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.
