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Tackling Precision Medicine with a New Kind of Decision Support

Intervention Insights' new platform, Trapelo, was designed to resolve the complexities of precision medicine in real time.

Intervention Insights has developed a decision support platform that aligns the priorities of oncologists, labs, and payers within the practice workflow, eliminating the need for prior authorization and speeding up access to the most appropriate treatments for cancer patients.

When Clynt Taylor joined Intervention Insights two years ago as CEO, the Burlington, MA-based company had already developed a platform that was being used to inform the results of molecular tests in oncology. At that time the platform was designed to take results from a molecular test and supplement that information with levels of evidence to help doctors determine which available treatment option had the highest level of evidence to support it.

It was a good idea, Taylor says, but when the company started in 2011 the need for that service was greater than it is today.

It wasn't long before Taylor recognized that the real unmet need was to help doctors determine who should be tested, what they should be tested for, what labs should be used and what products are offered by those labs, what will the patient's insurance company pay for – and perhaps more importantly, what will it not pay for – and if three labs qualify can the doctor use the one that they prefer? And on top of all that, there was a need to push the order automatically because about half of the orders placed today are placed on paper, he told MD+DI.

From there, Taylor spent a lot of time in oncology practices asking providers what their biggest challenge is for using precision medicine and the consensus was that when the lab results come back doctors have a hard time standardizing the approach they use because every lab looks at the information differently. So there was a need to somehow create a way to normalize the results from multiple labs in order to ensure that the clinical decisions being made were consistent with the latest evidence.

That's what led to the idea of Trapelo, a decision support platform aimed at aligning the priorities of oncologists, labs, and payers within the practice workflow, eliminating the need for prior authorization and speeding up access to the most appropriate treatments for cancer patients. The platform is designed to incorporate the most current published evidence along with the cancer center's own pathways to ensure every patient gets the most appropriate tests from preferred labs, and the most appropriate treatment, including clinical trials.

In developing Trapelo, Intervention Insights realized the importance of solving the precision medicine problems for all stakeholders, meaning the doctors, the labs, and the payers, because just solving the problems of one of those stakeholder groups would not be enough to really make a difference.

"That's what led us to the idea that we need a single platform that's deeply rooted in clinical evidence that's kept up to date in real time every single day but with a set of applications that can solve these problems and can be used by payers, labs, and providers together so that they can solve the complexities of precision medicine in real time," Taylor said.

Of course, doing so was easier said than done.

Taylor said the biggest challenge the company has had to overcome to make Trapelo what it is today is overcoming the inertia that is inherent within the healthcare system that "always seems to stand up and rear its head in the face of innovation."

Fortunately, that challenge is not insurmountable.

"The pressures that are now being put on oncology practices are really intense and it's causing practices to say 'okay we're willing to talk with you because you have an approach that could help us get there.' The same is true with payers," Taylor said.

Take the traditional prior authorization process, for example. Prior authorization looks at the very last stage in the decision process for an oncologist. It's basically the insurance companies telling the doctors that after they have decided what course of treatment they want to pursue, they have to ask the insurance company if it's okay to prescribe that treatment or not. By that point, the doctor has already decided which test to use, where to get that test performed, and they have interpreted the results of that test and decided what treatment they want to order. Then they have to go down the hall and give another staff member the task of logging into that payer's portal and re-entering all the information to seek prior authorization. Taylor said 20% of the time that information is misentered, which leads to bad results.

City of Hope, a private, not-for-profit clinical research center, hospital, and graduate medical school in Duarte, CA was the first to decide to adopt the Trapelo platform into its standard of care.

MD+DI asked Taylor to share some lessons learned through its partnership with City of Hope.

"City of Hope is already known as a leader in precision medicine'," Taylor said. "They have a sophisticated use of technology, they do research, they have their own molecular testing labs, and they have hundreds of oncologists spread across the state of California, so they represent perhaps one of the most complex types of customers."

The company said it is still "very early in the implementation process" with City of Hope and has "much to discover." However, Taylor said the company wants to make decision making easier for oncologists using molecular testing.

"But in our early meetings, we found that Trapelo can address many of the challenges faced by other departments that use precision medicine, like pathology and research. When fully implemented we hope we will have given City of Hope a precision medicine platform that can meet their needs and others across the enterprise, a platform that can grow with them in the continued support of their mission," Taylor said.

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