Interview with Vivien Ekuan from the Clinical Oncology team at Flatiron Health

December 1, 2021


We spoke with Vivien about the regimen workflow process at Flatiron, how OncoEMR is designed from a clinician’s point of view, and more.

Joining us today From the Community, we’re speaking with Vivien Ekuan from the Clinical Oncology team at Flatiron Health®.

Flatiron: Thank you for speaking with us today, Vivien! To kick things off, I’d love to hear about your role at Flatiron and what brought you into the field of healthcare.

Vivien: Well, I am a pharmacist by training and I worked for several years in a hospital setting, and then went on to work for a medical group in an outpatient oncology infusion center. I was later recruited to work on clinical content development for iKnowMed with McKesson Corporation. An opportunity to further my career at Flatiron came about so I made the move and took over the Regimen Library content management role here.

Flatiron: Has your career as a pharmacist changed the way you work with an EHR today from the back end?

Vivien: Definitely. Because of my clinical background, I try to approach the design of the EHR from a clinician's point of view. I focus on creating workflows with less clicking, less required form completion, so that clinicians can spend more time taking care of patients rather than navigating through their EHR. As the regimen lead, my priority is to ensure that clinicians have the chemotherapy regimens that they need as soon as possible while making sure the content is accurate.

Because of my clinical background, I try to approach the design of the EHR from a clinician's point of view.

Flatiron: Can you speak a bit about how the regimen workflow process happens here at Flatiron?

Vivien: Here at Flatiron, we have a partnership with the National Comprehensive Cancer Network (NCCN) to build their chemotherapy order templates content in OncoEMR. All of the updates and builds of regimen content in OncoEMR are approved by NCCN. We're one of their many customers, so it takes time for them to get to our content — although they've been really helpful and on time — but as you can imagine, if they have to review multiple diseases, it does take time.

So, our typical turnaround time from either new build or update, to NCCN review and approval, and then the release of that content to OncoEMR, is about two to three months.

Not all EHRs have partnerships with NCCN, so while some EHRs can release regimens in the time frame of a month, they aren’t going through the NCCN approval process that Flatiron does.

Flatiron: The new regimen for Adjuvant Abemaciclib Plus Endocrine Therapy for Select HR+ Early Breast Cancer was announced on October 13, and Flatiron had a regimen ready for customer use on October 20 — just seven days after it was announced, which is a 75% decrease in typical turnaround time. How did this happen?

Vivien: There are two types of regimens in our library — NCCN Regimens and custom Flatiron Regimens. Custom Flatiron Regimens fill a gap between FDA labeling and/or NCCN guideline recommendations in which an NCCN order template does not yet exist.

Since these gap regimens do not need to be approved by NCCN, we can move a lot faster on them. We can typically turn these around in about four to six weeks. However, we’ve received some feedback from practices that they would like to access these Flatiron regimens much sooner than one month. So, our release process was recently revamped to expedite the build and release of Flatiron regimens within seven to ten days and this is why we were able to release the abemaciclib + endocrine therapies much quicker than before.

We recently revamped our release process to expedite the build and release of Flatiron regimens within one week

Flatiron: Can you speak a bit about the collaboration here at Flatiron that happens internally to create these regimen builds?

Vivien: Well, the regimen team is composed of four clinicians who have years of experience building chemotherapy regimens. The four of us collaborate closely with NCCN to build, QA and approve the regimens before they are released to our customers. Currently, NCCN has 89 diseases for order template content, and we've already built out 78 of those, so we're pretty close to building out their entire library.

When I first started at Flatiron about 3 years ago, our available regimen count was at about 400; now we have over 2,700 regimens available covering 70+ cancer diagnosis in OncoEMR. Flatiron really does have a robust regimen library.

Flatiron: Vivien, thank you so much for speaking with us about the regimen process here at Flatiron!