of using direct high-pressure hot water (60C, 140F) and a quaternary ammonium compound to clean the inside of stainless steel pipe used to transport chicken giblets was evaluated. The giblets were collected from a commercial processing plant and were inoculated with Campylobacter jejuni. The cleaning system was effective in reducing the numbers of inoculated C. jejuni and naturally occurring mesotrophic bacteria (aerobic plate counts) on the inside surface of the stainless steel pipe used to transport the giblets. However, the decreases in naturally occurring Escherichia coli and coliforms were not significant. These results suggest that additional improvements are needed to better disinfect the piping system used to transport giblets to reduce the potential for cross-contamination with C. jejuni and E. coli. The devised cleaning system could be optimized to reduce the use of chemical agents, the cleaning time and the cost of cleaning pipes in poultry processing facilities. PRACTICAL APPLICATIONS These experiments suggest that the traditional use of hot water and quaternary ammonium compounds to clean the inside of the piping system used to transport chicken giblets may not be sufficient to reduce the contamination with Campylobacter jejuni and mesotrophic bacteria (aerobic plate count). Poultry processors should be aware of the limitations of cleaning closed piping systems and develop and test high-pressure systems to thoroughly clean the pipes used to transport giblets after processing to avoid potential sources of cross-contamination with C. jejuni and mesotrophic bacteria. [ABSTRACT FROM AUTHOR]

PURPOSE: The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requires eligible clinicians to report clinical quality measures (CQMs) in the Merit-Based Incentive Payment System (MIPS) to maximize reimbursement. To determine whether structured data in electronic health records (EHRs) were adequate to report MIPS CQMs, EHR data aggregated by ASCO's CancerLinQ platform were analyzed. MATERIALS AND METHODS: Using the CancerLinQ health technology platform, 19 Oncology MIPS (oMIPS) CQMs were evaluated to determine the presence of data elements (DEs) necessary to satisfy each CQM and the DE percent population with patient data (fill rates). At the time of this analysis, the CancerLinQ network comprised 63 active practices, representing eight different EHR vendors and containing records for more than 1.63 million unique patients with one or more malignant neoplasms (1.73 million cancer cases). RESULTS: Fill rates for the 63 oMIPS-associated DEs varied widely among the practices. The average site had at least one filled DE for 52% of the DEs. Only 35% of the DEs were populated for at least one patient record in 95% of the practices. However, the average DE fill rate of all practices was 23%. No data were found at any practice for 22% of the DEs. Since any oMIPS CQM with an unpopulated DE component resulted in an inability to compute the measure, only two (10.5%) of the 19 oMIPS CQMs were computable for more than 1% of the patients. CONCLUSION: Although EHR systems had relatively high DE fill rates for some DEs, underfilling and inconsistency of DEs in EHRs render automated oncology MIPS CQM calculations impractical. [ABSTRACT FROM AUTHOR]

Presents a case series of patients who developed cutaneous leishmaniasis after local trauma. Acquisition of cutaneous leishmaniasis from the bite of infected female sand flies; Medical records and histories of the patients; Clinical treatment received by the patients.

PURPOSE: In 2014, the ASCO developed CancerLinQ (CLQ), a health technology platform for oncology. The CLQ Discovery (CLQD) database was created to make data available for research and this paper provides a summary of this database. METHODS: This study described the clinical and demographic characteristics of the 12 most common cancers in the CLQD database. We included patients with a new malignant tumor diagnosis between January 1, 2013, and December 31, 2018, of the following cancers: breast, lung and bronchus, prostate, colon and rectum, melanoma of the skin, bladder, non-Hodgkin lymphoma, kidney and renal pelvis, uterus, leukemia, pancreas, and thyroid. Patients with an in-situ diagnosis were excluded. Summary statistics and Kaplan-Meier survival estimates were calculated for each tumor. RESULTS: From 2013 to 2018, 491,360 patients were diagnosed with the study tumors. Breast cancer (139,506) was the most common, followed by lung and bronchus (70,959), prostate (63,303), and colon and rectum (53,504). The median age at diagnosis (years) was 61, 68, 68, and 64 in breast, lung and bronchus, prostate, and colon and rectum cohorts, respectively. Compared to the SEER 5-year overall survival estimates for several tumor types were higher in the CLQD database, possibly because of incomplete mortality capture in electronic health records. CONCLUSION: This paper presents the first description of the CLQD database since its inception. CLQ will continue to evolve over time, and the breadth and depth of this data asset will continue to grow. ASCO and CLQ's long-term goal is to improve the quality of patient care and create a sustainable database for oncology researchers. These results demonstrate that CLQ built a scalable database that can be used for oncology research. [ABSTRACT FROM AUTHOR]

