Support for this episode is brought to you by Chirpy Bird Health I._T.. Consulting chirpy buried helps clinicians navigate the transition to value-based care <music> welcome to the hit like a girl podcast where with each episode we hear from different women experts in the health I._T.. Industry we like to hear about what makes me tick how they overcome challenges work. They're proud of advice advice. They would give to other women in Health I._T.. And much more I'm Joey Rios and I'm Robin Roberts. Today we are geeking out with Janine. Morales Director of clinical knowledge management intervention insights Janin's latest latest work involves ensuring the accuracy of platform that provides real time evidence supported technology to help oncologists practices in labs. Make them most appropriate decisions for cancer patients so let's get started. I'm currently <hes> my title Clinical Knowledge Manager at a company called intervention in place and within within the larger health I._T.. Ecosystem if you will we are focused on we are in oncology focused company <hes> and we use technology platform to assist addition and other stakeholders and in healthcare to support report about among patients through data driven approach and I'll certainly <hes> delve into that in more detail the minute but I actually didn't <hes> start out my career in knowledge management or certainly not trained in technology per SE EH <hes> i. I trained the basic signs of so I have my p._H._d.. In Pharmacology and most of my training was was basic research using the tools of biochemistry and cell biology to understand you know how communicate hey how they they know how they take us from their environment and <hes> initiate changes that met fell that lead to behaviors like growth or or migration or differentiation and when I was getting my degree <hes> we were we were starting to see a real translation of a lot of the basic research happening out there in in biology and cancer basic research. We're seeing those findings <hes> ING translated to new approaches to care <hes> to new therapies new diagnostics <hes> all of that was really starting to take off and come to fruition and some of the first <hes> some of the first what we call targeted therapies and I found that I was really fascinated by this translational <hes> aspect aspect of the field and I started to move away from the <hes> more to me was minutia of of working on something very very focused in the laboratory and starting to become really interested in the just the broader <hes> trends that were happening in the fields of <hes> you know healthcare and how technology <hes> be it <hes> diagnostic technology or sequencing technology or changing that healthcare and how people we're thinking about it and how all that information with being disseminated and so my first foray out of the laboratory and into information technology if you will was with in one of one of the first website to be honest out there and it will bio dot com <hes> <hes> and that that <hes> company or website is no longer in an aggressive but at the time the goal was to kind of aggregate a lot of the trends and biotechnology and use website at the platform to to disseminate information and and Castilla take conversation and <hes> on the trends that were were happening in that base and that really started me on my kind of departure from the basic scientists realm into the the larger field of information management and and I won't go into the all in between steps but eventually ended up in the oncology field and so two circle back to what we then are currently doing intervention insight the company were I'm working as I said were were for an oncology focused company and more specifically we are in some part of oncology if you will about the practice of precision medicine and oncology and so what do I mean by precision medicine. I think that <hes> you know some people argue that well precision medicine is something that physician always practice they've always looked at a patient and their characteristics and very precisely determined a course of treatment for them or or a series of actions that will hopefully we lead to better outcomes that patient but what the the current iteration of that term is really around using molecular information so some of the basic finding that I was talking about that I was we were seen coming out of basic research how we're how you doing some about basic molecular information about a patient's tumor to determine the best treatments to <hes> and select precise therapy for them so we can take patients tumor sent that off for or molecular analysis the sequencing of their genes or looking at the there gene products and how might differ from coming normal cell and then determine based on those results wh-what therapies <hes> might those patients be likely to respond onto or maybe have five sacks from or maybe not respond to it all so that that is the the area where intervention in places focused right now and what we have developed is <hes> technology platform that used by exhibitions and other stakeholders laboratories and payers designed to support the best care of oncology patients and at the point of care we provide decision support to facilitate and streamline the practice of precision medicine so how do we get the rate drug to the rate patient ultimate goal of improving those patient outcomes and hopefully ultimately minimizing harmful side effects so let me ask you a question that the platform Yala working on what's it called and then you know in in healthcare period their information changing literally every day. It's a double edged sword. It's one of the things they will most about being in healthcare but oncology's especially for cancer patient hotting thing even keep the platform up to date to make the alignment of the drugs treatments intervention or even the the research coming out about you know