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Roche's Navify Tumor Board Looks to Optimize Decision-making for Cancer Treatment

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CHICAGO (360Dx) – With the deployment of its Navify Tumor Board management platform at the University of Missouri School of Medicine and the related MU Health Care system, Roche is moving toward the twin corporate goals of establishing itself as a player in digital health and ingesting several recent acquisitions.

Introduced last year, Navify is clinical workflow and decision support software that optimizes decision-making for cancer patient case reviews in the clinic, on tumor boards, or in multidisciplinary team meetings. Navify Tumor Board is the first manifestation of that, serving as a hub for performing clinical decision support based on electronic health records, laboratory, pathology, and imaging information systems, genomics, and administrative datasets.

"Navify, for us, is an amalgamation of all these different data sources," said Ketan Paranjape, vice president of Roche's Indianapolis-based Diagnostics Information Solutions division. "What Roche is trying to embark on now is a digital health portfolio."

Tumor Board, he said, points Roche in the direction of its clinical goals: helping healthcare providers improve quality and access to care while also reining in costs.

"Precision healthcare is definitely on our radar," Paranjape said. "One of the beachheads we found to go create a healthcare product was clinical decision support."

He said that Roche wants to create a "federated environment" for health systems to share information that affects patient care.

Roche soft-launched Navify in September 2017.

The first go-live at Mizzou with real patient data was on April 9, with the hematology-oncology tumor board. The institution has since brought Navify up for breast cancer. "Eventually, we will go live in all nine of our MU Health Care tumor boards," said Jerry Parker, associate dean for research at MU School of Medicine.

At MU, the technology is helping to automate processes that have traditionally been laborious. Navify will essentially become the homepage for tumor board-related discussions within provider organizations.

"Tumor boards for cancer patients are really just interdisciplinary team conferences," Parker noted.

"In most settings, pulling all that data together for an efficient conference is quite a manual task," he said. "It involves various people, sometimes going into the record to create slide presentations as we do for most any conference. It's time-consuming, it's not permanent, and [the resulting presentation] doesn't go in the medical record in any way," he said.

In other words, physicians presenting at tumor boards at MU would have been relying on that 1990s technology known as Microsoft PowerPoint to present their findings from mostly manual information gathering.

"The Navify Tumor Board solution allows the data to be aggregated into an electronic application. This new technology allows the presentation of the data in a very user-friendly way," and over a multiple visits, Parker said.

"What it really does is allow providers to have much more efficient workflows to assemble this information, and much more efficient extraction and display of data that they need for a given patient," Parker explained.

At the moment, however, Navify is not fully interfaced with MU's Cerner EHR and other, ancillary information systems, but that work is underway. "It certainly is our goal to have this mostly automated by the end of this year," Parker said.

"Right now, we grab this data, select it, and pull it into the application," he noted. The interface with the organization's pathology and radiology information systems are running, but there is more work ahead.

"As this develops over time, it will indeed become a mostly automated process. That's all very, very doable within information technology capabilities," Parker said.

Navify also can run a suite of clinical decision support tools, and that is in MU's future plans.

"Think if I can augment that platform with applications," Roche's Paranjape said. For example, it might be possible to run a clinical trials application based on knowledge gleaned from the tumor board to identify appropriate trials for patients with a specific condition in a specific geographic area.

"More and more decisions for patients involve having access to genomic information, and there will be things like access to clinical trials' availability. There will be many tools that can be pulled into this platform that will make it enriched for providers in terms of their clinical decision-making," Parker said.

On the business side, this first US implementation of Navify is helping Roche take advantage of several recent acquisitions and partnerships.

Just two weeks ago, Roche announced plans to acquire the remainder of Foundation Medicine (FMI) for $2.4 billion. The pharma and diagnostics giant already had a 57 percent stake in Foundation.

That deal follows the $1.9 billion acquisition of Flatiron Health, a provider of electronic health record software with a focus on oncology, in April.  Flatiron and FMI had struck a partnership in 2014 to create an integrated data platform to develop oncology treatments.

Flatiron brings genomics and longitudinal clinical data into the Roche sphere, while Foundation Medicine has genomic profiling. That data is being integrated into Navify. "A lot of the focus we have on the genomics side is through the acquisitions of Flatiron and FMI," Paranjape said.

The November 2017 acquisition of Viewics, a privately held laboratory business analytics company, also has informed Navify development. Roche said at the time that Viewics will help the company expand its position in the integrated core lab space with business analytics capabilities, and will enable labs to make faster, data-driven, and informed decisions on their operations and processes.

The Viewics acquisition is particularly salient to in vitro diagnostics. That technology focuses on lab efficiency improvements, utilization of devices, and payor reimbursement for such services. Navify can help bring that data into the clinical decision support equation as well, according to Paranjape said.

As a launch customer for Navify, MU Health Care will provide valuable feedback to Roche, Paranjape said. "The biggest thing we get from them is feedback on requirements and features. That has been the biggest asset for us," he said.

MU is looking into patient pooling, for example, for the purpose of identifying trial candidates, according to Paranjape. For its part, Roche is helping MU create multidisciplinary tumor boards, not just for one or two disease types of the time.

“Our goal in working on this pilot with the MU School of Medicine and clinicians at MU Health Care was to fine-tune a digital decision support tool that could help transform the tumor board process,” Alan Wright, chief medical officer of Roche Diagnostics, said in a statement. "The collaboration gave us the opportunity to improve the software in a way that would fundamentally change the way their oncology care teams prepare for, conduct, and document clinical treatment decisions for cancer patients."