Onco-CoE
Cancer Care Patient OncoCare Intelligence Platform
A precision patient navigation operating system that orchestrates every touchpoint of a cancer patient's journey — from first diagnosis to last follow-up — across a hub-and-spoke care network reaching every pin code.
500Bed Hub Hospital
∞Spoke Partners
20+AI Flagship Modules
0Missed Waypoints
SCROLL TO EXPLORE
01 / THE VISION
The Patient OncoCare Intelligence Platform
Just as an air traffic controller ensures every aircraft moves safely, on schedule, and without conflict — Onco-CoE ensures every cancer patient moves through their care pathway with zero dropped handoffs, zero scheduling conflicts, and proactive course corrections.
CORE OPERATING PRINCIPLE
Every Patient is a Flight Plan. Every Clinician is a Controller. Every Touchpoint is a Waypoint.
✈
Flight Plan = Care Pathway
From diagnosis to survivorship, every patient receives a dynamic, AI-generated care plan — a "flight plan" — that defines all waypoints: consultations, labs, imaging, chemotherapy cycles, surgical windows, radiation fractions, and home care touchpoints. The plan self-updates as clinical data changes.
📡
Radar = Real-Time Patient Visibility
A unified command center gives clinical coordinators live visibility of every active patient: their current phase, next scheduled event, pending labs, and any risk flags. Like ATC radar, no patient ever disappears from the screen. Alerts fire before problems occur, not after.
🔀
Runway Coordination = Resource Orchestration
Chemotherapy chairs, OT slots, radiation linac time, and oncologist availability are orchestrated as shared national resources. Conflicts are flagged in advance. Priority sequencing ensures the most critical patients get bandwidth first, while routine care flows without bottlenecks.
≤24hTime from diagnosis to first care plan generation
100%Chemo cycle adherence tracked automatically
0-lagSurgical-to-radiation handoff coordination
HomeLast-mile care delivered at patient's pin code
AIToxicity alerts before next appointment
FHIRUniversal interoperability across all spokes
02 / COMMAND CENTER
The Onco-CoE Command Center
A real-time hospital operations dashboard — the "tower" from which patient navigators and coordinators manage the entire active patient population simultaneously.
Onco-CoE ◈ COMMAND
LIVE PATIENTS
SCHEDULE
ALERTS
NETWORK
247ACTIVE PATIENTS
12ALERTS TODAY
98.4%ON-PATHWAY
ACTIVE PATIENT CARE BOARD — LIVE
RK
Ramesh Kumar, 54 · Breast Ca. Stage III
Cycle 4/6 · Paclitaxel + Carboplatin · Day 3 of 5 · Infusion Ward B-12
CHEMO
PD
Priya Desai, 41 · Ovarian Ca. Stage II
Debulking Surgery · OT-3 · Surgeon: Dr. Mehta · ETA 2h 20m
Pre-op Assessment · OT Scheduled: 12 Mar · Jetpur Spoke referral
PRE-OP
LIVE ALERTS
Toxicity Flag — R. KumarGrade 2 neutropenia. Dose modification required before Cycle 5.
Scheduling Gap — V. ShahNo transport for fraction 19. Spoke coordinator notified.
Home Care UpdateA. Joshi wound care complete. No complications.
Pathway GeneratedS. Patel · H&N Ca. pathway ready for Tumor Board.
WEEKLY TREATMENT SCHEDULE — WEEK OF 10 MAR 2025
PATIENT
MON 10
TUE 11
WED 12
THU 13
FRI 14
SAT 15
Ramesh Kumar Breast Ca. Cycle 5
Lab Draw 8:00 AM
Chemo D1 9:00 AM
Chemo D2 9:00 AM
Chemo D3 9:00 AM
Rest
Rest
Priya Desai Ovarian Ca. Post-Op
ICU
ICU
Ward Transfer 2:00 PM
Physio 10:00 AM
Oncol. Review 11:00 AM
—
Vinod Shah H&N Ca. IMRT Fractions
Fr. 19 9:00 AM
Fr. 20 9:00 AM
Fr. 21 9:00 AM
Fr. 22 9:00 AM
Fr. 23 9:00 AM
Rest
Anita Joshi Colorectal. Home Care
Spoke Visit Surat PIN
Home
Wound Care Spoke Nurse
Home
Hub Review 11:00 AM
—
Suresh Patel H&N Ca. Pre-Op
Tumor Board 10:00 AM
Pre-Op Labs 8:30 AM
SURGERY OT-2 · 7:30 AM
ICU
ICU
—
ℹ️ Showing 5 of 247 active patients. Schedule auto-syncs from treatment pathways. Conflicts highlighted in red. Home care slots coordinated with spoke partners.
