Implementation of a national cancer subspecialist virtual consult pilot in an integrated health system.

Abstract

143 Background: Over 65,000 new cancer patients are diagnosed nationally each year at Kaiser Permanente (KP), with 12.7 million members in 9 states and the District of Columbia. KP developed the Cancer Expert Review Program (the Program) to connect oncologists with cancer subspecialists across the enterprise. The Program provides consultation and a chart note viewable by the patient within 2 business days. Methods: The Program was piloted from October 2022 to June 2023 for medical oncology patients with breast, gastrointestinal (GI), genitourinary (GU), sarcoma, thoracic, hematology, central nervous system (CNS), melanoma, head & neck, and gynecologic oncology (GYN) diagnoses or a need for molecular/genomic testing. Medical oncologists from Hawaii, Georgia, and Southern California submitted requests for virtual consults to designated cancer subspecialists using HealthConnect, KP’s EPIC system. Consulting physicians had direct access to the medical records for each patient, including pathology and imaging. Oncologists informed patients of the service and discussed the rendered opinion as part of shared decision-making. Implementation outcomes of feasibility and acceptability were evaluated. Providers were surveyed about perceptions of the service using an internally developed questionnaire. The time from consult request to completion was measured. Results: 108 consults (67.5%) were provided by individual subspecialists, while 22 consults (14%) were reviewed by multiple experts or a multidisciplinary team. 140 consults (87.5%) were completed within 2 business days. Of the 44 oncologists who requested a consult, 12 responded to a physician survey. 85% of physicians rated satisfaction with the service as “satisfied” or “extremely satisfied”. 75% said the advice helped to develop the treatment plan. Half of physicians reported the advice changed the original treatment or approach either “somewhat” or “to a great extent.” Half of physicians indicated that if this internal program were not available, they would have referred their patient to a non-Kaiser Permanente provider for a consultation. Conclusions: Implementation of a national cancer subspecialist virtual consult pilot within an integrated health system demonstrated the feasibility and acceptability of timely expert consults with high physician satisfaction. The Program facilitates subspecialist care in collaboration with the patient’s trusted general oncologist, keeping care close to home.Additional research is needed to understand the long-term implementation and quality outcomes of the Program.[Table: see text]