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Precision Medicine Platform for Oncology Aims to Streamline Molecular Testing, Therapy Decision-Making

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CHICAGO (GenomeWeb) — With City of Hope National Medical Center and Texas Oncology as the first customers for Trapelo, IT vendor Intervention Insights will be rolling out the new precision medicine platform to more than 800 cancer physicians over the next few months.

Burlington, Massachusetts-based Intervention Insights describes Trapelo as an evidence-based clinical decision support system that links healthcare providers, testing laboratories, and payors, giving them access to current, molecular testing information and results interpretation in order to optimize utilization of molecular testing services and offer the most appropriate care to patients, according to Intervention Insights CEO Clynt Taylor.

"We are enabling appropriate, scalable use of precision medicine, and we do that through this knowledgebase that we've been developing in the past year," Taylor said.

Trapelo is an application that augments a knowledgebase that Intervention Insights has been building since its inception in 2009. Prior to Trapelo, the knowledgebase would "inform the results for a lab," Taylor said.

Labs would use the Intervention Insights reporting engine to provide evidence supporting associations between gene mutations and potential therapies. It eventually became apparent that labs and clinicians needed a quick way to know whether they tested for the right indications.

Using the same knowledgebase and reverse-engineering it, the firm developed it to say, 'If you tell us a little bit about the patient's cancer, we can tell you what at a minimum you need to test to be sure that you that would give you an actionable result,'" Taylor said. The actionable result would be a treatment option supported by evidence, he explained.

Taylor described Trapelo as "clinical decision support for precision medicine that enables value-based testing," which means the information the software generates can help justify test orders to payers, saving time and the hassle of prior authorization on all sides. Intervention Insights has a team of molecular biologists and other bioinformaticians to curate medical evidence from published studies to keep the system current.

"I specifically wanted to address the challenges that exist today where you have oncologists who are deciding what to test based on their own relationships with labs and their personal knowledge," Taylor said. Their memory doesn't necessarily follow established medical guidelines, institutional policies, or payor rules, though. "We use our knowledgebase to do that," he said.

"It helps the physician identify which mutations to test for, which panels have those mutations, and then which laboratories can perform those panels," said City of Hope President Michael Caligiuri. "It allows us to make the decision for the physician very easy in terms of which test to order and then how to get the results back."

Insurance prior authorization has long been a bugaboo to cancer centers. While such authorizations can tell a provider what they can't do, they don't help them decide "whether you might have undertested or maybe you've missed the treatment option that was optimal," Taylor said.Trapelo could, for example, tell a practice that it missed the opportunity to test a lung cancer patient for the ROS1 mutation, now covered by many payors.

Taylor noted a 2016 American Medical Association survey showing that 90 percent of physicians reported care delays or changes due to prior authorization.

By, in Taylor's words, "prescreening for precision medicine" by involving the payor in the decision-making from the start, the technology can mitigate the often adversarial relationship between provider and payor and, more importantly, lead to better treatment choices.

According to Taylor, every patient should be prescreened. Trapelo, he said, gives doctors information that they can use to make clinical decisions, while payors can be assured that their policies were communicated appropriately.

The administrative part was a major selling point for City of Hope, which is located in Duarte, California.

"[Trapelo] really requires the information only to the extent that it's needed to help with the decision support. But it's also a tool that understands the operational aspects of the practice," said Harlan Levine, the cancer center's president of strategy and business ventures.

The technology also automates results processing and analysis. Test reports typically come back from labs in PDF format or in some other state that is not machine-readable. Trapelo addresses that issue, as well, by converting the documents to an HTML-based web page that looks the same no matter where the test was performed, according to Taylor.

A provider practice can order a panel from a lab, he said, and when it goes through the Trapelo system, it captures the  patient's type and stage of cancer, the chosen treatment line, line of therapy, prior therapies, history of previous tests, and whether the patient is interested in a clinical trial.

"By capturing that data, we use it to marry with the results data," Taylor said,

Now, the company is integrating its technology with electronic medical records, starting with the Epic Systems EMR that City of Hope installed in late 2017. The cancer institute will upgrade Epic by early spring. "At that time we'll be working hard to insert Trapelo right into our Epic flow," Caligiuri said. "That will be a heavy lift, but one of the things we're obsessing on is seeing to it that our physicians only have to look at a single computer screen [to get] context of their visit from the patient to get the information that they need."

Institutional users can customize and simplify the view to each physician. For example, Caligiuri specializes in leukemia. "If I'm seeing leukemia patients, there's going to be a limited spectrum of things that are going to be put in front of me," he said.

However, he said that the real value of Trapelo will be  for the 100 or so City of Hope-affiliated physicians who are not on the Duarte campus, but spread out across the Los Angeles area. Those oncologists might not be so specialized in terms of the cancers they see.

"For the doctor who is out in the community and seeing colon, lung, prostate, bladder, breast [cancer], etc., there will be a limited number of recommended tests per disease and per stage that the doctor will have to consider, and right there will be the literature to back it up so that if they wish to quickly take a look, they can," Caligiuri said.

"What we're looking to do is to get a high degree of safe, effective, timely, best-of-practice care across our entire enterprise," Caligiuri added said. "[Trapelo] is an instrument that allows us to have a secure and correct recommendation about what to do next, especially in the age of molecular oncology when we're looking to order the right test at the right time on the right patient for the right disease."