ALL ACTIVE ALERTS — SORTED BY PRIORITY
🚨 CRITICAL · Toxicity Flag — Ramesh Kumar (ID: GCH-00247)
Grade 2 neutropenia detected in CBC drawn 08:45 AM. ANC = 0.9 × 10⁹/L. Dose modification required before Cycle 5. Oncologist Dr. Sharma notified via app.
Today 09:12 AM · Auto-generated from Lab Integration
OPEN
⚠️ HIGH · Scheduling Gap — Vinod Shah (ID: GCH-00189)
No transport confirmed for Fraction 19 (tomorrow, 9:00 AM). Patient home in Gondal (52 km). Jetpur spoke coordinator sent automated WhatsApp alert.
Today 11:33 AM · Auto-generated from Pathway Engine
Patient has not completed 3 consecutive daily symptom check-ins on mobile app. Palliative care team notified. Community GP (Rajkot PIN 360005) flagged for home visit.
Today 08:00 AM · Auto-generated from Patient App
OPEN
✅ INFO · Home Care Completed — Anita Joshi (ID: GCH-00156)
Wound care session completed by NursingPlus Surat (PIN 395001). Wound photo uploaded, healing Grade A. No intervention required. Next hub visit: 14 Mar.
Today 02:20 PM · Spoke Partner Update
RESOLVED
🔵 INFO · New Care Pathway Generated — Suresh Patel (ID: GCH-00312)
Head & Neck Ca. Stage III pathway generated by AI engine. Includes: Tumor Board (10 Mar), Pre-op Labs (11 Mar), Surgery OT-2 (12 Mar), IMRT planning (17 Mar). Awaiting Tumor Board approval.
Today 01:05 PM · AI Pathway Engine
PENDING REVIEW
PATIENT GEO-DISTRIBUTION — 50 KM RADIUS · KAGVAD, GUJARAT
WITHIN 25KM
142
25–50KM
105
SPOKE-MANAGED
89
CATCHMENT DEMOGRAPHICS — 100 KM RADIUS · SAURASHTRA REGION
ESTIMATED CATCHMENT POPULATION (100 KM RADIUS)
~4.2Mpeople across Rajkot, Junagadh, Amreli & Porbandar districts
AGE DISTRIBUTION
<15 yrs
28%
15–44 yrs
42%
45–64 yrs
21%
65+ yrs
9%
EST. ANNUAL CANCER INCIDENCE (Gujarat avg: 95/100k)
~3,990
NEW CASES/YR
~1,850
NEED CHEMO
~1,200
NEED SURGERY
PREVALENT CANCER TYPES · SAURASHTRA REGION
Oral / H&N Cancer
28%
Breast Cancer
22%
Cervical Cancer
15%
GI / Colorectal
13%
Lung Cancer
10%
Other
12%
URBAN / RURAL SPLIT
38% Urban62% Rural
LITERACY RATE · RAJKOT DIST.
82.2%
Above Gujarat avg of 79%
03 / PATIENT JOURNEY
The Orchestrated Patient Flight Plan
Every patient's care is mapped as a living, adaptive journey — automatically generated by AI, continuously monitored, and seamlessly shifted between hub and spoke as the clinical situation evolves.
WAYPOINT 01 · DETECTION
First Contact & AI-Powered Intake
Patient arrives via referral, walk-in, or spoke partner. AI pre-consultation health intake captures structured history. Digital registration creates a unified longitudinal record.
📋
AI Health IntakeStructured medical history collected before first consult
📍
Pin Code MappingPatient's home location mapped to nearest spoke partners
🔗
ABDM Health IDABHA linked. All records federated from day one
WAYPOINT 02 · DIAGNOSIS
Integrated Staging & Tumor Board
Pathology, genomics, imaging, and clinical data converge on a single digital tumor board. AI generates staging summary. All specialists see the same truth simultaneously.
🧬
AI RadiomicsTumor detection, sizing, and molecular risk markers
👥
Digital Tumor BoardMDT collaboration with full imaging and genomics
🗺
Pathway EngineAI auto-generates care pathway in under 24 hours
WAYPOINT 03 · TREATMENT
Orchestrated Multi-Modal Treatment
Surgery, chemotherapy, and radiation are scheduled as an integrated symphony — not as siloed department bookings. Conflicts are resolved before they happen. Handoffs are automatic.
💊
Smart Chemo SchedulerAuto-calculates dosing, infusion slots, and toxicity windows
⚡
Radiation SequencingAll 25–30 fractions scheduled at pathway generation
🔪
AI Surgical Planning3D reconstruction, risk scoring, OT coordination
WAYPOINT 04 · MONITORING
Remote Toxicity & Symptom Surveillance
Between visits, patients report symptoms via mobile app. AI monitors for early toxicity signals and flags complications before they escalate to emergencies, enabling spoke-level interventions.
