Amplio is based on five principles:

  1. Confidentiality. The only individual who has access to a clinician’s results is the clinician him- or herself. In unusual circumstances, a service chief or department chair can make a formal request in writing to obtain data on an outlying observation, but clinicians are otherwise assured of full confidentiality.

  2. Interactivity. Amplio does not provide a static report, but offers an online environment where clinicians can explore their results. For any given outcome, clinicians can look up results for different periods of time (such as the previous 12 months or the previous five years) or groups of patients (such as high vs. low risk) and compare them with different types of surgical approaches (such as all operations, open surgery, or minimally-invasive surgery). In many cases, the outcome can also be configured in different ways (such as different timepoints for recurrence).

  3. Responsiveness. Amplio is a bottom-up rather than a top-down system. We work with clinicians to understand the information they want in terms of which outcomes are important, how they should be presented, and the covariates to be used for risk adjustment. When an Amplio system is implemented, a member of the Amplio team meets with each and every clinician to demonstrate the system, answer questions, and hear any suggestions for changes. This is an ongoing process: clinicians can and do continue to contact the Amplio team to request modifications.

  4. Multimodality. Patient care is multidimensional and care objectives can sometimes conflict. For example, a surgeon can maximize cancer control at the expense of function and complications, or minimize complications and avoid loss of function but compromise cancer control. As such, it is often critical to give clinicians feedback as to their outcomes on multiple dimensions, including patient selection.

  5. Persistence. Quality assurance must be an ongoing process throughout a clinician’s career. We will not establish an Amplio system without a clear plan for regular updates. An important corollary is that Amplio must be based on data that is routinely collected and stored in an electronic format.