Tata Memorial Centre (TMC) National Cancer Grid (NCG) Online – Navya Expert Opinion Service improves access to specialized expertise in pediatric oncology to patients nationwide

Since 2015, the service has recommended evidence and experience based treatment protocols for children that can give them the best possible outcomes.

MUMBAI, India – Feb. 15, 2017: In keeping with their efforts of democratising access to their significant expertise for patients across the country, Tata Memorial Centre (TMC) reviewed the impact of their online service in helping pediatric patients on the occasion of International Childhood Cancer day. TMC NCG Online – Navya Expert Opinion Service (available at www.navya.care) provides critical treatment opinions to parents and caregivers of children with cancer. The expert opinion helps them validate or discuss an evidence based change in treatment plan with their treating oncologists. For pediatric patients, choosing the right therapy vetted by an expert, can be the difference between cure and failed treatment.

“If a child is diagnosed early and treated appropriately, 80% of cases should lead to cure. However we are seeing many cases where parents are bringing children to us as a last resort after expensive and failed treatments” said Dr Shripad Banavali, Head of Department, Medical Oncology at Tata Memorial Hospital, Mumbai. “If they had reached out to us online through TMC NCG Navya and followed our opinion, the situation could have been better. We are also finding cases where aggressive chemotherapies are being prescribed that are not suitable for children. This is partially because of the absence of pediatric oncology expertise.”

Pediatric patients are treated differently with doses and regimens than adults, and there are only a limited number of cancer experts who specialize in pediatrics.  TMC NCG Online makes it possible for patients to get the advice of specialized pediatric experts at TMC while often continuing the treatment locally. In cases where expertise or treatments that are not available locally are required, patients are advised to visit accessible expert care centres, such as those in the National Cancer Grid (NCG).

“We have been able to provide appropriate treatment recommendation to many patients in small towns where access to specialized oncology centers is sparse” continued Dr Banavali.“ A lot of these families would either have to travel significant distances or worse still proceed with suboptimal treatments leading to a reduced probability of cure.”

Pediatric oncology is a specialized expertise and often unavailable everywhere. This leads to parents approaching oncologists and physicians who lack the experience and expertise needed in treating children. In many such cases, treatment plans are followed that are not beneficial and in some cases harmful to the patient.

TMC NCG Online has also received cases where parents are reaching out to validate the need for expensive therapies. In one such case of a three month old baby boy, a reputed private hospital had recommended an expensive robotic surgery. The experts at TMC clarified that conventional surgery would be sufficient and would avoid wait time and expense of robotic surgery.

Says Dr Tushar Vora, a nationally acclaimed pediatric solid tumor expert at TMC: “Pediatric malignancies have a very high cure rate but the best chance of cure is the first chance. Many a times, given the emotional state of diagnosis, families are financially exploited and given inappropriate treatment in the name of emergency, which significantly affects the ultimate cure rates. In such circumstances TMC NCG Online – Navya Expert Opinion Service can give the families the means to evidence based recommendations quickly and prevent the above.”

Continues Dr Vora; “also in circumstances when heroic efforts, again with financial and emotional appeal, are counterintuitive, the expert opinions can give realistic hopes and expectations and means for the best possible course.”

On the positive side, TMC NCG Navya has been able to empower families with expert opinions that have enabled them to change treatment plans leading to improved outcomes. A child from Delhi was being treated for Turberculosis without improvement. TMC experts suspected cancer and recommended a surgical biopsy which proved Lymphoma.  The child is currently under life saving treatment for the same.

Urging parents of pediatric cancer patients, Gitika Srivastava, Founder of Navya, shares her personal viewpoint:  “Most people who have had any experience with cancer are aware of TMC and that it is one of the largest tertiary care centres in the world. However not everyone from far flung areas in the Indian subcontinent or developing countries in Asia and Africa can come to Mumbai or is aware of the significance of a proper choice in treatment to a change in outcomes. Given the cases we have seen, we would urge everyone to get an expert opinion through TMC NCG Online. As parents, you can be assured that the opinion rests on the experience of world renowned pediatric cancer experts and follows evidence based protocols best suited to your child’s specific case.”

National Cancer Grid (NCG), tmc.gov.in/ncg Tata Memorial Centre (TMC) tmc.gov.in

The NCG is a consortium of 104 cancer centers, with a mandate to standardize cancer care, nationally. NCG is the largest global network of cancer centers collaborating to use technology and training to bring cancer expertise to every oncologist and cancer patient in India. TMC is Asia’s largest leading tertiary care expert cancer center, seeing over 67,000 cancer patients every year. Its strength necessitates a responsibility to make its expertise available to patients across India and developing countries, especially those who reside in locations where there are no expert cancer care centers.

Navya www.navya.info

Navya is a clinical informatics and patient services organization with a unique understanding of cancer patients and oncologists and a core commitment to cancer care. With a proven track record of successfully implementing innovative solutions that are low cost and effective, Navya is the first to develop technology systems specific to Indian cancer data for use by cancer patients and oncologists in India.
Contact:  Gitika Srivastava | gitika@post.harvard.edu

Twitter: https://twitter.com/NavyaNetwork

Facebook: https://www.facebook.com/NavyaNetwork/

LinkedIn: https://www.linkedin.com/company/navya-network

Data Driven Doc: As Easy As ‘Tak, tak, tak’

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Early on in creating Navya- Gitika and I met with the CEO of a private hospital in Mumbai exploring interest in Navya’s expert opinion services. He dismissed us offhand- saying he could email his friends ‘tak, tak, tak’ (Indian/Desi colloquialism for ‘instantly’) and get a response from them on any questions he had. Funnily enough – he was a radiologist who didn’t see the power of asynchronous and instantaneous collaboration on medical information. Today teleradiology is one of the largest medical services online.