📱
Patient App PRODaily symptom check-ins with AI triage engine
🚨
Escalation ProtocolAuto-alerts to nearest spoke nurse if flags triggered
WAYPOINT 05 · RECOVERY & SURVIVORSHIP
Home-First Care & Long-Term Follow-Up
Post-treatment care is delegated to spoke partners near the patient's home. Hub retains clinical governance. All data flows back to the hub via FHIR APIs. Long-term survivorship tracking automated.
🏠
Spoke Home CareNursing, infusion, and wound care at patient pin code
📊
Survivorship RegistryAI-tracked long-term outcomes and recurrence detection
Getwell Cancer Hospital operates as the central hub — the "tower" — while a federated network of partner clinics, nursing centers, diagnostic labs, and pharmacies extend its reach to every pin code in the patient's region.
● HUB · LEVEL 1
Getwell Cancer Hospital
The clinical command center. Houses full oncology capability: surgical suites, linac radiation, chemotherapy day care, tumor board, pathology, genomics, and imaging. All clinical decisions originate and are governed here.
Complex SurgeryRadiation TherapyChemo Day CareTumor BoardGenomicsICU OncologyClinical Trials
◎ SPOKE · LEVEL 2
District Cancer Clinics
Oncologist-led outpatient centers handling routine chemo infusions, follow-up consultations, and oral chemotherapy management. Directly connected to hub EMR.
Infusion SuitesOPD OncologyTeleconsult Relay
◎ SPOKE · LEVEL 3
Nursing & Home Care Centers
Nurse-led partner organizations providing post-surgical wound care, palliative support, vital monitoring, and medication administration at or near the patient's home.
NABL-accredited diagnostic labs and imaging centers distributed across cities. Reports auto-ingest into hub PACS and patient timeline within minutes of collection.
Blood LabsPET-CTDigital PathologyPACS Relay
◎ SPOKE · LEVEL 4
Community Pharmacy Network
Partnered pharmacies that dispense oral oncolytics and supportive medications to patients at their home pin code. Drug adherence tracked via scan-and-confirm app.
Primary care physicians at every pin code serving as first-responders for symptom escalations and as trusted community links for patient education and early detection referrals.
Symptom TriageReferral GatewayEarly Detection
PIN CODE COVERAGE MODEL
Every Zip. Every Patient. Every Day.
The Onco-CoE platform maps each patient to available spoke partners within their pin code at onboarding. The system auto-assigns care teams, optimises travel distance, and maintains real-time partner capacity visibility.
🏥
HUB
Cancer Hospital
360 001
💉
CLINIC
Oncology OPD
360 002
🧪
LABS
Diagnostic Centre
360 004
🩺
HOME
Nursing Partner
395 001
💊
PHARMA
Community Rx
395 003
👨⚕️
GP
Primary Care
382 015
🖥
TELE
Teleconsult Node
380 006
📦
LOGISTICS
Sample Pickup
380 015
🫀
PALLIATIVE
Hospice Care
396 001
➕
EXPAND
Onboard Partner
Any PIN
05 / AI FLAGSHIP MODULES
20 Signature Innovations
The Onco-CoE platform is built on 20 AI-powered flagship capabilities that work in concert to deliver the air traffic control model across all clinical, operational, and patient-facing domains.
🗺
01
Smart Patient Navigation
Google Maps-like indoor navigation for OPD, chemo ward, radiology, and labs.
⏱
02
Live Wait-Time Tracking
Uber-style real-time queue visibility for patients and families.
🧠
03
AI Pre-Consult Intake
Structured medical history captured before first physician encounter.
📊
04
Patient Journey Dashboard
Patient views full treatment roadmap — diagnosis through survivorship.
Real-time guideline suggestions at point of care based on diagnosis.
🧬
07
Oncology Protocol Builder
Auto-suggests NCCN-aligned chemo regimens for confirmed cancer type.
🔗
08
Unified Patient Timeline
Scans, pathology, chemo cycles, and surgery notes in one longitudinal view.
👥
09
Digital Tumor Board
All specialists review imaging, genomics, and plans in one collaborative platform.
🛣
10
AI Pathway Engine
End-to-end care pathway auto-generated within 24 hours of cancer confirmation.
🔬
11
AI Tumor Detection
Radiomics analysis: tumor size, progression, molecular risk markers from imaging.
🏗
12
3D Surgical Planning
CT/MRI-derived 3D reconstruction for preoperative surgical planning.
⚠️
13
AI Surgical Risk Prediction
Predicts complication risk, blood loss, and ICU requirements pre-operatively.
📝
14
Operative Note Automation
OT recording transcribed into structured operative notes automatically.
💊
15
Smart Chemo Management
Automated dosage calculation, infusion scheduling, and toxicity alert system.
