Stanford Health Care Launching eConsult Service for Community Physicians

Stanford Health Care is launching a suite of services, including eConsults, designed to equip California’s community physicians in diverse practice settings with data and solutions to assist them in delivering evidence-based care to their patients. 

In a recent interview, Tip Kim, M.B.A., executive vice president, chief market development officer at Stanford Health Care, described this effort, along with Brigham Hyde, Ph.D., CEO, and Saurabh Gombar, M.D., Ph.D., chief medical officer of Atropos Health, a company offering on-demand evidence from real-world data that was spun out of Stanford's Green Button Project. 

Palo Alto, Calif.-based Atropos began as a research project at Stanford Medicine in 2011. The “Green Button” concept aimed to answer the question: What if pressing a virtual button could trigger a search of millions of similar, anonymized electronic records to instantly aggregate data to inform patient care?

The concept grew into a research project called the Clinical Informatics Consult service, with a proof of concept built at Stanford Health Care. Upon the successful completion of the pilot, Saurabh Gombar, Nigam Shah, and Brigham Hyde founded Atropos Health in late 2020 to democratize access to real-world evidence. In 2021, Stanford Health Care partnered with Atropos to support clinical decision-making across its more than 2,000 affiliated physicians. Now Stanford is seeking to incorporate what Atropos has built into its “Patients Like Mine” offering. 

Kim said that these services will enable community physicians, including those at Federally Qualified Health Centers in California, to leverage Stanford Health Care’s digital tools, large language models and artificial intelligence-enabled services while preserving and strengthening their patient-provider relationships. 

In the coming months, Stanford Health Care will launch the following services: 
• Access to Stanford’s Cancer Survivorship program. Community physicians will have the ability to access Stanford Medicine cancer survivorship experts’ insights, experience and data when providing primary care to cancer survivors in the community. 

• The Stanford Health Care eConsult program. Community physicians can pose clinical, highly specialized questions and receive expert, evidence-based responses within three business days, further allowing them to better manage a broader range of patient needs and save patients the cost and burden of an unnecessary doctor visit. 

• The Stanford Health Care Patients Like Mine data reports supplement the eConsult program by providing detailed, publication-grade evidence using Stanford clinical data to help answer questions about patient conditions or treatment plans. These reports will be powered by Atropos Health. 

Healthcare Innovation: Can you you give an example of how you envision these services being used by community physicians?

Kim: A community physician who has a pretty good idea of what their patient needs but wants some confirmation from a specialist can trigger an eConsult, whereby our specialists asynchronously and digitally can review that particular case, using a very structured interface and render the specialist opinion back to the community physician in a matter of hours, thereby reducing the time to see that patient and without increasing the cost to to have a follow-up visit — and most importantly, without violating the original patient/physician relationship. We are a partner to the community physician, not a replacement.

HCI: In the example you described, does the insurer pay for the eConsult?

Kim: It is billable, according to CMS rules. But for Federally Qualified Health Centers and for community clinics, through philanthropy the cost of installing that platform is borne by Stanford. And again, we want to stress that we hope that this is a useful tool to affirm or to shape the great care that's already been provided by community physicians to their patients, without interceding in that relationship.

HCI: Brigham, how does Atropos’ work fit into this? 

Hyde: Patients Like Mine, as a concept, has been talked about for a while. I think what Tip and team have done here is a great package to achieve that goal. So one part of that is that we'd like to look at some data that represents patients like the one in front of that doc and be able to provide clear, transparent evidence where appropriate for what should be done with that patient. 

But that's only part of it. You've also got to help them understand how to coordinate care and support their patient. So if you look at the full package of the Patients Like Mine offering from Stanford, the data is one part. We help with the automation in that, but there are multiple pieces. I think Tip's done a good job of realizing that people need a package of human and automation. 

Our automation is enabling data insights to be part of this package. Tip has wisely crafted it as a set of data services and digital tools that can support these connections. We're a piece enabling one key part, but it's not the only part that's important. 

HCI: This offers community physicians and their patients the opportunity to access Stanford's cancer survivorship program. Can you describe that?

Kim: Our cancer survivorship program has been in place for decades. As cancer care improves, more people are recovering and living full lives after having cancer. There are, nonetheless, conditions, deferred maintenance, side effects of the treatment, complications and co-morbidities that perhaps were de-prioritized during the acute cancer care. As patients return to the primary care setting, that primary care physician has a lot of questions about what to do now that this patient is not acutely suffering from cancer. So there is an entire program that's been in place, but that program could benefit greatly from scaling via technology. Is there a way to scale that to have community physicians be able to access that? If we can personalize this to the specific patient, to the extent that it's possible and meaningful, then you've really got a force multiplier to magnify the impact of the intellectual capital and data that had been collected.

Gombar: We like the alignment to cancer survivorship because we look for places where current pathways of care lack evidence. That’s a great place for us, because we can produce new high-quality evidence. It’s somewhat sad to say but most of the trials in oncology are run on the big decisions like: This is first line therapy; this is second line therapy and so on, and that is as it should be. But not a lot of trials are run on this scenario: I've been treated; now I'm managing side effects or maybe I happen to be co-medicated for something else. Is there something I should watch out for? Those primary care docs are in the position of having to manage that patient after they are treated. There are not a lot of papers for them to go look at, but it is a great place for personalized evidence to be generated.

One example we had was a physician at Stanford was taking care of a person who had prior treated breast cancer and now developed an autoimmune condition. The physician wanted the patient to try a drug, but the patient herself said, ‘Wait a minute, what does this drug mean for my risk of having reactivation of my cancer?’ Normally, that physician would say, ‘I don't know, you're exactly the kind of person that they never studied with this drug.’ But instead, she was able to turn to our service, and say, ‘Tell me for all patients who had a prior history of treating cancer, how many of them after starting this drug of interest, reactivated their cancer or had a metastasis?’ And we could see that there was actually no difference between those that started that drug, and those that did not in terms of reactivating their cancer. And that was enough to have that patient feel safe about starting a medication that they needed to take, because it would have helped them with their other conditions. But they would have been really hesitant to take it without this kind of information. Kudos to Stanford for making this kind of thing available to cancer patients to help them have a better quality of life and better peace of mind.

HCI: Did Stanford do some kind of market research with community physicians to gauge the interest or develop some initial partners for this service?

Kim: Our eConsult program is either installed or in the process of being installed at Federally Qualified Health Centers around the Bay Area and Central Valley, as we speak. There are also further conversations with other hospital systems like Dignity Health, on the Central Coast, and other folks that we are in active conversations with. That is in addition to a pretty robust internal eConsult system.

HCI: Is it for for licensure reasons that you are not expanding beyond California yet? 

Kim: We are working on multi-state credentialing. And certainly the need extends beyond California. But our initial priority has been serving the patients in our region.