A few years later, I’m impressed with how many ‘tak, tak, tak’ connections Navya has created for our patients across the world. We had 20 requests for consultations today, and we were able to get instantaneous reviews of many of the cases by international experts.  Where one expert’s response wasn’t confident enough, we got two or three to confirm! Back to the patient in a day!

A well-connected CEO of a hospital may get his medical questions answered by specialists in a jiffy, but the true value of Navya on democratizing expert information across the world, instantaneously, is beautiful. It’s truly as easy as ‘tak, tak, tak’.

-Dr. Naresh Ramarajan

Online Expert Opinion: navyanetwork.com/tmh
Tata Trusts: tatatrusts.org
Tata Memorial Center: tmc.gov.in
Navya: navyanetwork.com

TMC Platinum Jubilee – Jan. 28, 2017

TMC Platinum Jubilee – Jan. 28, 2017

Dr. Pramesh – head of the national cancer grid, a consortium of 96 cancer centers around the country, said “Navya is our own solution for Watson”.

Navya is our own solution for Watson.

Navya’s evidence and experience based expert opinion system was presented at the 75th year Platinum Jubilee celebrations of Tata Memorial Centre.  TMC convenes the National Cancer Grid, a consortium of 96 cancer centred in India.  Navya was developed with experts at TMC and is now used by experts at NCG to provide online expert opinions to patients with cancer. Go to www.Navya.care  to be empowered with the best treatment decisions in cancer.

 

 

 

The Doctor’s Thoughts: A Medical Perspective

medical-563427_1280Evidence and Experience Overcomes Corruption

Narendra Modi, prime minister of India, announced a surgical strike against corruption in India today (November 8th 2016).  In one fell swoop, he declared all 500 (~8$) and 1000 Rs (~15$) cash notes illegal tender today. While this causes some hardship for people with small amounts of cash in hand, the implications for the formerly black money & cash rich in India are stunning. The mountains of undeclared untaxed cash are reduced to paper overnight.

The panic of the black money rich and the joy of the common man in India tonight reinforces Navya’s core values. Stay unbiased, stay independent, stay clear of cutbacks, commissions and conflicts of interest. Steer away from the murky transactions in the business of medicine.

The practice of medicine worldwide and in India both, has been mired in conflicts of interest. Pharma companies develop drugs that make you bleed uncontrollably – and aggressively market them to cancer patients until it replaces older and safer drugs. The same companies then sell antidotes to the same drug for those cursed with a major bleeding episode, profiting on both ends of the spectrum!

In India, I have had the personal shock of calling an MRI center to get a study priced – only to be rudely told that the price of the study depends on the doctor who ordered it. The charged price adds in the cutback to the ordering physician. Conflict of interest in America is more subtle but even more prevalent in dollar figures. Incentives to undertreat or overtreat patients are cooked legally into the medical system we practice in. Professional society guidelines, endorsed widely, reflect the financial incentives of medical groups rather than evidence based facts like true gains in efficacy of a treatment.

Navya, since its inception, has been evidence and experience based. We build measures of conflict of interest in our models. We do not engage in partnerships with diagnostic centers to reach their patients in exchange for referral fees.  Similarly, we do not recommend hospitals or clinical services to our patients.  We spread our word organically, from person to person, patient to patient, and physician to physician, in partnership with government mandated organizations like National Cancer Grid, and we work with true experts at Tata Memorial Centre who volunteer selfless opinions to patients. The choice of a medical treatment should be based on clinical efficacy, cost effectiveness, affordability, logistics of travel to a treatment center and patients’ tolerance of side effects – nothing else.

Our commitment to offer an unbiased, evidence and experience based expert opinion is a bedrock principle at Navya that Gitika, the experts at Tata Memorial Center and I share. To this end, the eradication of large cash transactions in India, properly implemented, could be a boost to all of us marching towards a corruption free world.

-Dr. Naresh Ramarajan

Online Expert Opinion: navyanetwork.com/tmh

Tata Memorial Center: tmc.gov.in

Tata Trusts: tatatrusts.org

Navya: navyanetwork.com

Evidence

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Today I was reminded that evidence matters.   Evidence is the premise of Navya.  It is where we started.   Why we started.  We added on Experience, Experts, Patient Preference, and always knew that Guidelines are a sum total of many things but not enough to make a patient-specific decision.  With so much noise about so many systems and so many sources of information, (from structured guidelines to unstructured patient blogs and doctor’s notes and specific institution practices), all away from the core of Evidence, (clinical trial data), I began to wonder whether our premise was not what many would value.  (What a convoluted sentence construction – pretty similar to the obscurity of that thought).  Evidence matters.  Experts (or should I say mother of all experts…!) at Tata Memorial Centre are singularly focused on how an evidence based system can empower their decisions, above and beyond what their experience and standard guidelines can already do.  That, is the hallmark of expertise.  The definition.  An evidence based expert decision.

When I was asked to momentarily scrap everything else and home in on the evidence based results of the Navya Expert System, and the informatics that enables it, I knew that my system is in the hands of the right critiques and the perfect users who will use it to empower their patients.  When I was reminded that it is the Navya Evidence Engine that is the heart and core of what an expert desires, I was reassured, reaffirmed, reignited to remain focused on what we set out to do:  use evidence to make treatment decisions that are uniquely applicable to an individual patient.

Thank you, Dr. G and Dr. B for your constant push and faith in evidence based expert decision making; and for the opportunity, the privilege, to build Navya with you.