maybe tumors or certain cancers period to to keep that all align to make sure you guys are staying on the cutting edge that ah well actually you. This is the perfect setup for why our company exists and back because <hes> I think that just to take one one brief step backwards like I said earlier while medicine has always he's the one would argue has always been. There's always a data driven approach to making those decisions. I think the sheer volume of information and data that can now be brought to bear on any individual Kishan case has really really started to out chase the ability of physician to you know manage about in the ways that maybe they they're used to. which is you know taking the courses or referring to the guidelines that are written documents that are really intended to address the broader population of patients that of course break that down to some degree but what we're finding now is there's so much information about individual patient that one can gather <hes> in some cases that is as relevant to care and others in his knocks that that's really beyond the capacity of humans to kind of manage just from a memorization or referring documents using using that kind of process so in fact the problem that you just stated what drove intervention edged played initially into existence in that we felt that there was an e for a really robust platform and process to manage all this information to be continuously surveilling all the available eligible literature for the coming out on these molecular changes than how they're affecting responses to therapy impeach him to bring that into our system to aggregate and compare align like study who studied that that share share the characteristics of maybe a single patient <hes> or what one individual patient might want to be a point of care and then use that knowledge base as a basis to then create tools and services that were others can tap into that knowledge and <hes> use it to make a decision about a patient that maybe relatively realistically rare like maybe someone <hes> physicians are seeing patients that have mutations but maybe they've they haven't treated a patient with that before and we're trying to bring combat information about these smaller and smaller segments of the population br bring those two positions more quickly rather than how them you know search through a variety of abstract or papers to try to find relevant information to that patient so you know our approach and we we started the navy five years ago the foundation of our services this robust precision medicine knowledge that <hes> that we bill so I lead a team of experienced <hes> molecular biology? Defy into and we also have fantastic team of clinician consultants that we tap into I mean we I started to tackle this knowledge base. We came up with a comprehensive duration process kind of you know meeting technology analogy aside for now but a process of what what did we want to survey a what were the data elements that we wanted to capture and then we worked with our engineers to build a custom application to help us manage and ultimately kind of objectively Ripley evaluate the clinical data. That's that's available and what we currently do. Now is a bit of a amalgamation of manual hard work and technology to help us get through all of the data. That's out there. Where are we use technology? We use that to kind of bring important papers to either because it's a known source of relevant information. There's a set of journals that we are looking at almost daily <hes> looking at those title but using a manual process to say we use issues meet me use technology and key words to kind of triage the review of all the data but we really rely on humans to read those titles abstracts and quickly they can determination as to whether it's relevant for our system or not and that we are we over the course of the year review thousands of primary research papers and thousands of abstract from <hes> conferences that that you know pretend to precision medicine and oncology more more broadly and then so we have a team that handles that surveillance outback they than triage that information pick out the stuff that is relevant for for our purposes and when we hand that up to a series of experts in the different disease domain and they abstract the the relevant data so like I said in the beginning when we developed this process we said you know what kinds of data would a physician want to have have at their fingertips when they're making a decision about a precision medicine or what we call targeted therapy therapy the target the particular molecular alteration and so we built that we build the system to capture that and our scientists scientists have gotten berry skill adapt at you know reading through the and picking out the key detail that we want to abstract and bring into our system that we ultimately used to about the way he's strength of an entire body a of active so let's say patient combined with a particular mutation our system would have an entire collection of evidence that pertain to that mutation in that patience is the type what we do we analyze that bobby data. We've developed an evidence framework so we assign kind of a string of evidence level that indicates the strength of that on the dominant and we were very strict about how we find that and we have a matrix that we plug are doubted area into who ultimately come up without evidence bubble can ask you a question absolutely it sounds like there is so much that's going into this thoughtful approach of how you're looking at all the data and evidence that is out there. Can you speak to any sort of patient. Accessories are patients that this approach has made a real impact in their life and potentially like helped them get to a diagnosis sooner or get to the right diagnosis or whatever the outcome is absolutely. I actually a really important question