The next step

Go to the edge of the cliff and jump off. Build your wings on the way down.

--Ray Bradbury

D.A. Freccia: You're a pretty smart fella.

Joe Moore: Ah, not that smart.

D.A. Freccia: [If] you're not that smart, how'd you figure it out?

Joe Moore: I tried to imagine a fella smarter than myself. Then I tried to think, "What would he do?"

--Gene Hackman, Heist (2001)

It’s smarter to be lucky than it’s lucky to be smart.

--Charlemagne “War is a Science” Pippin (1972)

I don’t think I’m jumping off a cliff – and I know I don’t have any wings, at least not yet – but I am taking a leap into something new, different, and exciting, and I want to share the news with all of you today. Beginning December 3, 2014, I will be leaving my current position in the breast cancer program at the Kimmel Cancer Center at Johns Hopkins and beginning a new full-time position as Medical Director of the Institute for Quality of the American Society of Clinical Oncology (ASCO) in Alexandria, VA. I will help lead and support a number of key programs that make up ASCO’s quality portfolio, including the Quality Oncology Practice Initiative (QOPI), the QOPI Certification Program, and the revolutionary and ambitious CancerLinQ project, among other ASCO quality initiatives. The ASCO Board of Directors and CEO Dr. Allen Lichter recently made the decision to bring on board to the ASCO staff a physician to provide medical oversight for this key area. I am deeply honored to be the inaugural person selected for this position.

ASCO’s vision for the future of oncology, well articulated in the 2012 document “Shaping the Future of Oncology: Envisioning Cancer Care in 2030” is one that really resonates with me. ASCO believes that all patients with cancer should have access to high quality care and that the information learned from every patient should accelerate the progress against cancer. ASCO has identified health information technology, particularly the ability to collect and analyze vast amounts of big data, as a key driver to achieve this vision. I couldn’t agree more. For the past 23 years that I have practiced clinical oncology, patients and families have come to me for my expertise in what is often the most overwhelming crisis of their lives. They may be full of fear and anxiety, but they are all hopeful for cure, while expecting compassion and respect. As a clinician, I know that the only thing that really matters is the needs of that patient in the exam room across from me, and my primary responsibility is to help them navigate the shortcomings of our byzantine and often-insensitive healthcare system, to deliver to them the right diagnosis and the right treatment, based on the best possible evidence and shaped by their own preferences and values. To do that, I need access to data, information, and knowledge of a complexity and quantity that was unthinkable when I graduated from medical school in the 1980s. To get this access, oncologists need tools that can’t be discerned in the Google searches and social media streams of today, as critical as the Internet is to medicine – let alone the medical libraries and Index Medicus of the last century! ASCO’s rich portfolio of quality programs, which started with QOPI, an oncologist-led, practice-based quality assessment and improvement program that launched in 2002, through today’s eQOPI and the growing library of practice guidelines, to tomorrow’s CancerLinQ rapid learning system, will continue to be foundational in providing oncologists with some of these needed resources.

I’m joining ASCO now as a full time employee because I’m passionate and optimistic about the future of our field, and I want to devote the rest of my career to enabling this change. I’ve not been blessed with unique or extraordinary vision, but I think I can see what it is going to take. We need to create a world where medical practice consistently reflects unfettered access to meaningful data; where clinical care and discovery co-exist and enrich each other; where oncologists discover new knowledge not only from the 3% of patients who bravely enroll on clinical trials but from the routine care experiences of all; where the documentation of such care experiences is freed from proprietary electronic systems – currently shoehorned into the rough and inflexible mandates of the meaningful use requirements (as necessary a first step as they were) –  and shared freely by all; where delivery is not constantly undermined by the specter of the perverse incentives of quantity-based reimbursement particularly “buy and bill;” where the amazing advances in panomics are allowed to flourish and inform today’s care processes and not exist only as vague promises of “precision medicine;” and where patient-centered care is something we all are proud to deliver, not just to satisfy next month’s Press-Ganey surveys, but because it represents the fundamental passion and dedication of our profession as physicians.

Will I be able to do all of these things as an ASCO Medical Director? Lordy, I’m going to need a lot of help! I’ve experienced oncology in both private practice and academics, so I know all too well the challenges of transformation and how disappointment oft rules. But I think I’m smart enough to associate myself with some very smart people, and I’ve been lucky enough in my career – blessed in fact – that I’ve been able to enjoy a wonderful, fulfilling practice environment and the collegiality and camaraderie of superb colleagues everywhere I have been. So I think this “leap” – from the familiarity of a single institution to a visionary, mission-driven organization like ASCO and this work blending quality, clinical medicine, and information science – is not just the next step for my professional development but something that feels positive, natural, and just right. I’ll build the wings later.

