e-Consults for Immune-Related Toxicities Improve Patient Access and Reduce Costs

This blog post is the second in a 6-part series highlighting the achievements of the 2023 ACCC Innovator Award winners before their in-depth sessions at the ACCC 40th National Oncology Conference. You can learn more about the innovations being recognized this year and those who pioneered them by joining ACCC in Austin, Texas, from October 4-6, 2023. 

Cancer programs and practices around the United States experienced a rise in telehealth use during the COVID-19 pandemic. For example, between March and July 2020, nearly 7,000 patients at the Sidney Kimmel Comprehensive Cancer Center at the Thomas Jefferson Health System received telemedicine care, compared to roughly 150 patients during the same time span in 2019. For Duke Cancer Institute, Duke Endo Oncology Program, Duke Endocrinology
Durham, North Carolina, that development was serendipitous.

In May 2020, the cancer program developed an e-consult service for patients experiencing endocrine immune-related adverse events. “At that time, I really wanted to address the bottleneck of access to high quality care, especially for patients with cancer,” said Afreen Shariff, MD, MBBS, assistant professor of medicine, director, Duke Endo-Oncology Program and associate director for the Cancer Therapy Toxicity Program at The Center for Cancer Immunotherapy at Duke Cancer Institute. “We have an excellent oncology and endocrine service, but they were not talking to each other—and that's where I felt there was the biggest need.” According to Dr Shariff, when the program was launched, the average wait time for endocrine oncology patients was about 90 days. “In today’s world, I find that hard to accept, that someone must wait 3 months to see a provider,” she said. “That is a long time—especially for a patient with cancer where consequences hold high stakes.”

Program Implementation

Upon inception, the program was solely staffed by Dr Shariff, but has since grown to include two more providers. The first 6 months of the program were spent incorporating an e-consult order into the electronic health record (EHR). Now, when a member of the Duke Cancer Institute care team suspects a patient has an endocrine toxicity or side effect, they submit a referral within the EHR for an e-consult with the endo oncology program. Once that referral is received, it is evaluated by Dr Shariff or a member of her team. 

“It takes us anywhere between 24 to 48 hours to review these cases and provide recommendations on what diagnostic tests need to be ordered, what treatment can be initiated and what the disposition is in the chart,” Dr Shariff explained. For patients whose needs require immediate attention, Dr Shariff or a member of her team can recommend initial laboratory testing, and schedule to see that patient the next day or within that same week.

According to Dr Shariff the program has been beneficial to patients with cancer, as well as providers. It has improved patient access and reduced healthcare utilization; as time to appointment and hospitalizations were reduced from 61 days to 39 days and from 11% to 2%, respectively. “There is a lot of satisfaction across the board,” Dr Shariff said. “Our oncology providers now feel they have the support of someone else when making a recommendation, getting patients seen quickly or answering questions they did not feel they were fully equipped to answer.”

The Future of Cancer Care

Dr Shariff believes the future of cancer will be centered around value-based services focused on delivering streamlined, cost effective, and personalized patient specific care. “I think having an electronic consultative service that is successful, really checks a lot of those boxes,” she said. However, Dr Shariff maintains that unless programs such as this are supported by payers and health systems, they are not sustainable and reproducible. “The only way to do this is if you have a payer incentive,” she explained. “In the past, we have not been very successful at getting these consults reimbursed, and different payers reimburse them at different rates, which is a shame.”

At the ACCC 40th National Oncology Conference this fall, Dr Shariff will provide an in-depth analysis of Duke Cancer Institute, Duke Endo Oncology Program, Duke Endocrinology Durham, North Carolina, innovative e-consults program. “It is important to come to these sessions because it helps you think about what we can do differently, and really push the envelope in addressing all of those long-standing issues that are circling the healthcare system today,” Dr Shariff concluded.

To learn more about implementing an e-consult service for patients experiencing endocrine immune-related adverse events at your organization, including the technology and support staff needed to find success with such a program, register to attend the 2023 ACCC National Oncology Conference in Austin, Texas, from October 4-6, 2023.