who does this who is currently applying to precision medicine and to be perfectly honest and I think it's important to be honest in the field did not a hyper too much but not everyone and is is benefiting from a precision medicine approach but there are some <hes> disease or cancer types where we are really seeing a real impact on patient Herod patient outcome. One of those is lung cancer so if we look at the group of patients who have what's called Lung Adenocarcinoma which is one of the most common forms of lung cancer we know a lot about molecular basis of that disease and certain what are called drivers of that these he's and it over the last couple of decades the pharmaceutical companies investors in the field have developed agent that are able to target and inhibit these specific mutations and have incredible edible response rate in lung cancer patients unlike those we've ever seen in in patients who are treated in the broader populations that are treated with chemotherapy so let's say I'll give an example in lung cancer. We can break get down into currently there are depends on who you ask but if I were you know me and what would I want to have tested or around ten or twelve markers if you will that define different populations of lung cancer education and if a patient has one of the alteration of named one of them e._g._F._R.. That patient has a pretty good chance of responding to an inhibitor of that gene product and the response rates. There's another one called Al there's another one called mats and if you don't have the alteration. There's no reason you should be getting these drug because the response rates are really quite minimal and if you do have the alteration the response rates are approach forty or fifty sixty percents and now currently much of this is being applied to late stage patients who their patients who have <hes> metastatic disease which is often in most those cases not a a curable setting but we are seeing that were extending alive these patients <hes> and this has been going on for some time that we're seeing real <hes> improvement in both <hes> survival and and quality of life because these are agents that are very specifically targeted to a molecular entity and so what we see is kate like I just described in long. Let me see happening in melanoma in colorectal cancer and some proven more intractable and <hes> in those cases you know precision medicine is still in that very early research they if you will and then others it's standard of care and impatient per now treated with these age agent you know upfront in the in the first line. I think that's really important because when I think about the impact of what you just described we know that lung cancer is by far the leading causes cancer more than Colon Brenton prostate combined great so doc when we're talking about that or even he's got older age. The average age of diagnosis is seventy among cancer the number of people that you have an opportunity to impact identifying the markers to align them with the appropriate drug is remarkable because seventy cindy in this day and age is really not that old and when you talk about the ability to find the right drug the right receptors because that's how it works works. Lung cancer is not just lung cancer the scientists the researchers the folks that you behind that get this sock doc that you have this sophisticated platform that can make that alignment is really something special right well. I think I appreciate that we find that one. The field is absolutely fascinating. It is very encouraging urging there are as you alluded to earlier. It's a very dynamic space and data isn't merging with you know regularity emmy on a daily basis we're finding new data that needs to be updated and improved approved and and I think that our approach is intended to really be very accurate about and <hes> let's say trump parents about the way that precision medicine is applied because as I said there our patients for whom we have very good data that precision medicine approach is going to be a benefit to them is without a doubt that if they have a particular alteration they should be getting and that treatment should be made available to them and yet as I mentioned we have these different evidence levels right there are so many different molecular alterations that have been measured some of which are actionable some of which are not and some are kind of that in that in between stage where the data's emerging but there's some uncertainty certainty in that population bill and we <hes> as a company feel like you know our point of view of courses that we would love everyone to have a precision medicine approach but I think that in the best interest of all the stakeholders the position position the patient <hes> the payers who are who are paying for the that everyone should have shared data set with which to understand where are we on that continuum of bringing you know agents and those agents that are associated it was much changes from the preclinical stage to the early clinical to believe clinical and that not only are we at tempting as you pointed out to gather all this information and keep it at the fingertips but also to put it into perspective and to make sure that I think everyone is aware of someone wrote an article within the last year. Maybe it was called the paradox of precision medicine and that is as we start to fragment the population into smaller. Caller and smaller cohorts you by definition have less and less data to support any given intervention in that group of patient. I mean that's just biology right and that's the way things are going but I think that what comes without that. There's some inherent rents uncertainty about and so what we're trying to really do as be transparent about. How much data is there really available for for you at the patients? Do you want to be making decision based on