My Hematology/Oncology Grand Rounds at Memorial Sloan-Kettering Cancer Center 2/4/14

I was honored to be asked by ASCO President Dr. Cliff Hudis (@cliffordhudis on Twitter) to give Grand Rounds at Memorial Sloan-Kettering Cancer Center in New York on the topic of social media, on Tuesday Feb 4 at 8:00 am EST. The title of my talk is "Connectivity, Collaboration, and Disruption: Social Media and the Oncologist." As I did with the last few talks I've given, I created a special hashtag "#msk_hcsm14" which I will use to create a live Twitter stream that I hope more than a few people will follow and respond to during the actual presentation. Also, using Tweetdeck, I pre-scheduled a series of tweets with the hashtag to be posted during the presentation, containing many of my references and few additional links to extend the talk. While I don't really think anyone will be fooled into thinking that I am live-tweeting in the middle of my presentation - not that I and others haven't thought about it - I find this a fun and educational technique to try to jumpstart online dialogue. And after the session is over, I will create a Storify of the collected tweets to share with the audience.

I know a few MSKCC doctors on Twitter, but I don't know how active they might be during the presentation. I don't think the level of interactivity you see at large meetings like #ASCO13 or #MedX is very common at smaller sessions like this, but there is always a first time!

So if anyone is reading this, feel free to join in the online Twitter conversation starting about 7:45 am on Tuesday 2/4/14. Be sure to save this hashtag and spread the word. Thanks.

#msk_hcsm14

Addendum 2/6/14:

I have posted my slides for my talk to SlideShare.

The Storify for the hashtag #msk_hcsm14 is here.

Spread the word and keep the convo going!

The importance of philanthropy for funding cancer research in 2014+

I probably received no fewer than 25 emails  last week asking me to consider donating to a variety of charitable organizations before the stroke of midnight 12/31/13. “There’s still time for that end-of-the-year deduction.” **sigh** Every one of them, no doubt, is worthy, and most were from organizations I had some contact with in the past, either as a member, an alumnus, a prior donor, or some other connection. (The most amusing to me are the requests for donations from the colleges where my kids are currently students, frequently a request that comes by phone. I tell the earnest young men and women who are calling to “verify my address” that I already make regular donations, called tuition payments.)

It’s easy to tune out requests that come in waves at the end of the year, or if you are like me, you may have already made some decisions about where you might be willing to give. But did you know one of the worthiest causes you can donate to is cancer research, specifically to the hospitals and medical centers where you or your loved ones may already be receiving their care? Many people are surprised to find out that much research is funded not only by the Federal government and the pharmaceutical industry, but by donations large and small from grateful patients and family members. While most have heard that Federal dollars for biomedical research have have been drying up in recent years, you should realize how bleak the situation truly is. The American Society of Clinical Oncology (ASCO) has pointed out that the research budget from the National Institutes of Health is almost 25% lower today than 10 years ago when adjusted for inflation. This infographic explains the issue pretty well.

What can you do? I would of course support the idea that as citizens we should work through our elected representatives to send them the message that we can ill afford to continue to mortgage our future in this way, although realistically few of us may be motivated to do that. But you can also make a difference at the local level by donating directly to centers that are doing research and benefiting people in your own community. You don’t have to have millions or thousands or even hundreds. You might be surprised at how welcome and deeply appreciated even a seemingly modest donation to a local doctor or research program would be. Those of us who work in an academic medical center like Johns Hopkins are thrilled when we hear about people who want to help our work by supporting a small (or large) part of it financially. And here’s another thought - instead of remembering your oncologist or his/her office with a Christmas gift or donation of fruit or candy, consider making a donation to the research program that he or she is a part of. While I am always flattered and grateful when a patient buys me a tie or other thoughtful personal item, an even better gift is research support. It may not sound as personal or glamorous, but it is something that will long be remembered.

When I moved from private practice in Sacramento to Johns Hopkins in 2009, quite of few of my California patients wrote me moving personal notes, every one of which I kept. Others bought me small gifts or similar items, again things that I really appreciated and still have. But the one gift I will never forget was from the couple (the husband was one of my patients, and I took care of one of his wife’s family members as well) that donated money in my honor to Johns Hopkins, before I even started working here.  

So let make a very direct “pitch," and I'll be clear I am speaking as an individual,  not as a faculty member of Johns Hopkins University (my employer) or as Editor-in-Chief of ASCO’s Cancer.Net (where I volunteer). I would ask you to consider giving to support research by donating to two worthy causes - the Kimmel Cancer Center at Johns Hopkins and ASCO’s Conquer Cancer Foundation, which in addition to supporting Cancer.Net’s patient education and advocacy efforts, has long supported the careers of gifted physician-scientists by funding their research.

