Bringing Real World Evidence into the Care Setting

Real-world evidence (RWE) has the potential to be a transformative tool for healthcare providers to enhance the care they deliver to patients. It is already well established as a window into how care is being delivered in a variety of ways, including:

• Understanding clinical adoption of new diagnostic and treatment options.
• Evaluating both clinical effectiveness and safety outcomes for new therapies in populations that are typically not included in clinical trials.
• Identifying healthcare disparities driven by social determinants of health.

More recently, much of the work done to track the COVID-19 pandemic has demonstrated the power of RWE to track the impact of disease across a population in near real-time. While these benefits of developing research leveraging RWE are meaningful, they only scratch the surface of its transformative potential. RWE can do much more.

To date, most of the focus for RWE efforts has been on performing observational research for the purpose of publishing and advancing the science in the field, which is a natural extension of the approaches that have been in use for many years (i.e., analyzing claims, registry, etc. to understand the disease epidemiology). Newer efforts in RWE have brought to the field an ability to help answer questions that cannot be addressed by traditional sources, bringing together new datasets to provide insights that were previously too difficult to collect.

These new studies ultimately suffer from the same challenges faced by those performed using more traditional datasets: how to move from evidence into practice. In order to impact patient care, these RWE studies often must either be read and acted on by individual physicians keeping up to date on the latest literature or sufficiently powerful (typically within an accumulated body of work) to influence care guidelines, formularies, or reimbursement policies.

Ultimately, RWE has the potential to bridge the divide between evidence and practice due to the power of where the insight is generated and its applicability to the real world.Rather than an amalgam of patients treated in a wide variety of modalities (i.e., claims), newer forms of RWE are developed from the record of the care decisions documented by a specific set of providers, for their particular patient populations. The insights include the full patient journey, not just the initial diagnosis and first treatments (i.e., registries), which allows them to be used to understand ongoing patient care choices and outcomes. Data supporting this newer RWE typically updates daily, allowing insights to be reflective of real-time care decisions, rather than care that was received months ago. And finally, these insights are also fully identified under the provider’s technology umbrella, allowing providers to bring insights back directly to patients currently undergoing treatment.

Providers can use newer forms of RWE not just to publish influential research, but also to develop specific, targeted insights into care gaps within their own systems that may be addressed to improve patient care quality, and then be able to track the impact of their efforts in real time. As patients are treated with these improvements in place, new opportunities for improvement can be identified, creating a virtuous cycle. Examples of this approach include:

• Identifying lists of patients who did not receive guideline recommended molecular testing and following up to offer testing where appropriate.
• Understanding systemic root causes driving lack of adherence to guidelines and proactively addressing them.
• Identifying drivers of disparities in care driven by social determinants of health and building programs to address them.

These types of interventions have only increased in importance as the COVID-19 pandemic has caused patients to delay care. As providers have sought to minimize the impact of the pandemic on patient outcomes, particularly in disproportionately impacted communities, RWE has been used to effectively direct resources to the areas of most acute need.

So, what does it take to bring RWE from evidence into practice? A successful program has three major components:

1. A high quality, comprehensive view of the longitudinal patient journey.Ideally, this view brings together not only the specialist outpatient EMR, but also data from the other care modalities (i.e., molecular testing labs, hospitalizations, treatments for comorbidities, and care by other specialists).Even after the current pandemic subsides, it will be important to understand and account for the impact of historical COVID-19 diagnoses and hospitalizations as a critical component of the comprehensive patient journey as well.

2. Targeted, actionable insights to support practice improvement. To support action, RWE must be translated from problems into potential solutions.Documenting a gap in adherence to molecular testing guidelines is only the beginning. To be truly actionable, the actual list of active patients that have not yet been tested must be created, vetted, and put into the hands of those who can address the issue. Root causes of disparities, rather than end results, must be understood with enough precision to enable providers to take systemic action.

3. Engaged provider network that is willing to invest time and resources to systematically improve care. Finally, the most direct line between the evidence and any patient is the provider who cares for that patient. The types of targeted opportunities to enhance care described above are most valuable when a provider system is actively engaged and willing to commit resources to drive practice improvements. The good news is that many large health systems have already committed extensive resources to this type of work. Thus, rather than requiring additional investment, the value of RWE lies in helping those existing resources focus their efforts on the most impactful interventions to systematically improve patient care.

In summary, while RWE has already proven its value in adding to the scientific record, newer forms of RWE hold unique promise in supporting targeted interventions to impact patient care, particularly in light of the key learnings from the impact of COVID-19 on patient care.I believe that in the next few years, we will see more and more of the provider community adopt this approach, and I am excited to see the future that it will unlock.

Ken Tarkoff is chief executive officer of Syapse.