FormalPara Key Points

  • Technology holds great promise and can be leveraged to address patient, provider, and organizational needs and goals in cancer care. It can be a powerful tool if the technology is well-integrated into the center and used to support patient care.

  • As larger centers and organizations increasingly rely on technology, smaller Indigenous programs are being left behind. Many technologies are not developed based on the needs, challenges faced, or guidance from Indigenous communities and may not be accessible or appropriate. In this way, IT can contribute to health disparities by entrenching a digital divide.

  • Investing in technology requires careful consideration and diligence in informed decision-making for program leaders.

  • An important example of technology being integrated into healthcare practice was developed in 2016 by the Native American Cancer Research Corporation. NACI Care™ is an iPad program used for patient navigation data entry, evaluation, and tracking.

Technology and information technology (IT) breakthroughs specific to cancer and/or patient care are continually emerging. Excitement for the “shiny new tool” occasionally overshadows careful review and consideration, as well as its appropriate use. IT can be a powerful tool, but it is not the end game. In this section, the use of technology in clinic and community-based cancer care is discussed, and a short case study of NACI Care™—an iPad program used to support patient navigation—is provided.

A Snapshot of the Technology Landscape for Cancer Care

Technology is increasingly important in the continuum of cancer care, including community education, screening, diagnosis, treatment, and survivorship [1,2,3]. The end users of technologies can be community members and patients, providers, healthcare professionals, and healthcare organizations. In recent years, technologies have emerged to support organizations and patients across the cancer continuum, some of which are described below.

Organizational Level

  • Electronic health records (EHRs): EHRs have become common in healthcare settings, allowing healthcare providers to access and share patient information easily [4].

  • Mobile clinics: Mobile clinics bring cancer screening services directly to communities, particularly in remote or underserved areas. They offer mobile mammography, HPV testing, Pap smears, and other screening tests on-site, enabling easier access [5].

  • Telehealth and telemedicine: Telehealth and telemedicine technologies are used to overcome the geographical and logistical barriers faced by many Indigenous communities. Through video consultations, healthcare providers can remotely guide patients on self-administered screenings or advise on the next steps based on individual risk factors [6].

  • Collaborative databases and information systems: Databases and systems help bridge the gaps in healthcare data for underserved populations. By centralizing health information, researchers and healthcare providers can track cancer screening rates, identify disparities, and develop targeted interventions to improve outcomes [7, 8].

  • Text message reminders: Sending text message reminders for cancer screening appointments and follow-ups can improve adherence to recommended screenings. This approach can help ensure that individuals receive appropriate cancer screenings and follow-ups in a timely manner [9].

  • Artificial intelligence (AI): AI is being used to enhance cancer screening processes. For example, AI algorithms can assist in the analysis of medical images, such as mammograms or CT scans, to aid in early detection and diagnosis. AI can also help streamline administrative tasks and improve patient management [10, 11].

For Patients

  • Mobile applications: There are various mobile applications available that provide information on cancer screenings, appointment scheduling, and reminders. These apps often include educational content, risk assessment tools, and the ability to track personal health data [12, 13].

  • Wearable devices: Wearable devices, such as smartwatches and fitness trackers, can monitor vital signs and collect health-related data. These data can be used to identify potential risk factors and encourage patients to undergo cancer screenings based on personalized recommendations [14].

Many advances in technology focus on clinical care, including imaging technologies, laboratory tests, molecular diagnostics, radiation therapy, surgical innovations, targeted chemotherapy, immunotherapy, and advanced data analytics. AI applications support clinical decision-making and enhance personalized medicine approaches.

Of course, the availability of technologies varies across organizations, regions, and health systems. Indigenous and other underserved communities have specific needs and cultural considerations that must be accounted for in developing and implementing these tools to ensure the already existing digital divide is not widened [6].

Benefits of IT

IT can be beneficial to both programs and patients. It can be used to provide patients and caregivers with timely, specific information—something which many patients feel is lacking [15, 16]. It can also be appropriate to the patient’s cultural needs or health literacy level. For example, easy-to-understand videos and electronic books can explain clinical appointments and procedures. Visual demonstrations in videos can be particularly helpful, as is the ability for patients to retrieve the information as often as needed [16].

For healthcare teams, IT systems can be tailored to provide messages and reminders to patients in real time (via email or text), with automated reminders reducing the burden on healthcare staff. Systems that can be linked to the electronic medical record (EMR) can be tailored to the individual patient’s issues, needs, or interests [16].

One useful example here is Cancer Advocacy and Patient Education (CAPE), a web-based patient education platform created by the Academy of Oncology Nurse and Patient Navigators (AONN+). It aims to improve patient education and enhance patient care by allowing navigators to identify resources specifically for an individual patient. The list of resources is sent from the navigator directly to patients via email or can be printed for patients who are uncomfortable with email [15]. Other technology platforms connect with the EMR and can deliver engaging patient education directly through email and text messages at the right time in the trajectory of care, such as preparing a patient for their upcoming port insertion [16].

Challenges and Limitations

IT systems bring multiple challenges, which need to be considered alongside the benefits. Many IT products are based on data sources that do not provide the detail needed for Indigenous, underserved populations. Some systems are not considered culturally appropriate by their audience [17, 18]. For example, even a well-developed and vetted tool like CAPE faced challenges because a sizable number of lung cancer patients found the materials upsetting [15].