You can learn about opportunities to donate to the Kimmel Cancer Center here (consider designating that your gift be used for breast cancer research) or to the Conquer Cancer Foundation here. Thank you so much for your consideration.

My Three Words for 2014

It’s fashionable for anyone with a blog to post their New Years’ resolutions, but I have never been very original or consistent. (Looks like my last attempt was in 2011 - that's lame.) So instead, I will follow the lead of Chris Brogan and Bryan Vartabedian and choose three words that I hope will be my guideposts for 2014:

Focus. I will try to be less distractible and multi-task less this year. I will try to start every week by creating a short, realistic list of what I want to accomplish. Certain things will always pull me away from tasks, with patient care being the most important. But in my other jobs - EHR design/implementation at Hopkins, Cancer.Net editorship, JOP podcasts, social media research and evangelism - I will focus more on the task at hand, even if it’s only 20 minutes of uninterrupted thinking. And speaking of 20 minutes, I will try to spend 20 minutes every single day in the month of January writing (here's the source of that one). Not sure if that means that my blog will be any more successful, but a 20 minute goal is manageable.

Innovate. I’ve never thought of myself as visionary or creative, since I’m more the slow, steady, and thorough type, but I will try to devote energy and personal resources to creating innovative ideas for the things that are important to me, including patient-centered care, consumer-health informatics and patient-reported outcomes, and the intersection of digital health and cancer care. I would like to look back at the end of 2014 and say these are the 5, 10, 20, whatever truly original ideas I came up with and what I did with them.

Recharge. I will try to spend a fixed amount of time every week unplugging from what I have to do and do what I want to do (notice I didn’t specify the amount of time - I’m still trying to figure that out). I will recharge by exercise, listening to music, and reading for pure pleasure.

Wish me luck…

San Antonio Breast Cancer Symposium 2013

This week I was happy to be able to attend my first-ever San Antonio Breast Cancer Symposium, which is probably the largest and most successful scientific conference devoted exclusively to breast cancer research and treatment. The meeting was exciting, intellectually stimulating, and full of great insights into both the basic and translational aspects of the disease and practical management. While I won't give in to hyperbole and say that there were "practice-changing" findings around every corner (a phrase I did hear a few times while there), a number of important research studies were discussed that I know will influence the care I give to breast cancer patients as soon as I return to my practice tomorrow.

As expected, the backchannel of the Twitter stream (using the #SABCS13 hashtag) was very active, despite some annoying WiFi woes in the convention center, with over 5700 tweets and 16+ million impressions. Thanks to the folks at symplur.com, full analytics and a transcript of the tweets can be downloaded here. If you weren't following along live during the meeting, reading the Twitter stream can provide some interesting glimpses into the science that was presented and immediate reactions and commentary.

There was plenty of media coverage from mainstream news sources, as well as specialty media like MedPageToday and the ASCO Post. Don't miss the press releases from the Symposium web site or these helpful audio interviews with some of the speakers.

And finally, I am grateful to Dr. Deanna Attai, breast surgeon and #BCSM Tweetchat co-moderator, for asking Dr. Julie Gralow and me to write blog posts for the BCSM Community site about some of the research findings presented. Rather than wasting electrons by duplicating my post here, I am linking to it here on the BCSM Community blog page. Dr. Gralow's post can be found here. Feel free to comment below on my post or anything else you wanted to share about the Symposium and findings.

My 12/4/13 talk at Johns Hopkins - "Social Media for Professional Education and Patient Engagement"

Today I was honored to be able to give a talk at Johns Hopkins on the topic of healthcare-related social media. This was a joint seminar of the Cancer Outcomes and Health Services Research Interest Group and the Johns Hopkins Welch Center for Prevention, Epidemiology, and Clinical Research. I set up a Twitter feed in advance using the hashtag #cohsrig13 and prescheduled a series of tweets to go out with links to references for some of my slides. The audience was engaged and enthusiastic, and several of them live-tweeted my talk - which I strongly encouraged of course.

I created a Storify with all of the tweets from today associated with the #cohsrig13 hashtag here. 

I've prescheduled tweets when I've given talks before, and I think it's a potentially effective way to share references realtime and encourage interaction. I've never done a Storify before this but it's incredibly simple and seems to be useful for archiving this type of event. Let me know what you think.

Engage With Grace 2013

Last year for Thanksgiving, I joined many other bloggers in sharing Engage With Grace, which encourages families as they join together for Thanksgiving to consider having the all-important conversation about their wishes for advanced care and end-of-life care. I'm trying to do my part for 2013 as well. A tougher, but more important, conversation can't be had. Please take a moment to read about Engage With Grace and the One Slide Project, and consider having this conversation with your family as you finish your Thanksgiving feast. 

Engage With Grace

Answer and share the 5 questions here.