A virtual cancer expert review program

This Research Roundup examines Kaiser Permanente’s Virtual Cancer Expert Review (VCER) program, which improved access to subspeciality expertise to ensure timely cancer care regardless of geographic location.

This brief is part of our Research Roundups series.

Timely cancer treatment is critical to improving survival.1 Patients also need treatment informed by the most current, evidence based recommendations, which often requires input from oncology subspecialists with expertise in specific cancer types like breast, lung, or blood cancers.2 These specialists play a vital role in guiding complex treatment decisions, yet they are not always readily accessible when and where they are needed most. Clinicians practicing in rural settings or under-resourced areas, for example, often face difficulties insecuring timely input from cancer subspecialists.3 Research shows that even a 4 week delay in starting treatment can increase the risk of death by 6 to 13 percent, depending on cancer type and treatment modality.

2025 NEJM Catalyst article

How Kaiser Permanente Created a Virtual Cancer Expert Review Program | NEJM Catalyst

A recent New England Journal of Medicine – Catalyst article highlights Kaiser Permanente’s Virtual Cancer Expert Review (VCER) program, which leveraged its shared electronic health record, automated dashboards, and virtual consultation workflows within the Kaiser Permanente value-based care system to improve access to subspeciality expertise and ensure timely cancer care regardless of geographic location.

The article explores several questions of interest to policy audiences:

  • Can virtual consults improve care quality and patient outcomes?
  • How could virtual consult models be quickly integrated into routine cancer care, to make current evidence-based recommendations more accessible to providers? What kinds of infrastructure and coordination supports are
    needed to expedite these processes?

Kaiser Permanente created a Virtual Cancer Expert Review (VCER) program so more patients can benefit from top cancer specialists’ input quickly, no matter where the patients live. Since 2022, the program has allowed doctors across
the system to easily connect with 11 groups of cancer experts.

To set up the program, Kaiser Permanente established 11 national subspecialty teams made up of board-certified, fellowship-trained experts within Kaiser Permanente. Participating subspecialists have protected time built into their schedules for VCER consultations to support their participation. By leveraging the existing shared electronic health record system, virtual care technologies, and this new network of specialists,doctors are able to get quick advice to support treatment decisions. Treating oncologists can reach these subspecialists by placing a simple order in the electronic health record, which nurse coordinators then route to the appropriate expert for response.

Leaders promote awareness and adoption of this program by actively engaging regional oncology teams and providing ongoing training and feedback to clinicians.

Key findings

The VCER program has expanded access to cancer expertise and improved provider decision-making and care coordination:

  • 93% of participating oncologists indicated that expert recommendations influenced their care decisions. In most cases, subspecialists confirmed the treatment plan or added recommendations such as genetic testing, referral to clinical trials, or supportive care services.
  • In 37% of cases, subspecialist input led to an actual change in diagnosis or treatment plan.

The VCER program enabled faster, more collaborative care, helping oncologists improve treatment planning based on timely input from subspecialists. Recommendations were typically delivered within 2 business days – about 10–12 days faster than other systems typically provide guidance.5 The VCER program has made it easier for doctors to get expert advice that matches their patients’ specific cancer types, no matter where the patients live.

Policy opportunities

No single study can suggest the full range of policy needs and opportunities. Based on existing research and internal discussions among Kaiser Permanente leaders, we recommend several avenues for improving care access and quality:

Include telehealth, including physician-to physician consults, in evidence-based measures of health care quality and access: As telehealth shifts health care delivery, ensure that measures address these changes.

Incorporate telehealth quality standards into overall care quality measurement:

  • Align quality and outcome measures for in person and telehealth services, so that virtual care is held to the same high standards for quality, safety, patient satisfaction, clinical outcomes, and health equity as in-person care. Digital health research can inform telehealth guidelines, reimbursement policies, and approaches for monitoring and incentivizing excellent care.
  • Consider impacts on access: When telehealth broadens access to high-quality, equitable care, consider approaches to better incorporate telehealth into network adequacy evaluation frameworks.

Develop guidelines and supports for providing telehealth services: Support effective implementation and continual improvement.

Education and professional training:

  • Support education and training that builds health workers’ trust in technology and the skills necessary for safe and effective use of digital technologies.
  • Ensure health care professionals have the resources they need: Develop and optimize evidence-based education, training, and workflows on virtual care for clinicians.
  • Support research and evaluation: Measure patient and health care professional experience and satisfaction with virtual care services and use the resulting data to drive improvement.
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References

  1. Hanna, Timothy P., PhD, et al., “Mortality Due to Cancer Treatment Delay: Systematic Review and Meta-analysis,” The BMJ, November 4, 2020, Vol. 371, m4087, https://www.bmj.com/content/371/bmj.m4087.long
  2. West, Howard Jack, MD, MPhil, et al., “Novel Program Offering Remote, Asynchronous Subspecialist Input in Thoracic Oncology: Early Experience and Insights Gained During the COVID‑19 Pandemic,” JCO Oncology Practice, April 2022, Vol. 18, No. 4, e537–e550, https://pmc.ncbi.nlm.nih.gov/articles/PMC9014456/, and Health Care Transformation Task Force (HCTTF) , Specialty Integration in Value-Based Care, HCTTF, 2024, https://hcttf.org/wp-content/uploads/2024/11/Specialty-Resource-Combined-4-FINAL.pdf.
  3. Charlton M, Schlichting J, Chioreso C, Ward M, Vikas P. Challenges of rural cancer care in the United States. Oncology Journal, Practice & Policy (Cancer Network). 2015 Sep 15;29(9), and Nguyen, Christina A., MD, et al., “Organization of Cancer Specialists in US Physician Practices and Health Systems,” Journal of Clinical Oncology, September 10, 2023, Vol. 41, No. 26, pp. 4226–4235, https://pmc.ncbi.nlm.nih.gov/articles/PMC10852402/
  4. Hanna, Timothy P., et al., “Mortality Due to Cancer Treatment Delay: Systematic Review and Meta‑analysis,” The BMJ, November 4, 2020, Vol. 371, https://www.bmj.com/content/371/bmj.m4087
  5. Kolevska, Tatjana, MD, et al., “How Kaiser Permanente Created a Virtual Cancer Expert Review Program,” NEJM Catalyst Innovations in Care Delivery, March 2025, Vol. 6, No. 3, https://doi.org/10.1056/CAT.24.0186
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