📡
16
Remote Toxicity Monitoring
Patient symptom app feeds AI model that flags Grade 2+ events proactively.
🤖
17
Smart Nurse Task AI
AI prioritises medication times, urgent patients, and pending tasks per shift.
📦
18
Predictive Drug Procurement
Forecasts chemo drug demand, expiry risk, and supply chain replenishment.
🏛
19
Hospital Command Centre
Real-time bed occupancy, OT utilisation, chemo chair status, and patient flow.
📈
20
AI Oncology Research Platform
Automatically structures datasets for outcomes research and clinical trial matching.
06 / DATA ARCHITECTURE
The Intelligence Fabric
Every module in Onco-CoE is connected through a standards-based interoperability layer — ensuring data flows freely, securely, and in real-time across the hub, all spokes, and the patient's mobile device.
Interoperability Standards
All data exchange built on open healthcare standards, ensuring vendor neutrality and future-proofing. Compatible with ABDM, NHA, and international health networks.
HL7 FHIR R4Core
ABDM / ABHAIndia
DICOM / PACSImaging
SNOMED CTCoding
CDS Hooks / CQLRules
ICD-10 / TNMStaging
AI & Analytics Architecture
The platform's intelligence layer processes clinical, operational, and patient-reported data in real-time — powering predictions, alerts, and automated pathway adjustments.
Pathway AI EngineCore
Radiomics AIVision
Toxicity PredictorNLP+ML
Surgical Risk ModelPredict
Clinical NLP ScribeLLM
Demand ForecastingOps
08 / NATIONAL POLICY ALIGNMENT
Anchored in India's National Cancer Mission
The Onco-CoE platform is purpose-built to operationalise the Government of India's healthcare vision articulated at the highest level — translating national policy commitments into hospital-level digital workflows and a regional care network.
PRIME MINISTERIAL MANDATE · GETWELL TRUST CANCER HOSPITAL, AMRELI
"30 new cancer hospitals in 9 years. 10 more under construction. 1.5 lakh Ayushman Arogya Mandirs for early detection. This is India's model of healthcare reforms."
The Prime Minister's address at the foundation stone laying ceremony for the Getwell Trust Cancer Hospital & Research Centre articulated a three-pronged vision: accessibility through distributed infrastructure, affordability through price controls and Jan Aushadhi, and early detection through village-level screening mandirs. Onco-CoE is the digital operating system that makes all three actionable at scale.
30+10Cancer hospitals built + 10 under construction
1.5LAyushman Arogya Mandirs for village-level screening
6CrBeneficiaries of free Ayushman Bharat treatment
₹1L CrOut-of-pocket savings for Indian patients
10,000Jan Aushadhi Kendras → Target: 25,000
80%Discount on medicines at Jan Aushadhi centres
₹30K CrAnnual hospital bill savings via Jan Aushadhi
Apex Cancer Center — New national CoE anchor for Saurashtra
THE GUJARAT MODEL · 20-YEAR HEALTHCARE TRANSFORMATION
📊 THEN vs NOW · GUJARAT MEDICAL INFRASTRUCTURE
METRIC
CIRCA 2002
2024
Medical Colleges
11
40
MBBS Seats
Baseline
5× Growth
PG Medical Seats
Baseline
3× Growth
Pharmacy Colleges
13
~100
Diploma Pharmacy
6
~30
Specialised CoE
None
Apex Cancer Center
🎯 Onco-CoE PLATFORM ALIGNMENT TO NATIONAL GOALS
🏥
Accessibility Hub-spoke network extends GCH reach to every pin code in Saurashtra. Apex Cancer Center as Tier-0 CoE enables complex case referrals.
💊
Affordability — Jan Aushadhi Integration Platform auto-flags Jan Aushadhi alternatives at prescription time. Drug adherence tracked across 25,000 partner kendras.
🔍
Early Detection — Aarogya Mandir Link 1.5 lakh Ayushman Arogya Mandirs feed cervical & breast cancer screening data directly into Onco-CoE via ABDM APIs.
🛡
Ayushman Bharat Claim Processing NHCX-integrated claims engine ensures all 6 Cr+ beneficiaries receive cashless care without documentation friction.
GOVERNMENT SCHEME INTEGRATION · BUILT INTO Onco-CoE PLATFORM
🛡
Ayushman Bharat Yojana
Real-time NHCX claim initiation at point of registration. Auto-eligibility check via ABHA ID. Cashless discharge workflow for all covered procedures.
6 Cr+ beneficiaries
💊
Jan Aushadhi Kendra Network
Prescriptions auto-cross-referenced against Jan Aushadhi formulary. Nearest kendra mapped to patient pin code. Oral chemotherapy dispensing tracked for adherence.
