even using some of the templates under discussion at the workshop, could potentially increase clinical trial enrollment among adults, which now stands at 3 to 5 percent. Dr. Poplack is optimistic that the passport can be adapted for survivors of adult cancer, but he cautioned that “the devil is in the details.” In the context of adult cancer, he advised starting with a discrete population of patients, for example, breast cancer survivors. For this group, evidence-based guidelines can be developed and integrated into a passport-like tool that can be tested as a “proof of principle.”

Dr. Shapiro congratulated the passport developers for their outstanding work and pointed out that the Passport for Care comprehensively applied principles embodied in the IOM report. He asked how the passport works in practice, for example, “Who inputs data into the system?” Dr. Poplack responded that, in the COG, the care summary information can be entered by oncology physicians, nurse practitioners, or certified research administrators. The physician checks and verifies the information. This aspect of the passport is key, because the underlying algorithms use this information to generate the individualized guidelines. Once the treatment summary information is entered, the rest is automatically generated.

Dr. Poplack reiterated the monumental nature of the guideline development process. While difficult, the process of adapting the guidelines into the standard format required by the passport system has improved the guidelines.

Dr. Ganz asked about interoperability and wondered if oncology providers could download guideline recommendations from the passport system into the physician’s own electronic record. Dr. Poplack described how physicians can read or can access and retrieve information electronically and then can use it in their own systems. The passport will be interoperable, and one of the goals will be to have automatic population of the passport with information that is entered into the treatment summary record. The COG has developed a very comprehensive care summary that, once completed, will be linked with the Passport for Care.

REACTION

Dr. Lawrence N. Shulman


As an invited reactant to the presentation given by Dr. Poplack and his colleagues on the Passport for Care, Dr. Shulman credited the pediatric community with leadership in all aspects of survivorship. Examples include not only the Passport for Care effort, but also early adoption of survivorship clinics and an organized system to develop comprehensive guidelines. In his view, incorporating information technology into adult care systems



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