When David Baer, MD, joined The Permanente Medical Group in 1981, he says he had little interest in conducting cancer research. “I may have been the only hematology-oncology fellow at UCSF in 1980 who wasn’t doing it. I very much wanted to be a clinician,” Dr. Baer says.
Yet looking back on his nearly 5 decades with the medical group, he says research quickly evolved into a lifelong passion. “I became captivated by the kinds of questions being asked, and the fascinating answers that researchers were coming up with.”
Dr. Baer cofounded the Kaiser Permanente Oncology Clinical Trials (KPOCT) program in the 1980s—just a few years after joining TPMG—and has remained a champion of the program throughout his career. By the end of 2019, he had enrolled about 175 patients in these trials and helped expand what initially was a regional effort into a national program. Since its inception, KPOCT has administered more than 600 clinical trials involving nearly 5,000 patients.
He received TPMG’s Morris F. Collen Research Award in 2019 for his role in bringing cutting-edge cancer clinical trials to patients, and conducting and supporting cancer research throughout his medical career.
“I cannot think of any oncologist in TPMG who has contributed more to cancer research than Dr. Baer,” says Louis Fehrenbacher, MD, retired TPMG oncologist and KPOCT’s medical director for 25 years. “His knowledge of our integrated data system and uses of big data, as well as his understanding of the unique questions that arise in cancer research, have been of great value, not only to researchers, but to cancer patients, too.”
Improving care delivery
Dr. Baer’s career in medicine began at University of Michigan in the late 1960s, when he was a premed majoring in English literature, followed by medical school at University of California, San Francisco (UCSF), and post-graduate training at KP San Francisco and the San Francisco Veterans Administration Medical Center. He was board certified in internal medicine in 1979 and medical oncology in 1981, and began building an active and vibrant practice in blood-related diseases and cancers at KP Oakland.
His experience as an intern trying to solve the problem of an overburdened lab at KP San Francisco “got me interested in how things work. I always had an interest in processes operating more efficiently,” Dr. Baer says.
Just a year and a half into his medical career, Dr. Baer was appointed Oakland’s assistant chief of medicine, in which his main responsibility was filling in the on-call schedule.
“It was a complex crossword puzzle that took several hours, once a month,” Dr. Baer recalls. He quickly got to work figuring out how use technology to make the task easier.
“I had discovered the Macintosh computer, a program called Excel, and these things called macros. I created a little program using all three that automated the process. It would take two hours to run every month, but it was both fun and practical.”
Dr. Baer’s effort to wrestle the on-call schedule into submission was among the first uses of desktop computer-based applications to help our hospitals run more efficiently.
Over the years he has led and participated in numerous committees related to cancer care, including lab utilization, quality assurance, bone marrow transplantation, breast care, radiation safety, and blood usage.
“Dr. Baer has been a medical oncologist for hundreds, if not thousands, of cancer patients, helping them navigate their disease,” says Betty Suh-Burgmann, MD, chair of gynecologic oncology. “What’s so inspiring about him is his sustained commitment to and energy for making our care better, through both his own practice and as a leader in clinical practice.”
Managing chemotherapy treatment
Dr. Baer’s interest in programming led him to attend some of Apple’s first programmer user-groups. In 1996 he developed CAMMOLOT (Case Management for Medical Oncology with Laboratory and Outcome Tracking), an electronic system to manage chemotherapy for patients at KP Oakland.
Like the automation of the on-call schedule, CAMMOLOT helped Dr. Baer transform a once-laborious process into an efficient system that reduced treatment errors and increased efficiency.
“I built an interface to our mainframe that allowed users to download data,” Dr. Baer explains. “Physicians could enter new patient, staging, and diagnostic information; write orders via templates; and build treatment plans on calendars. The system also enabled pharmacists to configure lists of medications needed on any particular day, and then print labels of different sizes using an easily configurable interface.” CAMMOLOT even stored digital photos of patients, which could be printed on drug labels to help avoid “wrong-patient” medication administration errors.
CAMMOLOT was operating at eight of our medical centers in Northern California by 2005. Between 2000 and 2010, it was used to help manage cancer treatments for more than 50,000 patients who received more than 1.5 million medication doses.
Dr. Baer received TPMG’s Sidney R. Garfield Exceptional Contribution Award in 2006, and in 2007 he shared the Morris F. Collen Research Award with seven other TPMG oncologists for these efforts.
When KP Northern California began implementing HealthConnect, Dr. Baer once again took a leadership role in developing a chemotherapy module, called BEACON, for the national KP oncology program. He received a 2011 James A. Vohs Award for his role on the BEACON steering committee.
“David Baer is a visionary—he’s constantly imagining new approaches and asking sophisticated questions,” says Tracy Lieu, MD, director of the Division of Research. “He invented a computerized system to keep track of chemotherapy many years before we adopted a similar approach embedded within HealthConnect.”
Individual research projects
As an individual researcher, Dr. Baer has initiated numerous research projects, including monoclonal gammopathies, the role of hepatitis B in cancer chemotherapy, iron metabolism and cancer, and lung cancer mortality, among others. He is lead author of 12 published research papers and a coauthor of at least 28 more.
His first major research project involved screening for hemochromatosis. During the early 1990s, Dr. Baer partnered with researchers at the Division of Research, including Lisa Herrinton, PhD; Gary Friedman, MD; and Joe Selby, MD, to review data from tens of thousands of patients who had their iron levels measured as part of Kaiser Permanente’s groundbreaking multiphasic physical exam.
Hemochromatosis, an inherited disease in which people absorb too much iron, can cause serious damage over time to the organs where the iron is absorbed, especially the liver, heart, and pancreas. Once diagnosed, however, the condition is easily treated. “You just have the patients donate blood once or twice a week,” Dr. Baer says. “It’s amazing.”
Related research projects involved using the multiphasic database to study the effects of increased iron load on developing cancer and heart disease. About a third of Dr. Baer’s published studies centered on hemochromatosis diagnosis, treatment, and comorbidities.
Other studies that involved CAMMOLOT include a project in the early 2010s in which Dr. Baer and his colleagues identified cancer patients treated with chemotherapy who also had fulminant hepatitis B. “We were able to use data collected via CAMMOLOT to embed universal hepatitis B screening in our chemotherapy protocols in all KP regions,” he says.
A leader in clinical research
In the service of cancer care and research across KP Northern California, Dr. Baer has served as:
-Chair of oncology from 2011 to 2017
-Chief of oncology at Oakland from 1991 to 2014, and chair of the local research committee for Oakland and Richmond
-Member of a group that focused on quality improvement and subspecialization for TPMG cancer care
-Assistant, and now associate, clinical professor of medicine at UCSF since 1984
At the same time, Dr. Baer has been a leading member of the Northern California Central Research Committee for most of his career, providing valuable experience for other clinicians in the practicality of conducting research within Kaiser Permanente. The Central Research Committee supports and facilitates clinician-led research projects across the region. He was also instrumental in creating the region’s tumor registry, which has served as a foundation for many cancer-related research projects and quality improvement efforts in the decades since.
“Dr. Baer’s depth of experience on the Central Research Committee has made him a potent champion for clinicians doing clinical trials and many other types of research,” Dr. Lieu says.
Dr. Baer says one of the greatest joys in his medical career has been sharing his passion for research with TPMG colleagues. He regularly takes clinicians who are interested in doing studies out to lunch to talk with them about how they can get started on the path to research.
“Nothing has been more rewarding than meeting the outstanding new clinicians that continue to join TPMG, to listen to their enthusiasm about engaging in research, and to help guide them in their efforts.”
-This story originally appeared in Permanente Excellence magazine