80% cost savings
🌿
Ayushman Arogya Mandirs
Village-level screening results for cervical and breast cancer flow into Onco-CoE as structured FHIR records. Positive screens auto-trigger referral pathways to nearest spoke or hub.
1.5 lakh mandirs
🆔
ABHA / ABDM Ecosystem
Every patient's ABHA ID is the universal key linking their cancer journey across all tiers — from Aarogya Mandir screening to Apex Cancer Center tertiary care — without re-registration.
Universal health ID
🏛
Apex Cancer Center — Tier-0 CoE
Complex oncology cases requiring advanced genomics, proton therapy, or rare tumour boards are seamlessly referred via the Onco-CoE referral engine to Apex Cancer Center with full patient record transfer.
Regional apex anchor
🔬
National Cancer Registry
Anonymised, structured oncology data automatically flows to ICMR's National Cancer Registry. Onco-CoE becomes a data contributor to national cancer epidemiology and research.
Population-level data
09 / THREE-TIER CARE ARCHITECTURE
Apex Cancer Center → Onco-CoE → Community A Three-Tier Oncology Ecosystem
The addition of Apex Cancer Center as the national Centre of Excellence creates a three-tier architecture: Tier-0 (Apex Cancer Center — apex national CoE), Tier-1 (Getwell Hospital — regional hub), and Tier-2/3 (district clinics, nursing centres, Aarogya Mandirs, GPs — community spokes). Each tier is digitally connected through Onco-CoE.
● TIER 0 · NATIONAL CENTRE OF EXCELLENCE
Apex Cancer Center
📍 Rajkot, Gujarat · ~63 km from Kagvad
The apex referral node for the entire Saurashtra region. Handles rare tumour boards, proton therapy, complex genomics, high-risk surgeries, and cutting-edge clinical trials. All Onco-CoE referrals arrive pre-loaded with complete FHIR patient record via secure ABDM data bridge.
Proton TherapyRare Tumour BoardsAdvanced GenomicsRobotic SurgeryPhase I–III TrialsPET-CT / MR-LinacComplex ReconstructionApex Cancer Center Research Platform
🔗 Onco-CoE Integration: Seamless bi-directional patient record transfer via FHIR R4 + ABDM APIs. Onco-CoE tracks patient status during Apex Cancer Center care and re-integrates at discharge.
📍 Kagvad, Jetpur Taluka, Rajkot District · PIN 360370
The primary oncology hub for the Saurashtra region. Handles full-spectrum cancer care including surgery, chemo, radiation, tumor board, and palliative. The operational home of the Onco-CoE platform. Feeds upward to Apex Cancer Center and downward to all spokes.
OT × 4 SuitesIMRT / IGRT LinacChemo Day CareDigital Tumor BoardPathology & GenomicsInterventional Radiology500-Bed InpatientOnco-CoE Command Centre
◈ TIER 1B · FUTURE EXPANSION (AMRELI)
Getwell Trust Cancer Hospital — Amreli
📍 Amreli District, Gujarat · New Foundation Stone Laid
The second regional hub, announced at the PM's address. Will mirror Kagvad's full oncology capability and serve the Amreli, Bhavnagar, and Gir Somnath districts. Onco-CoE will deploy as a parallel hub instance sharing the same spoke network and data fabric.
Full Oncology (Planned)Onco-CoE Hub Instance 2Research & Clinical TrialsShared Data FabricAmreli District Coverage
🚧 Foundation stone laid. Projected operational: 2027. Onco-CoE platform scalable to multi-hub topology from day one.
↕ CARE COORDINATION · FHIR APIs · SPOKE ASSIGNMENT ENGINE
◎ TIER 2A · DISTRICT ONCOLOGY CLINICS
District Cancer OPD Centres
📍 Jetpur · Gondal · Junagadh · Amreli
Oncologist-led centres for chemo infusions, follow-ups, and oral chemotherapy. Directly on the Onco-CoE network.
Infusion SuiteOPD OncoTeleconsult
◎ TIER 2B · DIAGNOSTIC & IMAGING
NABL Diagnostic & Imaging Centres
📍 District HQs & Taluka Towns
Labs and imaging nodes feeding results directly into Onco-CoE patient timelines. Auto-matched to pathways.
Blood LabsCT / MRIDigital Pathology
◎ TIER 2C · JAN AUSHADHI NETWORK
Jan Aushadhi Kendras
📍 10,000 → 25,000 Across India
Oncology prescriptions auto-routed for Jan Aushadhi fulfilment. 80% cost saving tracked per patient. Adherence data back to hub.
80% DiscountOral ChemoAdherence Tracking
◎ TIER 2D · NURSING & HOME CARE
Home Care & Nursing Partners
📍 Every Pin Code in Catchment
Nurse-led post-surgical and palliative care delivered at home. Vital telemetry and wound data sync to Onco-CoE in real-time.
