The Navya Expert System is the world’s first clinical decision making system that synthesizes information from a universe of evidence based medical literature, factors in the consensus opinion of a global network of medical experts, and then arrives at a treatment recommendation tailored to patient’s preferences and risk/benefit tradeoffs. Navya decisions can be carried out immediately and patients are comforted in knowing the expert decision on their treatment options.
Navya has a simple goal of reaching each and every cancer patient and empowering them with information and clarity when they are faced with the challenge of making complex medical decisions.
To accomplish this goal, Navya has developed a clinical informatics and machine learning based technology system and partnered with world leading experts and expert cancer centers such as Tata Memorial Centre and centers part of the National Cancer Grid to offer an online service so patients worldwide can receive a patient-specific evidence based expert opinion in 24 hours.
Navya’s journey is intricately linked with Tata Memorial Centre (TMC). When the idea came to us to use data and technology to create an offering that would empower cancer patients, we reached out to top oncologists in the world. TMC being one of the world’s largest tertiary care expert cancer center was an obvious choice to reach out to. We got tremendous support from TMC’s leadership as our vision aligned with TMC’s goals of providing standardized, evidence based care across the country in a scalable manner. Navya’s products were created in close consultation with TMC and the service TMC Online - Navya Expert Opinion Service was developed to democratize access to world class scarce expertise available at TMC via the internet to anyone in the world.
There are many online portals in the healthcare domain and it can be confusing to patients because you don’t know whom to trust for what. Some of them are informational where generic literature is available but patients are not often able to find advice that is tailored to their particular condition. There are several directory or listing services by which you can find a doctor in your location. There are some telemedicine services by which a patient can get on an audio or video call with a doctor. Given the complexities of cancer treatment planning where several reports need to be examined in detail, we believe that telemedicine solutions are suboptimal. In the best tertiary care centers (like TMC), trained clinical professionals spend significant time going through cases including the patient history and reports before they approach the expert whose time is scarce. The experts then utilise their significant wisdom to provide the best treatment plan that follows international guidelines and are informed by the experience of the hundreds of cases they see every week. Navya looks to replicate this in an efficient manner where a patient advocate reaches out and understands the complete medical history, trained clinical staff analyse and extract the relevant information from the medical reports and the case is presented to the expert in a structured manner. The Navya system is used to determine the most applicable evidence based treatment options for each case, which too is presented to the expert. The expert then looks at the pertinent information and makes a decision on the treatment opinion. All this is typically done within 24 hours through Navya.
This is very common in cancer treatment planning. Given the multiple modalities of treatments in cancer, such as surgery, chemotherapy, radiation therapy, targeted therapy and the involvement of more than one organ when the disease metastasizes, ideally a tumour board consisting of multiple experts collaborating needs to be set up to provide the best treatment plan. Under normal circumstances getting access to one expert can be difficult and getting to tumour board even more so. This is available only in the best tertiary care centers in the world.
Navya looks to replicate this using technology. Cases that require the opinion of more than expert are sent to the appropriate experts who are able to collaborate online and consensus is formed when synthesising the treatment plan for the patient. A process that can often take weeks is completed within minutes in a day through Navya.
Many cancers are curable if diagnosed early and treated appropriately. The first treatment is the best chance and can mean the difference between the best possible outcome and a failed treatment. The treatment is life changing both clinically as well as financially. For this reason, everyone who is faced with a treatment decision should look to get their case opined by an impartial expert before continuing the treatment locally. This can be when initially diagnosed with cancer and no treatment path has been decided or when your local physician has given you a treatment path and you want to get the peace of mind by knowing what the best treatment recommended is for your particular case. Finally, in advanced or complex cases, there is limited expertise to determine the path forward. This is the most common scenario in which many patients reach out to us, to know what best can be done for the patient given the difficult circumstances.
There can always be small variations between treatment paths. However our experience has shown that glaring errors are made when there is a lack of expertise available. Non standard treatments are prescribed that do not follow accepted guidelines and this leads to suboptimal or catastrophic results. Experts on Navya’s panel are part of tertiary care centers where they have the experience of hundreds of cases every week and are regarded as experts by treating physicians of patients at local centers who would have ordinarily wanted to or welcome the referral opinions from expert colleagues in the field. Navya’s aim is to provide everyone with access to these experts in an efficient manner.
It is important to understand that Navya is facilitating an opinion from the experts at TMC and NCG. We understand the patient’s questions and ask the experts on their behalf. The core question that we answer is “What is the best treatment recommendation for my specific case?” and the answer is explained in a manner that both the patient and the treating physician can understand and apply it. This includes details of what therapy to follow (surgery, chemotherapy, radiotherapy or immunotherapy) as well as the details which depending on the therapy include the specific drug, dosage, number of cycles and frequency of response assessment. In certain cases, experts recommend surveillance as the more appropriate course of action and these follow internationally accepted guidelines of cancer care.