PURPOSE: ASCO, through its wholly owned subsidiary, CancerLinQ LLC, developed CancerLinQ, a learning health system for oncology. A learning health system is important for oncology patients because less than 5% of patients with cancer enroll in clinical trials, leaving evidence gaps for patient populations not enrolled in trials. In addition, clinical trial populations often differ from the overall cancer population with respect to age, race, performance status, and other clinical parameters. MATERIALS AND METHODS: Working with subscribing practices, CancerLinQ accepts data from electronic health records and transforms the local representation of a patient's care into a standardized representation on the basis of the Quality Data Model from the National Quality Forum. CancerLinQ provides this information back to the subscribing practice through a series of tools that support quality improvement. CancerLinQ also creates de-identified data sets for secondary research use. RESULTS: As of March 2020, CancerLinQ includes data from 63 organizations across the United States that use nine different electronic health records. The database includes 1,426,015 patients with a primary cancer diagnosis, of which 238,680 have had additional information abstracted from unstructured content. CONCLUSION: As CancerLinQ continues to onboard subscribing practices, the breadth of potential applications for a learning health care system widen. Future practice-facing tools could include real-world data visualization, recommendations for treatment of patients with actionable genetic variations, and identification of patients who may be eligible for clinical trials. Feeding these insights back into oncology practice ensures that we learn how to treat patients with cancer not just on the basis of the selective experience of the 5% that enroll in clinical trials, but from the real-world experience of the entire spectrum of patients with cancer in the United States. [ABSTRACT FROM AUTHOR]

PURPOSE: Next-generation sequencing (NGS) of tumor and germline DNA is foundational for precision oncology, with rapidly expanding diagnostic, prognostic, and therapeutic implications. Although few question the importance of NGS in modern oncology care, the process of gathering primary molecular data, integrating it into electronic health records, and optimally using it as part of a clinical workflow remains far from seamless. Numerous challenges persist around data standards and interoperability, and clinicians frequently face difficulties in managing the growing amount of genomic knowledge required to care for patients and keep up to date. METHODS: This review provides a descriptive analysis of genomic data workflows for NGS data in clinical oncology and issues that arise from the inconsistent use of standards for sharing data across systems. Potential solutions are described. RESULTS: NGS technology, especially for somatic genomics, is well established and widely used in routine patient care, quality measurement, and research. Available genomic knowledge bases play an evolving role in patient management but lack harmonization with one another. Questions about their provenance and timeliness of updating remain. Potentially useful standards for sharing genomic data, such as HL7 FHIR and mCODE, remain primarily in the research and/or development stage. Nonetheless, their impact will likely be seen as uptake increases across care settings and laboratories. The specific use case of ASCO CancerLinQ, as a clinicogenomic database, is discussed. CONCLUSION: Because the electronic health records of today seem ill suited for managing genomic data, other solutions are required, including universal data standards and applications that use application programming interfaces, along with a commitment on the part of sequencing laboratories to consistently provide structured genomic data for clinical use. [ABSTRACT FROM AUTHOR]

Purpose: A joint data quality initiative between the Cancer Treatment Centers of America and the ASCO big data health technology platform CancerLinQ® was initiated to document and codify the steps taken to evaluate, stratify, and determine the potential effect of data elements used for electronic clinical quality measures as captured within structured fields in electronic health records. Methods: The processes involved the identification of clinical concepts required in measure population criteria and then to map these to the corresponding components of the CancerLinQ data model. A quantitative assessment of mappings between electronic clinical quality measure clinical concepts and attributes from the CancerLinQ clinical database was performed. In parallel, a qualitative analysis of high-impact data elements from the Cancer Treatment Centers of America clinical measures was made using local, expert consensus. Results: An impact assessment was derived using a count of the data elements across measures and the specific population criteria affected. Conclusion: A list of putative high-impact data elements can provide guidance for clinicians to facilitate specific data element capture related to quality metrics in an electronic environment. [ABSTRACT FROM AUTHOR]

Abstract: Early experience of structured inputs and complex sound features generate lasting changes in tonotopy and receptive field properties of primary auditory cortex (A1). In this study we tested whether these changes are severe enough to alter neural representations and behavioral discrimination of speech. We exposed two groups of rat pups during the critical period of auditory development to pulsed-noise or speech. Both groups of rats were trained to discriminate speech sounds when they were young adults, and anesthetized neural responses were recorded from A1. The representation of speech in A1 and behavioral discrimination of speech remained robust to altered spectral and temporal characteristics of A1 neurons after pulsed-noise exposure. Exposure to passive speech during early development provided no added advantage in speech sound processing. Speech training increased A1 neuronal firing rate for speech stimuli in naïve rats, but did not increase responses in rats that experienced early exposure to pulsed-noise or speech. Our results suggest that speech sound processing is resistant to changes in simple neural response properties caused by manipulating early acoustic environment. [Copyright &y& Elsevier]