Wound CareVitals TelemetryPalliative
↕ EARLY DETECTION & REFERRAL · ABDM HEALTH RECORDS
◎ TIER 3A · AYUSHMAN AROGYA MANDIRS
Village Screening Centres
📍 1.5 Lakh Centres Nationally
Cervical & breast cancer screening. Positive screens trigger auto-referral into Onco-CoE spoke pathway.
Cervical ScreenBreast ScreenAuto-Referral
◎ TIER 3B · PRIMARY CARE / GP NETWORK
Community GP Network
📍 All Pin Codes in Saurashtra
First-responders for symptom escalations from home care patients. Integrated with Onco-CoE alerts engine.
Symptom TriageAlert ResponseReferral Gateway
◎ TIER 3C · PATIENT & FAMILY
Patient App & Family Portal
📱 Mobile · Any Device · Any Language
Daily symptom check-ins, appointment visibility, drug reminders, and care plan access in Gujarati & Hindi.
Symptom Check-insCare Plan ViewGujarati UI
◎ TIER 3D · AYUSHMAN BHARAT CLAIMS
Financial Assistance Engine
💰 Cashless · NHCX-Integrated
Beneficiary verification, claim initiation, and approval workflow embedded into Onco-CoE registration. Zero friction for 6 Cr+ beneficiaries.
NHCX ClaimsABHA VerifyCashless Discharge
GLOBAL BEST PRACTICES IN CANCER DIGITAL CARE · EMBEDDED IN Onco-CoE
🏆
NCCN & WHO Guidelines Engine
All treatment pathway recommendations are validated against NCCN 2024 guidelines and WHO ESSO protocols. Clinical decision support fires at every prescribing event.
🤝
Multidisciplinary Team (MDT) Workflow
Every cancer diagnosis triggers a structured MDT workflow — mirroring best practice from UK's Cancer Alliance and US NCI cancer centres. Minimum 5 specialists per board.
📡
Remote Patient Monitoring (RPM)
Continuous wearable integration and symptom app reporting — aligned with ASCO's telehealth guidelines and proven to reduce unplanned ER visits by 38% in published trials.
🧬
Precision Oncology & Genomics
NGS-based biomarker testing integrated into the staging pathway. Results auto-populate the AI protocol builder with targeted therapy and immunotherapy recommendations.
🌍
Patient-Reported Outcomes (PROs)
EORTC QLQ-C30 quality-of-life assessments embedded in the patient app. PRO data feeds directly into the tumor board view and influences supportive care decisions.
🔐
Data Sovereignty & DISHA Compliance
All patient data governed under India's Digital Information Security in Healthcare Act (DISHA). On-premise deployment option for sensitive genomics data with zero export to foreign clouds.
10 / IMPLEMENTATION ROADMAP
From Vision to Operations in 18 Months
A phased rollout that delivers quick wins in the first 90 days, then progressively activates the full ATC model and hub-spoke network over three structured phases.
PHASE 01
Foundation & Core ATC
Months 1–6
EMR deployment with AI medical scribe
Patient portal and mobile app launch
Command centre dashboard (hub-level)
Smart chemo management system
AI pathway engine (top 5 cancer types)
Digital tumor board platform
ABDM/ABHA integration
First 3 spoke partners onboarded
PHASE 02
Intelligence Activation
Months 7–12
Radiomics AI and PACS integration
Remote toxicity monitoring with app
Surgical planning AI module
Spoke network expansion (20+ partners)
Pin code-based care assignment engine
Pharmacy network integration
Predictive drug procurement AI
Clinical decision support (NCCN rules)
PHASE 03
Full ATC & Research Platform
Months 13–18
Full Saurashtra spoke network live (50+ partners)
Apex Cancer Center Tier-0 referral pathway live
Amreli Hub (GCH-2) Onco-CoE deployment
Ayushman Bharat + NHCX claims automation
Aarogya Mandir ABDM screening data ingestion
Jan Aushadhi formulary integration at all spokes
AI oncology research + ICMR registry contribution
Survivorship, palliative & long-term follow-up
11 / CITIZEN LONGEVITY INDEX & EARLY DETECTION
Citizen Longevity Index & Early Detection Architecture
A population-health layer combining community-led early detection with globally validated Healthy Longevity Medicine diagnostics. The architecture begins at the community frontline — before any clinical encounter — and progresses through four rings to the hub. Every citizen receives a Longevity Quotient (LQ) derived from biomarkers across those rings.
70%
11.0 · THE PROBLEM THIS SOLVES
70% of cancer cases in the catchment present at Stage III or IV — due to social hesitation, delayed referrals, and absence of a trusted first point of contact.
