Clinical Pathways in Oncology: How City of Hope Delivers Optimal Cancer Care Coast-to-Coast

Linda Bosserman, M.D., joined City of Hope in Los Angeles nine years ago as a medical oncologist specializing in breast cancer and value-based care.

During her 26 years in private practice, prior to joining City of Hope, Bosserman developed a special interest in combining key components of the health care ecosystem to enhance and measure outcomes against costs of care for patients with cancer.

Now, as part of her current role at City of Hope, Bosserman puts this interest into practice as medical director of value-based care. Her expertise has been vitally important as City of Hope expanded to become one of the largest cancer research and treatment organizations in the U.S. Throughout its growth, City of Hope has applied Bosserman’s insights on personalized team-based care, implementation of Epic electronic health record (EHR) software, and oncology pathways to deliver high-value care across its clinical network.

City of Hope began using Elsevier ClinicalPath oncology pathways in 2017 to provide standard-of-care treatment pathways for its medical oncology, hematology and radiation oncology teams to treat most solid tumors and hematologic malignancies. These pathways are evidence-based, standardized approaches to treatment for specific forms of cancer that can guide personalized care based on a patient’s unique needs. Additionally, outcomes from delivered pathways can be evaluated against individual and population benchmarks to provide insights for continuous improvements. At City of Hope, pathways help ensure the most advanced therapies are used in treatment to efficiently achieve the best possible health outcomes. 

“To ensure the highest quality care across our system, it’s critical to bring payers, providers, oncology pathways, EHR, and analytics together using a decision-support infrastructure that optimizes personalized care for each patient,” says Bosserman. 

When City of Hope acquired Cancer Treatment Centers of America in 2022, it brought new treatment facilities in Atlanta, Chicago and Phoenix into its fold. Bosserman has been an integral member of the team expanding Epic’s EHR platform to these new facilities, which will help support uniform policies, protocols, clinical trials and personalized decision support throughout the system.

Once Epic implementation is complete at City of Hope Atlanta, Chicago and Phoenix, the clinical pathways for oncology, hematology and radiation oncology will be fully integrated across City of Hope’s system with clinical trials and supportive care. Clinicians will also be able to easily access experts throughout the system for peer-to-peer consultations and education, tumor board participation and complex oncology case discussions.

“With this approach, we’re providing sophisticated, integrated clinical decision support at the bedside combined with practical orders to ensure complex treatment regimens are given in the most effective way possible,” says Bosserman. “It’s a process we’re excited about and continuously improving by incorporating our clinical trials and supportive care into pathways, while utilizing analytics and insights from Epic.”

To further support consistent patient care across all locations, City of Hope leverages six key tools within Epic: diagnosis on a problem list, use of Epic staging, patient-reported outcomes, treatment pathways, goals of care and social determinants of health screening. Among other benefits, these tools enable providers to monitor a patient’s response to treatment and minimize side effects, while ensuring they consider their patient’s individual goals.

“We've standardized pathways against evidence in our system and tied them back to EHR ordering. So now, within a pathway, we’ve accounted for all components of the patient experience, like the correct lab tests, genomic testing, medications to minimize side effects, tools for patient education and follow up visits,” says Bosserman. “It’s all built into order sets so that we offer a comprehensive plan for the patient.”

Throughout City of Hope’s expansion, it has utilized pathways to reduce unwarranted variability, support clinicians in an increasingly complex field and provide individualized high-quality care. With each new discovery, as reviewed by City of Hope disease experts, pathways are updated to ensure clinicians can make the most appropriate treatment choices based on specific cancer therapy needs. 

Pathways have also been added into a four-tiered pyramid of decision support that City of Hope utilizes, which includes formal and informal faculty consultations, tumor boards and complex oncology case discussions, to bring rapidly evolving knowledge to its clinicians. This type of optimized decision support, backed by multidisciplinary cancer expertise, can personalize individual patient treatment plans to achieve optimal care and survival wherever patients are treated.

“This is truly delivering high-quality, personalized precision care to patients,” says Bosserman.  

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