Patients sometimes ask for therapies that align with their preferences. These could be a desire to avoid surgery or chemotherapy or the preference for a more economical option should one exist. For example, in several cases of breast cancer we strongly believe that patient preferences play a strong role in treatment decisions and they need to be taken into account. The question is posed accordingly to experts and when possible, the treatment plan is made keeping in mind these preferences. Sometimes decision trees are given where a patient is advised different paths that can be taken. For example a decision tree could state that patient is recommended surgery but if the treating physician feels that the patient is not fit for surgery then chemotherapy may be administered.
We also get asked a variety of associated questions that patients often don’t get to ask a doctor in a brief consultation. Some examples are recommended diet, expected side effects, affect on fertility. Patients also ask us for definitions or meanings of cancer related terms.
As the expert is not seeing the patient physically, there are certain questions that cannot be answered. Fitness for surgery, for example, is best assessed by the local treating physician.
Navya exists to empower patients with information and clarity when they are confronted with a critical medical decision. Since 2014, when this service was launched, we have had over 10,000 people from 42 countries reach out to us.
What is most heartening is when someone whom we have empowered with an expert opinion goes on to follow that treatment plan and is better for that treatment. We have had numerous cases where based on the expert opinion, a potentially suboptimal treatment was changed that led to improved outcomes. There have also been many cases where when family members reached out to us for patients under their care, the expert recommended that the best course of action was best supportive care. In such cases any potential benefit of therapy would be far outweighed by its toxicity or side effects in that particular case. Often these would be cases where false hope or expensive treatments are weighed against quality of life and patient preference. We are able to provide objective information and guide the patient forward with empathy and care on what is the best path or best step to take at this time. When patients have successfully completed prior therapies are and are back for future course of action on a course to likely recovery is the happiest outcome that we look out for.
The first step is registering on www.navya.care and filling out the form and uploading the reports. Following this, a patient advocate from Navya reaches out to the user to understand the case in detail including what preferences, if any, exist. Once this is done, trained clinicians go through all the reports (a typical case has 25-30 reports but some cases can exceed a 100) and extract the pertinent information from it. This information is fed into Navya’s Evidence Engine, and Experience Engine and relevant treatment plans emerge. A summary of the case along with Navya’s recommendation are presented to the relevant experts to opine. The experts choose either one of the recommended treatment plans or provide their own based on their experience. This process ensures that the expert’s time is optimally used. Using the expert’s response, a patient report is created that answers all the questions asked by the user in a manner that is simple to understand and actionable.
We recommend that the expert opinion be shared with your treating physician who ultimately decides the course of action. Treating physicians look favourably at the expert opinion provided by experts at TMC and NCG..
A processing fee of Rs 6500 covers a portion of the cost to collect the medical reports, data entry, and write the personalized expert opinion report for each patient, answering every question and follow-up question at that decision point that the patient asks. Users who are unable to afford this fee, can upload their Below Poverty Line (BPL) card and we process the case free of charge. We are supported by Tata Trusts in our endeavour in the form of grants which enable us to keep the processing fee at these levels. The processing fee covers a portion of our costs and eliminates the of cost of travel and in-person consultations at the limited number of expert centers in the metropolitan cities for patients from anywhere in India. Going through Navya also ensures that patients are able to get critical answers quickly (within 24 hours) when confronted with complex decisions. In normal circumstances, just the time taken to travel to tertiary care centers and getting appointments with specialists would mean that the time lost is invaluable and could result in irrevocable damage in the patient’s condition. We find that given the urgency to do something quickly, people are often making decisions based on insufficient information or on the basis of advice from doctors who lack the experience of those at an expert center such as TMC. Cancer treatments have the potential to either completely cure or deteriorate the condition of a patient so getting this right is of critical importance. Given the decision and the potential costs involved in treatment, we have so far not had patients find the processing fee a hindrance. They recognize that taking the right decision in a timely manner based on expert opinions is not only best for the patient’s health but also financially prudent.
The Hindu: Online platform for cancer a game changer
The Telegraph: Cancer advice network expands
The Economic Times: Tata Trusts, TMC & NCG unite to make cancer expertise affordable
The Indian Express: Now an online portal to help in cancer treatment
The Sunday Guardian: National Cancer Grid gets more power
The Times of India: Nation’s best oncologists offer quick second opinion service
2014: Navya Network and Tata Memorial Centre accepted to present results of retrospective trial on Validation of a Software Based Clinical Decision Support System for Breast Cancer Treatments in a Tertiary Care Cancer Center in India at the 2014 San Antonio Breast Cancer Symposium
2013: Dr Sandy Swain (past president of ASCO, Medical Director of Washington Cancer Institute, Professor in Georgetown University) launched Indian Breast Cancer Resource – a collaboration between Navya Network, Dr Reddy’s Laboratories, Tata Memorial Centre, All India Institute of Medical Sciences, Rajiv Gandhi Cancer Institute at the Indian Cancer Congress.