While many technologies link to EMR data, in healthcare settings this may not be successful. Departments within the same health system may use different EMR software, with only some linking to the new IT. For example, even relatively small American Indian clinics specific to a single Tribe in the southwest use 13 different EMR programs. In this situation, the EMR programs do not interact with one another [19]. For example, a cancer patient who also has hepatitis may have data entered for the hepatitis program, but those data are not accessible to oncology program staff and vice versa. Staff must re-enter patient information, which can lead to data-entry errors and delays.

Even in centers where the same EMR system is used by all departments, the system may be used differently—with different data fields used and different criteria for inclusion. It can be challenging to have access to all data points that the program needs. No matter what system is chosen, it can only be as good as the quality of data it contains, and staff need training and support to use it appropriately [20, 21].

For small healthcare centers, there is a specific challenge. Many Indigenous healthcare centers are small and lack infrastructure. Purchasing technology that suits the location and clients can be difficult and cost prohibitive. Yet as larger centers increasingly rely on technology, smaller Indigenous programs are being left behind. In this way, IT can contribute to health disparities by entrenching a digital divide [17]. The questions for small Indigenous healthcare centers are numerous: How do Indigenous communities afford both the IT purchase and the constant upkeep? How does a small rural clinic or non-profit program connect or find resources to access and learn to use IT appropriately? How do small programs access ongoing support from people who understand the technology? [22, 23]

Currently, many IT programs do not work well together, but this may change with Health Level 7 (HL7) phrasing for programming. HL7 provides global standards for the transfer of clinical and administrative health data between applications. It enables the various systems, such as patient administration, clinical tasks, and medication management, to interface with each other [24].

Recent technology is becoming more accessible and easier to use—even for those without much technological experience. For example, tools like Microsoft Power BI can report on any device, from anywhere—creating data summaries and sharing information. Tools like this may enable communities to organize data easily and better use information to represent the community’s needs [25, 26].

IT Does Not Stand Alone

Ideally, IT complements programs that are trusted in the community. These community partners can ensure that technologies are being integrated into the community setting and support the utilization of these tools, especially since most of these tools have not been developed from the community perspective. It is important that the materials, where printed or technologically generated, are designed or adapted to be culturally appropriate, easily accessible, and available in Indigenous and other languages. In addition, tools developed by and for these communities are important to explore since they are designed from the start with this perspective. It is also important to think about how these technologies support and can be used by community health workers, patient navigators, Aboriginal patient liaisons, and Aboriginal liaison officers who are often the respected and trusted sources in their community. The integration of high touch (person to person) and high tech is essential for the technologies we employ to have value in our communities and address health equity across the cancer continuum.

Case Study: NACI Care™

This case study (co-authored by Linda Krebs and Linda Burhansstipanov) illustrates how a small, minority-owned non-profit organization and its staff, the Native American Cancer Research Corporation (NACR), integrated technology with the approval of the local Indigenous community to engage Indigenous peoples in cancer research. NACR first started to incorporate technology into its work in 2003, when it adopted audience response systems (hand-held keypads) to gather real-time feedback from participants at events.

In 2016, a project titled A Tool to Improve Evaluation of Patient Navigation Services in Underserved Populations was initiated to create NACI Care™, an iPad program for patient navigation data entry, evaluation, and tracking. NACI Care™ evolved from NACR’s web-based interactive evaluation program. It offered a comprehensive, portable system for staff to use when working with patients or community members. NACI Care™ (1) supports accurate and easy data input, (2) allows for real-time data entry and individual summaries, (3) allows program administrators to monitor oncology patient navigator interactions and produce activity summaries to document navigators’ value, and (4) collects patient perspectives and satisfaction related to navigation services. The program provides a central data repository that uses HL7 language and has the capacity to link with EMRs. It is designed to support registered nurses, social work oncology patient navigators, administrators of navigation programs, program evaluators, and researchers.

NACI Care™ has three main components (see Fig. 74.1).

  1. 1.

    Patient information and healthcare visit data: Data are uploaded by the patient navigator or user, including patient identification information, demographics, general health behaviors, current health status, health history, barriers and solutions, referrals and appointments, survey results, patient program status, and an interaction summary.

  2. 2.

    Patient navigator information and activities: This includes data about the patient navigator, such as contact details and demographics, education and training, outreach work, and dissemination records.

  3. 3.

    Administrator functions and tailoring: The system administrator can add system preferences, user approvals, default reporting templates, and report filters. The program also will provide an overview of a program’s return on investment.

Fig. 74.1
A chart illustrates three components of the N A C I care system exhibiting patients, patient navigator or user including P N sub-SIDEBAR, and P N administrator including P N administrator sub-SIDEBAR. Patients are classified into new and existing patients. Existing patients include interactions and reviews.

The three components of NACI Care™

Full size image

NACI Care™ can be tailored to meet local program needs including selecting how to sort patient lists, choosing which measurement system is used (metric or imperial), selecting what topics can be accessed for data entry, and using filters to tailor reports. There are more than 5000 fields, available to be controlled by the administrator—though no program would use all of them. For example, a program focused only on outreach, education, and early detection/screening may not want the information from surveys, while another program may not want the navigator or user distracted by health behavior and status information.

NACI Care™ offers default report templates for approximately 36 navigation program metrics, which can be used to evaluate program success. These are based on nationally recognized metrics. NACI Care™ provides reports for accreditation, manages patient care (in and out of clinical settings), focuses on cancer care, addresses the entire cancer continuum, and can generate tailored reports about individuals, groups, or programs.

NACI Care™ enables users to add or modify filters for all summaries and reports, including filtering for individual patient navigators, patients, or groups. A particularly useful feature is the ability to filter according to specific demographics, general health issues, cancer types, or medical issues.

NACI Care™ has received trademark protection in several countries.