the molecular alteration because it really trump the standard of care which might be chemotherapy in your K. and so we're we're watching that we're tracking that and <hes> making sure that precision medicine is applied at the right time and in the appropriate way I was gonNA actually ask about the patients they 'cause. You're mentioning all this data that they have and it's available to them but <hes> this <hes> this level of looking at precision medicine either patients actually involved or is this something that it's really for you know the lab during College Street and payers. I think part of making that decision for the patient or how involved is the patient in signing up for precision medicine approaches to their care. That's excellent question I I think that that probably vary in the field right now and I would say that while precision medicine in many cases is being used and applied and patients are being educated on their options options. We know that there are still cases where that's not happening so even in lung cancer where we know it's been come years now. Where we're applying precision medicine approach we know and anecdotally that there are some conditions that that are using that approach or are informing their patients that that's an option for them so I think that there are no standards around that currently certainly in an ideal world you you bring a patient into that in shared decision making process right and I think that one of the things that were not currently doing but we certainly would love to be able to migrate to that the company is to Really Bring Ring <hes> we certainly hope that the patient is always in the conversation but that we hail are contents to the patient as well so that they understand some of the you know some of the basic from the consideration that go into having the tapping on and then making decision based on that test <hes>? I don't answer your question I guess there I think that certainly <hes> patients should be involved. <hes> and I think that it's really important that as a field we think about about how we simplify and make it consumable by a layperson or you know a patient that we kind of take the science and make something that's really understandable for a piece so that's really ultimately going to the greatly impacted by a lot of these new development yeah. I think that your your company has an opportunity to play a key role in translating that 'cause I mean genetic mutation education. I mean wow that's just a whole other level of healthcare literacy with patients to be understood but also important one when we're talking about the kind of diagnoses that you will know with so I think he already not questioning that is if you could snatcher fingers and solve one problem in a very magical world of healthcare and how I._T.. What would it be and why well? Oh Gosh it's hard to pick one. You know I'll say that kind kind of broadly. I think that what one sees them a field in of patient care at least the application of I._T.. That the physician level is that there's a lot of data collection. There's a lot of data entry and we're not seeing a a lot about effort really translate to greater efficiency in care now that stating the problem. I don't know not dating solution yet because I think the solution is perhaps multi sectorial but I think that if I were to pick you know even a problem and hone it a little bit more. I think that if we could think about prior authorization of some of these therapies that we've been talking about it seemed that currently even though we're asking positions to enter very specific the guy that about their patient we have very specific molecular data available. They're still all these inefficiencies than hurdle that prevent patients from getting access to the right treatment in a timely way and I think that that leads to you know obviously delayed care delivery and part of that is that you know they're easy ways to share some of the information between the various stakeholders so even though if addition of putting in very specific information that on face value qualify a patient for an agent they're still getting on the phone and spending time talking with a pair and I won't say fighting but it is I think in the mind but many physicians and more a somewhat adversarial relationship where you're on the phone on and making an argument for your patient taking time out of your day creating in the cost of the prioritization process have been on a fight in their in their significance so I think if we can use technology to expedite did I some of the things that are kind of straight down the fairway right. Here's a patient that clearly need the guidelines the the indication for an agent wire doctors on the phone when you know so that that is in there but it's not being used and that could be partly the technology problem <hes> partly a prophet. I think that hairs are some wedded to prior authorization and someone has to come along with a better way to help the manage that certainly that's one way yeah they they manage cost currently but I guess maybe I'm not pointing at a so at the solution precisely but an area where I think technology can play a role is in that process of getting you know you're taking information information about the patient and quickly acting on this but does that apply. Do you think that that answer yes. I know that that's great. I know that I had a molecular diagnostic done a little over a year ago. I just got a bill for it. The prior off the doctor very much felt isn't that you know the clinical criterion and specification based on everything he knew but the amount of time he spent on the phone of the office is nurse did waiting on hold to put him on phone <hes> for peer to peer review the <hes> letters and medical necessities element as they're called <hes> and everything that happened just end up holding thirty four hundred dollar