Erika Rosato is an oncology nurse at Massachusetts General Hospital, and her day revolves around…paper.
She checks flow sheets at patients’ bedsides for vital signs. She writes on a clipboard when speaking with them, and then hunts down a binder at the nurses station to report her notes. But she has to wait if another provider, like a respiratory therapist, is already using it.
After wrapping up her notes, she takes handwritten orders from physicians—some with “better penmanship than others”—and transcribes them into orders. She checks, highlights, and initials her work in red.
But that was 25 years ago in 2000. Now, Rosato is the associate chief nurse for the Mass General Cancer Center’s Obstetrics, Pediatrics, and Medical Infusion Center.
“Having to do all of that in writing…today, any of us can be at the same time writing notes, putting in data,” she said. “The electronic medical record has been a game changer.”
Updates in electronic health record (EHR) systems are just one of the many ways hospitals have changed since the turn of the century. Rosato and her longtime colleague Dave Ryan, an oncologist and physician in chief for Mass General Brigham Cancer, spoke with Healthcare Brew about what cancer care was like in 2000 and what has changed over the last 25 years.
EHRs cont.
The 1990s were all about the development of EHRs, the 2000s and 2010s were about adopting them, and the 2020s have been for integrating other technologies into EHRs, according to NIH. In 2008, 9% of all acute care hospitals in the US used EHRs, and by 2021, that shot up to 96%, according to data from the Assistant Secretary for Technology Policy.
Now, Rosato said other providers can see her notes immediately, which enables communication across multiple departments.
Imaging moved online as well, Ryan added. When he first started, he used to “run to the radiology imaging room all the time and get the actual films out,” he said.
The downside, Rosato said, is that nurses had more face-to-face time with patients back in 2000, adding that caregivers today are more likely to look at a screen when speaking with patients.
Within the last 10 years, health tech companies like Abridge and Suki have added to EHR platforms AI scribe functions that can listen and take notes for clinicians.
As more technology comes into use, care delivery changes, too.
“The life of the oncologist changed,” Ryan added, as the doctors are now spread out at different sites compared with the past, when they previously met in person with hospitalized patients each day. And now with telehealth, he said physicians can meet with patients daily on video calls from wherever they are.
Treatments
Some technological advancements have also come in the way of medications.
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For one, immunotherapy “didn’t exist,” and it has “dramatically changed the way we approach cancer and the way we think about treating somebody,” Ryan said. There are now targeted therapies that can also attack specific cancer mutations, he added.
Immunotherapy, which helps a patient’s immune system fight cancer, rose in popularity in the 2010s after the first immunotherapy for cancer, ipilimumab, received FDA approval in 2011 to treat advanced melanoma. A 2022 Canadian study of 60,000 cancer patients found that while only 3.3% of patients received immunotherapy in 2011, 39.2% were treated with it in 2019.
Prognostic awareness, or the patient’s understanding of their disease, has also improved over the last 25 years as more resources have become available to patients online, Ryan said.
This has all culminated in patients living longer, he said. In fact, cancer-related deaths dropped by 4.5 million people from 1991 to 2022, equating to a 34% drop in the overall cancer death rate, according to research from the American Cancer Society.
“It used to be I had one line of therapy. If they had metastatic disease, people would die [from gastrointestinal] cancers in the course of six months if they didn’t respond,” he said.
Nursing shifted attention to wellness as a result, Rosato said, and nurses today have more conversations with cancer patients about nutrition, exercise, mental health, and survivorship.
Longer lives also means there’s an increased need for multidisciplinary care, Ryan said. As the patient experiences side effects from treatments and natural aging, they may require medical care outside of oncology, like hip replacements or dermatology treatments.
Nancy Foster, VP for quality and patient safety policy at the American Hospital Association, echoed this, saying that since patients have more options now, they have more conversations with doctors about their care and how they can meet their individual goals.
Looking forward
Looking to the next 25 years, Rosato said the shift to home health, where nurses can care for patients at their residences, is “huge.” Last year, consultancy HealthCare Appraisers projected that total home health expenditures will rise from around $150 billion in 2024 to $250 billion by 2031.
The increased understanding of the immune system and “how to harness it” is something Ryan is excited about in the next quarter century. This includes drugs that “rev up” the immune system like CAR T-cell and TIL therapies that attack cancer without hurting other organs, he said.
“I would anticipate that, broadly speaking, this immunotherapy space is going to be where most of the breakthroughs happen,” he said.
This is one of the stories of our Quarter Century Project, which highlights the various ways industry has changed over the last 25 years. Check back each month for new pieces in this series and explore our timeline featuring the ongoing series.