Clinical diagnostic excellence at the hub cannot solve a problem that begins in the community. The Pilgrimage to Public Health Framework — grounded in Jan-Bhagidari (people's participation) — shifts cancer care from a reactive treatment model to a proactive community movement, converting cultural gathering points into the first layer of the detection network.
70%
LATE STAGE AT PRESENTATION
5 min
GCH SCREENING CHECKLIST
Weekly
VIRTUAL TUMOR BOARDS
4 Rings
COMMUNITY TO HUB PATHWAY
THE FOUR-RING CARE CONTINUUM · COMMUNITY TO HUB
⓪
Community Frontline
Jan-Bhagidari · Moksha Kshetras
ASHAs · ANMs · Panchayats · Community Volunteers · Cultural Gathering Points
Surgery · LINAC · Chemo · PET-CT · Tumor Board · Research · Apex Cancer Center Referral
COMPREHENSIVE TX LQ RING 3
PILGRIMAGE TO PUBLIC HEALTH · FRAMEWORK SUMMARY
LAYER
PRIMARY CAPABILITY
KEY ACTION
Community Frontline
Jan-Bhagidari
Trust & Behaviour Observation
Building "First Conversation" and "First Decision" — ASHA/ANM digital app for symptom flagging and confident counselling
Arogya Mandirs
Universal Ring 1
Rapid Screening
5-minute GCH Screening Checklist with digital auto-referral trigger to nearest spoke or hub pathway
District Spokes
Diagnostic Ring 2
Diagnosis & Navigation
Weekly Virtual Tumor Boards connecting district clinicians to hub specialists — reducing travel burden while ensuring diagnostic accuracy
Moksha Hubs
Onco-CoE Treatment Ring 3
Comprehensive Treatment
Specialised Surgery, Radiation Therapy (LINAC + Brachytherapy), Chemotherapy, Research & Clinical Trials at GCH
11.0 · RING 0 PLATFORM CAPABILITIES — COMMUNITY EARLY DETECTION
🤝
Community Frontline Network
RING 0 · Jan-Bhagidari · Moksha Kshetras · ASHA / ANM Digital App
MODULE
ASHA/ANM Mobile Companion App — a lightweight Android-first tool for frontline health workers to log high-risk symptoms, refer citizens to Aarogya Mandirs, and track counselling outcomes.
FEATURES
Symptom checklist in Gujarati. Confident counselling protocol guide. Referral trigger → nearest Aarogya Mandir or spoke. Moksha Kshetra event scheduler for community health camps. Offline-first with ABDM sync when online.
ACTORS
ASHAsANMsPanchayat LeadersCommunity Volunteers
Platform Outcome: Converts cultural trust at Moksha Kshetras into structured referral data, feeding the Onco-CoE funnel before any clinical encounter.
📋
5-Minute GCH Screening Checklist
RING 0→1 · NAMO Screening · Digital Referral Trigger · Arogya Mandir Interface
GCH SCREENING CHECKLIST · v1.0
~5 min
ABHA ID: 14-2981-3042-7
Age: 52
Sex: Female
PIN: 360370
SECTION A · WARNING SYMPTOMS
SECTION B · RISK FACTORS
RISK SCORE
HIGH RISK — 3 flags
⚡ AUTO-REFER TO SPOKE
Nearest spoke: Jetpur District Clinic · 8.2 km · Appointment: Tomorrow 10:00 AM
Platform Outcome: Auto-referral fires the moment score threshold is crossed — zero friction, zero paper, zero missed cases.
🏥
Decentralised Spoke Diagnosis
RING 2 · District Spoke Centres (Onco-CoE Network) · Tele-oncology Navigation
MODULE
Spoke Tele-Oncology Navigation Engine — localised diagnosis and guided care navigation reducing the travel and financial burden on rural families.
FEATURES
FHIR-linked referral intake from Aarogya Mandirs. Diagnostic order set auto-generated from checklist flags. Tele-oncology video consultation with hub specialists. Day-care chemotherapy at spoke level for eligible patients. Transport coordination with patient's home pin code mapping.
IMPACT
↓ Travel burden
↑ Stage I/II detection
↑ Referral conversion
Platform Outcome: Diagnostic accuracy at the local level — no patient needs to travel 60+ km to GCH just for an initial assessment.
📡
Weekly Virtual Tumor Board
RING 2→3 · District Spoke × Hub Specialist · Early-Stage Screening Case Review
MODULE
Early Detection Virtual MDT — a weekly scheduled session distinct from the hub-level treatment tumor board. Designed for high-volume, lower-acuity screening-detected cases requiring specialist input before hub referral decision.
FEATURES
Weekly fixed slot (e.g. every Tuesday, 4:00 PM). District spoke clinicians present checklist-flagged cases. Hub oncologist reviews imaging and lab results via shared PACS/FHIR. Outcome: refer to hub, treat at spoke, or watchful waiting protocol. All decisions recorded in patient Onco-CoE pathway.