bill when all of a sudden done not believes frustrating for me the patient watching this whole thing be navigated the gate in the anxiety is gearing drive ill but on the front end if you went back to their site and I went back to the commercial payers site we checked all the boxes and so yeah it the insanity are thinking that somebody's even waiting to have that done when it's simply a not the right thing to do for the patient is wildly unfortunate so I think it's a lofty but necessary wish right lofty probably but hopefully I think that you know there's more and more coming out about kind of the burden that this prior authorization is has on on the healthcare system at the whole role from edition burn out and costs associated with the prior authorization process and you know both costs from from the pairs on the pair side that administrative burden of that and definitely from the position than than most frustratingly for resulting in and delay than care so I think that you know at some point payers they continue to require those should be you know we really need to improve simplify the process and standardize the methods for requesting in granting those per authorizations that hopefully you know taps into to the data that fingertips and not everything should require a peer to peer our telephone call for sure gene we are working on building a reading list for our podcast listeners so that I can essentially fast track their learning. Are there any books that you can think of personally nearly a professionally fiction nonfiction could be a blog and it's okay if you listen to books instead of read them and is there anything that shows up three that you would be interested in sharing and adding to reading list shorts when it comes I'm CA- books because I spent so much of my time looking at journals and very detailed clinical literature. I spent most of the books I read our fiction or <hes> some nonfiction I recently read the book educated which Gosh I certainly not one among many <hes> I thought that was a fabulous book about the perspective that that education brings to life and certainly at amazing journey that that that woman went through to get to where she is today so certainly recommend that as at least as the something outside of the scope of of what we've been talking about today but in terms of the field that I'm in. I guess you know if I were to say. Where should one look to learn more about this? I'm not sure that that books currently are really as we've been talking about. Such a rapidly evolving field will tend to be probably a little behind the time by the time they're published I but I tend to do and that helped needs to take that back and step away from the details. I tend to look at some of the major major journals and a lot of the commentary or editorial that are written in those so I find myself routinely ainley reading the editorial in the journal Kinda College Either Their Clinical Cancer Informatics Journal or some of the more esteems journals like nature that I find that these really helped me to to look at the what's happening and precision medicine from a higher level either. They're giving me a perspective on the patient experience or the physician experience and some of the changes of how quite made it to the clinic but we're approaching. I really like that dishing out of the nature magazine. I would not have guessed it that would have been one of them but I guess thinking about the bigger picture that that does that. That's a good addition. Yeah I mean we find but things like nature spying like I said the Journal of Clinical Oncology that you have real thought leaders the are putting some of these new developments into perspective and then recently I found myself consumed with there was a in late two thousand eighteen. They had a Palliative care symposium you know ecology and just reading through all about and how technology can and <hes> either through mobile health applications that monitor patients than some <hes> and how can really improve the patient experience and improve outcomes. I think that there are so many sources of inspiration out there in the journal but I think would for the most part there's some technical jargon to get through but I think they can provide sources of information for people who want to make an impact in healthcare using I._T.. Solutions Janine also in addition to reading. I know that you and your organization also have a podcast so that people want to hear more about precision medicine they can you talk a little bit about that sure I'd be happy to so the position medicine podcast which is sponsored by Capello the platform. I've been speaking about today as an example of our commitment to accelerate personal life healthcare at the point of care and especially for cancer patients we've been discussing and so we launched that podcast late last year and we already have feature a variety of experts in the field and I think that what I've been trying to amplifies during our discussion today is that we would like to bring multiple stakeholders together to share knowledge knowledge-based Sharon data sets share solution to support the appropriate use of precision medicine and so we've interviewed ginormous than educators pathologists and diagnostic backwards because as we think that hearing all these different perspective that ultimately going to help us build better solutions to the problems that are out there and so I think our hope is that this informal and efficient platforma will neighbor more thought leaders to kind of just step step away from their work and participate in the the broader conversation and help us you precision than more effectively back so wonderful well. I think that brings us to last question which is if folks wanted to find you in and more about you or your company where they look finding me specifically probably the best way through linked in and