Navya’s Expert System 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 is partnered with Tata Memorial Centre(TMC) and National Cancer Grid (NCG) to provide expert opinions from experts at TMC and NCG to patients/caregivers worldwide. Patients upload their medical reports per Navya’s list of requirements. Navya translates the patient’s medical reports and questions into a structured case summary and decision question for experts at TMC and NCG. Using Navya’s ExpertApp, experts respond and provide an expert opinion on the patient’s case. Navya combines the opinion of multiple experts from different Disease Management Groups at Tata Memorial Centre and National Cancer Grid and prepares a final report for the patient. Navya’s reports are easy to understand and in patient-speak. Navya’s case summaries to the experts are quick to review and may include evidence and guidelines based treatment options for the experts to quickly choose from, thereby reducing the turnaround time for an expert opinion. Navya also includes evidence and guidelines information for the patient as necessary, which provides strength to the expert opinion. The strength of the expert opinion and the simplicity of the patient-speak, provide clarity in complexity of decision making for the patients/caregivers. They are comforted that they now know and understand their treatment options and are guided by an evidence based multidisciplinary expert decision.
Since May 2014, Over 18,000 cancer patients from 22 developing countries and 47 countries including worldwide including Bangladesh, Dubai, Kuwait, Iraq, Russia, Singapore, Hong Kong, Malaysia, Kenya, Mozambique, Nairobi, South Africa, Australia, Canada, United States, United Kingdom, and from all across the Indian subcontinent have reached out to Navya an expert opinion on their treatment options.
Keyword searches on PubMed/MEDLINE or on medical information websites don’t provide patient specific results and prove to be time consuming. Each paper needs to be read to fully understand the results and their applicability to the patient, if any. Navya’s Evidence Engine provides a solution to these concerns by indexing medical evidence information that can be searched by individual patient data. Our scope is narrower compared to PubMed and only papers relevant to treatment assessments are indexed. Our database is updated with the latest medical findings and treatment applicability analyses are performed when requested for each query. Navya’s Evidence Engine is a comprehensive and dynamic search for evidence relevant to a particular patient’s case.
Navya provides two interfaces to the physician to use Navya’s Evidence Engine.
The physician can enter the patient’s medical case in Navya’s medical case database, called Navya Form. Thereafter, with a single click, the Navya Evidence Engine can search Navya’s database of published medical literature and match the patient with the inclusion/exclusion criteria of trials, returning treatments most applicable to the given unique patient ranked by quality of trial and other factors such as strength of endpoints, sample size, effect size, and match of the patient with demographic data/Table 1.
An Advance Search interface for the physician to search based on any patient or disease criteria is also available.
Similar to Evidence Engine, the Guidelines Engine stores the latest 2014 NCCN Clinical Practice Guidelines and can also include any custom hospital guidelines. Similar to the Evidence Engine, case based Guidelines Search matches the incoming patient with decision criteria of the guidelines. Advance Search interface is also available.
The Navya ExpertApp is a software application to poll for and collect treatment recommendations from a group of medical experts and build a single consensus opinion. The ExpertApp uses templates to summarize the medical case of a patient and present guideline based treatment options for the experts to choose from. The ExpertApp uses preset weights for each expert, based on his or her experience and expertise, and uses reconciliation algorithms to build a consensus opinion for the treatment. Navya prepares a comprehensive report for the patient, which includes the case summary, information and opinion of each of the experts, and the consensus treatment recommendation.
With a single click the Navya Form creates the Navya Question, which includes the case summary and the range of applicable treatment options from the NCCN guidelines.
The experts provide Navya with information about their education, experience, and field of practice. This information is used to determine the Expert Weights.
The objective of the ExpertApp is to enable collaboration amongst multiple experts and quickly arrive at a single treatment recommendation for the patient. Hospitals and Physicians use the Navya ExpertApp to solve referral patient cases that routinely get emailed to them. The ExpertApp helps Navya facilitate consultation of the patient’s case with a multidisciplinary group of oncologists.
Hospitals can use the Navya Expert System to make evidence based expert treatment decisions and maximize patient outcomes. In a retrospective trial at one of Asia’s largest tertiary care cancer centers, Navya decisions—based on its Evidence Engine and Guidelines Engine—were deemed concordant with expert clinical practice. Results of the trial were presented at the San Antonio Breast Cancer Symposium in December 2014.
Navya’s Expert System is built upon the premise that there are five information sources that physicians and patients must consult in order to determine the best treatment decision for a unique patient:
1. Evidence Engine: published literature from randomized control trials and global conferences
2. Guidelines: such as the NCCN, which list globally recommended treatment options
3. Experience Engine: a registry of patient information, treatment decisions, and outcomes
4. Experts: via the Navya ExpertApp, a workflow tool that quickly summarizes the patient’s medical reports into a structured format, and collects and combines the opinion of experts online
5. Patients’ Preferences: a conjoint analysis survey that determines a patient’s risk-benefit tradeoff vis-à-vis the possible treatment options, by assessing longevity vs quality of life vs side effects
Each of these products or information resources, separately or together as part of the Navya Expert System, is available for use by the physicians and patients in a hospital.
In practice, use of each of these information sources work in tandem or concert with each other, and contribute towards determining the best treatment option for a patient i.e. most relevant or applicable to a given unique patient, based on an exhaustive combination of evidence, global expertise, and experience based on treatment decisions and outcomes of several hundred (thousand) similar patients.
This is achieved by using the same structured ontology to index and combine treatment recommendations from patient data registries, global evidence and guidelines, and expert opinions such that key decision criteria (i.e. key disease characteristics and related treatment information, for example the inclusion/exclusion criteria and Table 1 data in published literature) are quickly, easily, and accurately consulted/searched, matched by relevance to a given unique patient, and ranked by quality of the information source, (for example quality of the published trial).
Navya’s search tools and computational model are protected by two patents issued by the United States Patent and Trademark Office, with international filings, and one patent in final office action.
Tata Trusts is supporting Navya in its endeavour to empower patients with expert opinions. Grant support from Tata Trusts subsidizes the per case cost for an expert opinion and enables Navya to offer the service at a nominal processing fee. Further, patients Below Poverty Line receive the expert opinion for free.
Additionally, Navya analysts assist in navigating the decision making process. This includes assistance in obtaining the medical reports via email, phone, or other online communications, and conversations in native languages when possible, to communicate the process and the expert opinion. Navya handholds the patients/caregivers throughtout the process to obtain an online expert opinion.
Please contact us for an expert treatment opinion from our network of oncology experts from Tata Memorial Centre, National Cancer Grid, and select experts based in the United States and the United Kingdom. Navya Expert System in collaboration with these experts uses its information resources to provide the most applicable opinion for a given unique patient. This includes consideration of patient preferences and resource constraints of cost and logistics such as unwillingness to receive radical surgery at the age of 75 or inability to afford radiation therapy due to logistics of travel to metropolitan cities, etc.