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What can big data tell us that clinical trials cannot? I have found the perfect person to help us sort through these questions. Peter is physician-in-chief of the Hartford Health Care Cancer Institute and head of health informatics at the Memorial Sloan Kettering Cancer Alliance. I know this has been one of your passions for a long time. It is such an important issue and we need to get this front and center to a broader audience, so I very much welcome this conversation today.
Dr Miller: This is also an area in which ASCO, our professional society, has started some really important initiatives. ASCO feels that there are times when professionals, physicians, and oncologists need to take the lead in the conversation, because it is so important an issue that it should not be entrusted to others.
Dr Yu: Cancer Lin Q traces back to the Institute of Medicine, now called the National Academy of Medicine, which held a series of workshops a few years ago about big data and what was called "rapid learning systems." The idea was, with the massive data that we will be acquiring in the decades to come, how can we learn from that data and create a system where we learn from real-world experiences, understand what is actually happening out in the field, and supplement what we learn from randomized clinical trials?Dr Yu: They're very bad at talking to each other, in part because there isn't a trusted steward that can bring all of these elements together.That is one of the things that is lacking, and one of the things that ASCO is providing is being that trusted steward, trusted by our members, trusted by our doctors to bring the data together.We have been hearing a lot about big data over the past year or so.We need to think carefully about what the clinical value is of huge compilations of patient information. Dr Miller: I really appreciate you taking the time from your busy schedule to talk to us about big data.It allows us to look at the retrospective performance of practices to see how they measured up with generally accepted quality guidelines. Rather than looking back and saying, "In the past 6 months you did really great here, but maybe could have done better there; think about that for next time, please," we would rather have real-time clinical decision support so that practices can say, "Maybe I should consider this, maybe I have not done that yet; time is slipping by and I need to do this." The first task will be to take our initiatives in quality improvement and measurement and make that into a real-time tool.The second is hypothesis generation—looking at the data without any preconceived notion.ASCO will begin to make sense of it and to explore it in a reasonable and trusted manner. One is quality improvement; it is the most obvious and one of our strengths at ASCO.For many years now, we have had Quality Oncology Practice Initiative® (QOPI), and now an electronic version of QOPI is being developed called e QOPI.We are asking our members to share their data and their electronic health records.To collect the data, to bring it together, is what ASCO will do.