I'm in their Janine Morale's so of an employee of intervention in place I think as I mentioned the podcast you can tune in and subscribe at the precision medicine podcast dot Com and follow us on twitter at p._M._p.. by Tr- Appello <hes> and the company is often linked in at intervention under intervention in replaced with company so yeah those are the way that you can get in touch with us and if anyone has the suggestion for someone who would make a great gus for the precision but it's been podcasts they'd like to hear from they can do that as well. The precision medicine called Tau Dot dot com so much for sharing with us about what you guys are doing and how precision medicine is playing a role in people's lives and sharing some of the insights. No Pun intended <hes> that you did today no problem thank you I enjoyed it continued. Can I ask you an aside question so in the event of a rare disease or rare cancer or maybe no information exists. <hes> mutation is not identified or you're dealing with something. That's you know referred to you guys. <hes> AH protesting. What do you do anything to Align Asians with clinical trials or maybe you know there isn't a drug? There isn't an intervention but something the you know exists. Yes absolutely that's. That's a great question so I think that what what happens when patients have their <hes> have their tumor profiled or have some of the molecular information at hand is as I was mentioning earlier you there's kind of this continuum of actionability if you will and some of those things are are on the far end that are highly supported and for which there's an approved drug and there are others for which there may not be an approved drugs but there may be an existing clinical clinical trial with an investigational agent that may or may not have existing data <hes> and so that is absolutely a march part of what we do is if the information <hes> about that patient in tumor doesn't lead directly to you know an approved therapy or their trial that that patient would be appropriate or and I think that's a huge part of precision medicine right now because there is so much in development and I think there are so many patients true are eligible and really should consider one of these trials. We know that trial accrual is really difficult. Laborious Prophet and a very small percentage of patients ultimately go on trial and our goal is to hopefully facilitate that and I know that not only ours but many others that if we take the molecular information look at that and say hey based on this mutation. You're really eligible this drug that target you know cancer that looks like yours. We definitely take steps to try to to to bring not that information to the point of care so that's all included in a report that intervention advice would generate actually cool so very important very important people the puzzle but yeah we discussed Israeli or no it is and not an in oncology but then a different face my son had a rare disease and you know you're talking about this small subset of information that are out there but I will take that small subset of detailed information when there are no no answers known ideology for problem in no direction to go in in no trials on the basis of planet that are available and I'll run with it and when we talk about even the the play now in citizen science and these other things you know I I thought working in healthcare that I was equipped to deal with the challenges that were thrown at us and I could not have been more wrong <hes> outrightly dead wrong so I would schaller doing to align oncology patients. You know it it really as some personal resonance with me but is thinking about that or even the fact that you say if there's not an auction that there are trial other things. Sometimes people are just clinging to hope and what's next into know that at least you're offering mount in the report. That's getting back to the patient family. The people are sitting on the other side of this transaction not a business transaction but a real change in their life. especially with cancer is really the that makes me feel really good to know the dollar doing that. I played in that space as well to help that cling to that. I'm kisses hope. which is what that person on the other side is hoping that's GonNa come back in your report quite honestly right? No you're absolutely right and I think clinical trials and making patient. The whereabout aware about is is such a key part of moving the yield forward as well not only for that individual patient but just for the continuous evolution of the information that we're gathering and thank goodness for patients who are willing to put themselves themselves on these trials and I think what they're doing for you know making a good decision for themselves and certainly contributing to the greater good of the precision field and and future patients and what they'll have available to them. Yeah I think it's I think it's a really important point and I and the team when we you know we always try to remind ourselves. When we're summarizing these reports or the information we step back and this is for a person who for an individual making a decision about about their lives live and how let's make sure that you know we're so careful about how we are word than and choose are carefully but for that we're not either pushing into the wrong thing this leading them or or denying them something that might be benefit awesome so really really important point yeah? No thank you so much. Thank you for sure and thank you for listening to the hit like a girl podcast. If you want to know more about us or this gets checkout her website at hit like a girl pod Dot Com while you're at it. If you found value in this episode we'd appreciate a ratings on items or simply. Tell a friend you can also connect with us on twitter or instagram at the handle hit like a girl todd.