2017 ASCO Annual Meeting!
Session: Health Services Research, Clinical Informatics, and Quality of Care
Type: Oral Abstract Session
Time: Monday June 5, 8:00 AM to 11:00 AM
Global impact of a clinical informatics system: Scalable delivery of on-time access to evidence-based multidisciplinary expert treatment decisions for all cancers.
Access to Care/Care Delivery
Health Services Research, Clinical Informatics, and Quality of Care
2017 ASCO Annual Meeting
J Clin Oncol 35, 2017 (suppl; abstr 6502)
Author(s): Rajendra A. Badwe, Pramesh CS, Sudeep Gupta, Nita S. Nair, Nancy Renee Feldman, Anil D'Cruz; Department of Surgical Oncology, Breast Disease Management Group, Tata Memorial Centre (TMC), Mumbai, India; National Cancer Grid (NCG), Mumbai, India; Department of Medical Oncology, Breast Disease Management Group, Tata Memorial Centre (TMC), Mumbai, India; Department of Medical Oncology, University of California Los Angeles Olive View Medical Center, Los Angeles, CA; Department of Surgical Oncology, Head and Neck Disease Management Group, Tata Memorial Centre (TMC), Mumbai, India
Background: There is a scarcity of expert oncologists in the world. Patients in nonurban areas have poor access to evidence-based treatment decisions and worse outcomes. In India, there are ~1600 experts for 1.8 Million patients. Created in May 2014, “TMC NCG Navya Online” is an expert opinion service based on an informatics system. We prospectively study its real-world impact. Methods: Navya exhaustively searches and outputs evidence and experience based treatment options for an individual patient. Its accuracy was validated in trials at TMC (one of the world’s largest tertiary care centers) and UCLA-OVMC. Navya’s patient data summary and treatment options are rapidly reviewed and vetted (1-2 minutes) on mobile by experts from TMC and NCG, (consortium of 104 cancer centers in India). Expert decisions are converted into a simple language report for patients. System generated evidence based information on diagnostics, regimens, side effects etc are also provided. To prospectively assess impact, from July to December 2016, all patients were asked via phone follow-up: 1. If report was shared with treating provider, 2. Final treatments delivered. Results: 9361patients from 22 developing countries registered with TMC NCG Navya Online. 3402 expert decisions were provided and converted into 2614 simple language reports. 5229 patients received system generated evidence based information. Median time to deliver a report was 24 hours. The prospective sample was 582 decisions with a 75% (n = 436) follow-up rate. 74% of reports were shared with treating providers. 73% of TMC NCG Navya’s decisions, (n = 306), were the final treatments delivered. Common reasons for non-implementation included decline in ECOG status and not testing biomarkers (ER/PR etc). Conclusions: Expert oncologists use Navya to provide rapid online opinions to patients across 22 developing countries. Patients shared the expert opinions with their providers and received evidence-based treatments. Expanding the reach and impact of such a service to nonurban USA and the world, can maximize outcomes for patients without ready access to expertise.