While nearly all oncologists would agree that clinical research is an essential component of cancer care, the reality is that most oncology practices lack the infrastructure, resources, and time to meaningfully implement novel clinical research at their institution. But what if it were easy for every oncology provider -- regardless of practice setting -- to engage in clinical research? What if patients could participate in clinical trials and receive cutting-edge therapies anywhere in the country? These challenges and opportunities are what inspired Dr. Mark Lee, MD, PhD and his team to found N-Power Medicine in 2021. Initially trained as a medical oncologist, Dr. Lee spent many years of his career in the pharmaceutical and diagnostic industries, where he encountered the same fundamental problem time and again: our system is not set up to enable the vast majority of cancer patients (and their data) to contribute to the development of new life-saving drugs. The existing model needs to be revamped to increase access to clinical research: as a part of every oncologist’s practice and every patient’s care.
N-Power Medicine aims to re-invent this model through a comprehensive point-of-care platform that introduces a single workflow for both routine patient care and clinical research, simultaneously. The goal is to generate research-ready data for all patients in real-time while dramatically reducing clinician workload, especially for tasks such as gathering patient data and generating clinical notes for the electronic health record (EHR). The N-Power platform is comprised of 3 core components: the Kaleido™ Registry (a point-of-care technology solution) as well as on-site and virtual experts to support clinic and research staff. But what does all of this actually mean? The best way to understand the benefits of the N-power platform is to walk through the journey of a single patient who has consented to the N-Power process in a participating clinic. N-power platform is to walk through the journey of a single patient who has consented to the N-Power process in a participating clinic.
Starting about a week prior to the patient’s appointment, the N-Power virtual team begins the process of abstracting the patient’s data from the clinic’s EHR and other data sources into the N-Power Kaleido™ Registry. Alongside the data abstraction, the N-Power team is also synthesizing the patient’s information into a pre-built note template for the provider to review and use during the appointment. (As you can imagine, this is a substantial time-saver for oncology practitioners in the clinic.) During data collection, patients are automatically identified for potential trials available at the site. These findings (including data needed or tests that must be ordered) are communicated to the clinic and research staff before the visit. When the provider eventually sees the patient, they are prepared to discuss the clinical trial with the patient. Once patients enroll onto a trial, the on-site N-Power staff function similarly to clinical research coordinators to provide support to sites in various capacities, enabling the clinic staff to focus their efforts on patient care and opening new trials.
Essentially, the N-Power model empowers providers to become more involved with research by reducing the administrative burdens of routine care, such as data gathering and documentation. N-Power also reduces the legwork involved with pre-selecting patients for trials and handling back-end research operations. In the Kaleido™ Registry, every patient becomes a potential research candidate, as the data are structured and standardized for research at every visit. The N-Power Registry thus serves as a launchpad for clinical research by elevating the data in the routine care population to bridge the gap to clinical research. Even the non-trial patient data contribute to the drug development process by helping to inform optimal trial design and realistic eligibility criteria.
Currently, N-Power is partnered with 4 community oncology sites across the country. We spoke with Dr. Barbara L. McAneny, MD, medical oncologist and CEO of New Mexico Oncology Hematology Consultants and founder of the New Mexico Cancer Center Foundation. We discussed her institution’s experience with N-Power since bringing them on board in 2021, shortly after their launch. Dr. McAneny first came across the company at a National Cancer Care Alliance (now ONCare Alliance) business oncology meeting, where stakeholders discussed barriers to leveraging oncology data and the need for cleaner data. At the same time, providers expressed frustration with trying to extrapolate clinical trial results from demographically homogenous study populations to the diverse range of patients who are actually seen in their practices: individuals from underrepresented backgrounds with multiple comorbidities, prior cancers, abnormal lab values, and other clinical idiosyncrasies.
Community-based oncologists frequently expressed the desire to have clinical research as an integral part of their practice but felt limited by inadequate resources and infrastructure. As Dr. McAneny describes, conducting research often becomes a “money-losing hobby” in the community setting. One or two providers may see a patient with a specific mutation and decide to open a trial for that type of patient, but by the time the next eligible patient comes along, many months may have passed, and it becomes inefficient and cost-prohibitive to keep these trials open under such circumstances. In these settings, it would be ideal to have a data platform to identify which types of patients (genetic mutations, etc.) are seen frequently enough in a particular clinic to statistically power a given clinical trial. Dr. McAneny has tried various new programs throughout the years to identify patients for trials, but none of them lasted long in her clinic because they created an unsustainable logistical burden for her staff. What has made N-Power a successful partner over the last few years, in her words, is how well the model has embedded itself into the daily workflow of New Mexico Cancer Center (NMCC) and alleviated administrative hurdles for the staff.
Dr. McAneny notes that the N-Power Digital Health Staff, who she refers to as “superscribes,” are especially helpful for the physicians because of their strong medical backgrounds. This fund of knowledge allows them to synthesize information in a way that is more useful than a routine scribe who is primarily transcribing speech-to-text. The “superscribe” can identify which patients have been flagged as potential candidates for a trial, review the chart to see if the patient is eligible, and prompt the provider to collect more information or discuss the trial with the patient. For patients enrolled in trials, the N-Power clinical trial staff have also been an asset: Dr. McAneny’s research staff essentially see the N-Power team as an extension of their own team. The N-Power system was first implemented for one physician in the practice, and after that provider was comfortable with the process, it was rolled out to others. Currently, all medical oncologists actively seeing patients at the Albuquerque NMCC site use the N-Power platform.
All in all, Dr. McAneny believes that the N-Power platform has elevated provider awareness of clinical trial opportunities in the practice and has incorporated clinical research as a routine part of the workflow for patient care. The “superscribes” not only help to save time for providers, but also enhance the overall quality of documentation, as they often find discrepancies in notes while reviewing a patient’s case. The prospective data curation empowered by the Kaleido™ Registry has worked well to identify suitable trial candidates at the institution. Additionally, Dr. McAneny’s team has leveraged data from the N-Power Registry CMS for MIPS (Merit-based Incentive Payment System). Dr. McAneny reports that since partnering with N-Power, her site has met all metrics for getting patients on the registry and enrolling patients onto trials in a timely manner. Moreover, they have been able to demonstrate that their community oncologists are conducting next-generation sequencing (NGS) testing at similar rates as academic oncologists. These findings have recently been accepted for presentation at the 2024 ASCO conference.
Regarding opportunities for growth with N-Power, Dr. McAneny pointed out that occasionally, the goal of opening more trials at community oncology centers will conflict with the site’s current capacity. For N-Power, an important objective is to empower sites to open more trials, while Dr. McAneny also has the goal of ensuring the clinic’s ability to enroll patients and close trials expediently. Identification of suitable trials is a complex, multifactorial decision that looks different for each clinical practice. For example, which imaging scans are covered by the trial? Which scans will need to be billed through insurance? What are the costs to open the trial? How much time will it require from the PI? Will it be appropriate for the clinic’s patient population (i.e., patients who do not have the means to travel 3 times per week for follow-up and lab work)? The right trial should be a good fit for the site’s patient population, garner physician interest and support, have economic terms that are suitable for all parties, and minimal procedural barriers. Just because a site can open a particular trial, does not always mean that it should.
Despite these complexities, it is clear that N-Power Medicine is making a strong impact on the ability of community oncology centers to conduct clinical research and offer novel therapies to traditionally underserved patients. By prospectively generating data and creating a single platform where all routine patients become potential research candidates, N-Power Medicine is helping to cultivate a world where every patient and their data can contribute to accelerated drug development in this new era of personalized cancer care.
