Russell Langan, MD, chief of Surgical Oncology and Hepatopancreatobiliary Surgery at Saint Barnabas Medical Center and surgical oncologist at Rutgers Cancer Institute of New Jersey, discusses the workflow of a potentially game-changing cloud-based data management platform for patients with pancreatic cysts.
The Pancreatic Cyst Surveillance Program, a collaboration between Saint Barnabas Medical Center, an RWJBarnabas Health facility, and health care technology company Eon, is one of the first cloud-based data management platforms in the country to identify, track, follow and monitor patients with pancreatic cysts.
How is the technology being incorporated into day-to-day patient care?
So now here at St. Barnabas Medical Center with our partnership with the Rutgers Cancer Institute of New Jersey, which is the state’s only NCI designated comprehensive cancer center, we are able to immediately identify a patient with a pancreatic abnormality or a pancreatic cyst. That patient will then be contacted by one of our preventative medicine nurse navigators and offered consultation with a pancreatic specialist. Of note, we are a high-volume pancreatic surgical center, we are a high-volume Pancreatic Cancer Center, and myself and all of my partners are high-volume pancreatic surgeons. That is who would see the patient if they would like to participate in the surveillance program. The patient will also get a letter which is automatically populated and sent out, and then the caring physician or provider for that patient will get a letter from the program as well as a call to make sure that everyone is on the same page with what was found on that patient. If the patient elects to be part of our surveillance program, they would then be set up to meet with one of our pancreatic specialists. And then, using international and national guidelines, the patient’s risk would be stratified and the patient would then be set forth on a management program for life. One thing which we also do differently here is that, through our partnership with the Rutgers Cancer Institute of New Jersey, we have a weekly pancreatic conference, colloquially known as a tumor board or multidisciplinary conference, where we weekly discuss patients with pancreatic pathologies. There are surgical oncologists, medical oncologists, gastroenterologists, nutritionists, geneticists, we all come together and discuss all of these cases. And we are now doing that for the pancreatic cyst population as well. So our pancreatic cyst patients are getting many minds coming together to determine what is the best course of follow up for that patient? Does that patient require an operation or can we just keep them on a surveillance?
So really, we have a few main goals. One main goal is to identify a patient, timely, who has a pancreatic cyst. And that can be done exceedingly well by this platform. Then once they are identified, we are trying to prevent patients from having unnecessary or unneeded surgery. Pancreatic surgery comes with its own set of potential complications and even potential mortality from pancreas surgery. If we can prevent a patient from having an unneeded surgery, and only keep that patient on a surveillance platform, that’s a win. And then on the flip side, and patients that do require surgery, we of course want to perform that operation before a cancer forms and remove an at-risk portion of the pancreas and therefore, overall reduce that patient’s risk of developing a pancreatic cancer, or operate on them when they have an early pancreatic cancer before it develops into a larger tumor, of course, before it spreads. With the identification aspect of the program as well as the management aspect of the program, we feel like we are improving or increasing the quality of those 3 metrics. The platform itself blends into the electronic medical record, and it’s a cloud-based system, meaning when I’m in clinic seeing a pancreatic cyst patient, I can open this up and have it right in my clinic in front of me and see their longitudinal management. There are a few factors of pancreatic cysts that are important: the size of the cyst, the growth tempo of the cyst, or are their nodules in the cyst? What is the size of the pancreatic duct? Is there pancreatitis? What are the components in the cyst? You know, we do check the cyst fluid, and we look for certain levels. And at times we do genetic analysis on that fluid. And all of those metrics are put into our electronic platform. So now when I see this patient in clinic longitudinally over time, everything’s immediately in front of me. And that is no doubt an improvement in quality.