Purpose: Social media channels such as Twitter are gaining increasing acceptance as mechanisms for instantaneous scientific dialogue. Professional medical societies such as ASCO are using social media to expand the reach of scientific communications at and around their scientific meetings. This article examines the how Twitter use by oncologists expanded at the ASCO Annual Meetings from 2010 to 2011. Methods: In both years, tweets that were specifically generated by physicians and that incorporated the official meeting hashtag were harvested from the public domain, and a discourse analysis was performed by three independent raters. Follow-up surveys were conducted to assess physician attitudes toward Twitter and its potential role in clinical practice. Results: A combined total of 12,644 tweets were analyzed for 2010 and 2011. Although the number of physicians authoring tweets was small (14 in 2010, 34 in 2011), this group generated nearly 29% of the total meeting dialogue examined in this analysis in 2010 and 23% in 2011. Physicians used Twitter for reporting clinical news from scientific sessions, for discussions of treatment issues, for promotion, and to provide social commentary. The tangible impact of Twitter discussions on clinical practice remains unclear. Conclusion: Despite the 140-character limit, Twitter was successfully used by physicians at the 2010 and 2011 ASCO Annual Meetings to engage in clinical discussions, whether or not an author was on site as a live attendee. Twitter usage grew significantly from 2010 to 2011. Professional societies should monitor these phenomena to enhance annual meeting attendee user experience. [ABSTRACT FROM AUTHOR]

Artesunate (AS) is a potent antimalarial that is used worldwide for the treatment of malaria. A simple method with a total run time of 12 min was developed and validated for the quantification of AS and dihydroartemisinin (DHA), its active metabolite, in human (heparinized) plasma based on one-step protein precipitation in acetonitrile using artemisinin (ARN) as an internal standard, followed by liquid chromatography with a single quadrupole mass spectrometry system connected to a C18 column. Peak area ratio responses were fitted to the 2nd-order curve type, polynomial equation with weighting (1/concentration) over a quantification range between 3.20/5.33-3,000/5,000 nM (1.23/1.52-1153/1422 ng/mL) of AS/DHA showing linearity with very good correlation (r² > 0.999). Single ion recordings of 5 μL injections of plasma extracts allowed for limits of detection of 1.02 nM (0.39 ng/mL) for AS and 0.44 nM (0.13 ng/mL) for DHA. The inter-assay and intra-assay accuracy and precision of the method was very good with an inaccuracy of ±12.4% and coefficients of variation of ≤10.7% at all tested concentrations. The recovery of the analytes from plasma was ≥95%. Other commonly used antimalarials including mefloquine, quinine, and chloroquine, did not interfere with the analysis. Post-preparative tests over 24 h in an autosampler (10 °C) showed that the DHA response was only 2.1% of AS from auto-hydrolysis, and β-DHA was the major, stable epimer that was used for quantification of DHA. In contrast, α-DHA increased steadily up to 600%. Artesunate and DHA in plasma were stable through three freeze/thaw cycles for up to 6 h at room temperature and up to one year at -80 °C. [ABSTRACT FROM AUTHOR]

Abstract: Broiler retail samples (n =113) were analyzed to determine (i) the effectiveness of buffered peptone water (BPW) supplemented with blood and antibiotics for the isolation of Campylobacter jejuni and C. coli, (ii) if a 1:4 enrichment ratio performs similarly as a 1:9 ratio, and (iii) if BPW is similar to Bolton broth for enumeration of Campylobacter spp. in retail broiler meat using the most probably number (MPN) procedure. Chi-square comparison showed that BPW performed similarly as Bolton broth (P ≤0.05) for Campylobacter isolation in breast tenders, boneless breasts, split breasts and skin samples. However, BPW showed a lower detection rate (P ≥0.05) for thighs and boneless thighs. When the results were combined, BPW performed similarly as Bolton broth for the isolation of Campylobacter spp. (P ≤0.05). BPW at an enrichment ratio of 1:4 was statistically similar to Bolton broth or BPW at a ratio of 1:9. No differences were observed between the MPN data from Bolton broth and the MPN data from BPW (P ≤0.50). A multiplex PCR assay revealed that ca. 48% of the isolates obtained from Bolton broth and 59% of the isolates obtained with BPW were C. coli. Both Bolton broth and BPW allowed for the growth of C. jejuni and C. coli from the same sample. Remarkably, a large genomic variability was observed by PFGE analysis of the isolates collected from the same sample with Bolton broth or BPW, which confirms that more than one genotype can successfully multiply during enrichment and be recoverable on agar plates. These findings suggest that BPW could be used as an enrichment medium for isolation of Campylobacter from retail broiler samples. The implications of the high number of C. coli isolates found in this study is discussed. [Copyright &y& Elsevier]

Campy-Cefex, a modification of Campy-Cefex, modified charcoal cefoperazone deoxycholate (mCCDA), Karmali, CAMPY, and Campy-Line agars were evaluated for their efficiency to isolate and enumerate Campylobacter spp. from poultry carcass rinses. Campy-Cefex and its modification produced the best results but were statistically similar to CAMPY, mCCDA, and Karmali. [ABSTRACT FROM AUTHOR]