Let's Not 'Waste' COVID-19: Opportunities for Improvement

Kathy D. Miller, MD


May 07, 2020

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This transcript has been edited for clarity.

It's Dr Kathy Miller here, from Indiana University. I'm coming to you from Indianapolis, which is one of the emerging hotspots of COVID-19.

All of us have had our lives upended in many, many ways by this pandemic. Rahm Emanuel is widely quoted as having said, "Never let a good crisis go to waste." What he meant is that this is an opportunity for us to do things differently and to do things we never thought we could do.

In oncology here at Indiana University, we've had discussions about who we would continue to treat if we reached a point where we couldn't treat everyone. Those are not easy discussions, but they've been useful. We've also thought about ways we could conserve resources without impacting outcomes for our patients, and we've thought about new ways of delivering care.

Undoubtedly, many of these changes will be temporary. They are a short-term need because of this crisis and the need to keep our patients safe. However, some of these changes should become permanent. Think of the innovations in telemedicine forcing us to question who really needs a physical exam and who needs to be physically present.

Other considerations include the way we administer clinical trials. If a drug is oral, could we ship the drug to our patients at their home rather than shipping to our pharmacy and demanding that patients physically come here to pick up their next supply? Could we give external monitors electronic access to our clinical trial system so that they could monitor the data and help us ensure quality without physically being here?

Those are things that, prior to this point, we may have talked about on the fringes, and perhaps some places have tried to do them, but we've never really jumped into this work with both feet. I predict that there will be huge advances in implementation science that could come from this crisis if we're willing to follow that path.

I'll give you an example. Yesterday I saw two new patients for consultation via virtual visits. If the patients had been in my office, I would have examined them, though in reality I would have acknowledged that I was examining them more out of convention—that's what I am supposed to do and that's embedded in our billing codes—more than the fact that there was something I was going to glean from that physical exam that would change the recommendations and our treatment discussions.

These were patients facing difficult therapeutic decisions: Do I take the path of chemotherapy or do I take this path with only endocrine therapy? What's the best choice? That's an area where my expertise in discussing the data and helping them think through these decisions could be really helpful.

We didn't need an in-person visit and I didn't really need to examine them. If we think about that in a larger way, how many other patients might be able to take advantage of these discussions and the expertise at academic medical centers if we didn't mandate in-person visits for those consultations? Think about what this could mean for reaching underserved populations if we could find a way to make these technologies available.

There's much more to think about here than just the immediate crisis planning. I look forward to your thoughts on what changes you have made in response to the virus that have been good and you think should continue.

Kathy D. Miller, MD, is associate director of clinical research and co-director of the breast cancer program at the Melvin and Bren Simon Cancer Center at Indiana University. Her career has combined both laboratory and clinical research in breast cancer.

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