NEXT SESSION · TUE 11 MAR · 4:00 PM · 6 CASES QUEUED
GCH-ED-01F/48 · Oral patch · Tobacco use · Gondal SpokeURGENT
GCH-ED-03F/62 · Mammogram flag · Kagvad MandirIMAGING
Platform Outcome: Hub specialist oversight at the spoke level — every screening-detected case gets expert review without leaving the district.
PILOT COHORT DESIGN · PHASE 1
Start with 500. Scale to 500,000.
The CLI pilot enrolls 500 citizens across 5 pin codes within 25 km of Kagvad — a mix of rural, semi-urban, and tribal populations. Baseline LQ scores are established, biomarker gaps identified, and the data model validated before district-wide rollout. Expansion gates trigger at 80% pilot completion and government authority sign-off.
500
PILOT CITIZENS
5
PIN CODES
4
RINGS (0→3)
11.1 · THE THREE-RING PROGRESSIVE DIAGNOSTIC FRAMEWORK (RINGS 1–3)
①
Universal Ring
📍 Delivered at: Aarogya Mandir · PHC · Spoke GP
Feasible at every community touchpoint. No lab required beyond basic equipment. Covers the foundational LQ score for 100% of pilot citizens.
Requires NABL-certified labs and ECG/imaging equipment. Targets 60% of pilot cohort based on Ring 1 risk stratification results.
● RECOMMENDED OPTIONAL
ECGVO2 Max (CPET)Carotid UltrasoundCoronary Calcium ScoreBone Mineral DensityPSA (Men)Mammogram (Women)Colonoscopy (50+)Skin Cancer ScreeningOGTTInsulin + C-PeptideIGF-1 / Growth HormoneFull Hormonal PanelESRLiver Function (ALT/AST/GGT/Bilirubin/PT/Albumin)Micronutrient PanelHeavy Metal ScreenOral Health AssessmentWearable Sleep (FDA-approved)
LQ Weight: 40% · Adds cardiovascular, hormonal, organ function, and guideline cancer screening dimensions.
③
Hub / CoE Ring
📍 Delivered at: GCH Hub · Apex Cancer Center · Research Protocol
Advanced diagnostics for high-risk citizens identified in Ring 1–2. Requires specialised labs and clinical oversight. Informs precision prevention strategies.
● NEEDS FURTHER VALIDATION
TMAO (cardiovascular)Galectin-3MyeloperoxidaseWhole Genome / ExomeOral / Skin / Vaginal MicrobiomeDNA Methylation (Epigenetic Age)ImmunophenotypingGlycan TestingProteomicsMetabolomicsEarly Cancer MarkersWhole Body MRI
LQ Weight: 20% · Precision longevity layer for research-track and high-risk individuals only.
THE LONGEVITY QUOTIENT (LQ) — COMPOSITE SCORE DESIGN
The LQ is a normalised 0–100 composite score calculated from completed biomarker rings. A score of 80+ indicates optimal longevity health. 60–79 indicates moderate risk requiring lifestyle and clinical intervention. Below 60 flags high disease-risk requiring immediate clinical pathway activation.
80–100
Optimal
70–79
Good
60–69
At Risk
50–59
High Risk
<50
Critical
Simulated pilot cohort average
DISTRICT HEALTH INTELLIGENCE TRACKER
A dual-persona dashboard — the Hospital Administrator monitors clinical LQ trajectories and biomarker flags, while the Government Authority (CMO / Collector) tracks population-level screening compliance and district health risk distribution.
PILOT COHORT · INDIVIDUAL LQ TRACKER
SHOWING 8 OF 500
CITIZEN / PIN CODE
LQ SCORE
RING
METABOLIC
CARDIO
CANCER RISK
Harish Patel, 58M
Kagvad · 360370
48
Ring 3
🔴 HbA1c 9.2
🟡 BP High
⚠ PSA Elevated
Meena Bhatt, 44F
Jetpur · 360370
71
Ring 2
🟢 Normal
🟢 Normal
🟡 Due Mammo
Raju Solanki, 67M
Virpur · 360380
55
Ring 2
🟡 Lipids High
🔴 CAC Score 320
🟢 Low Risk
Savita Rathod, 39F
Gondal · 360311
83
Ring 1
🟢 Optimal
🟢 Optimal
🟢 Low Risk
Dhruv Mehta, 52M
Jetpur · 360370
63
Ring 2
🟡 Pre-diabetic
🟢 Normal
🟡 Colonoscopy Due
Ananya Desai, 31F
Kagvad · 360370
88
Ring 1
🟢 Optimal
🟢 Optimal
🟢 Low Risk
Babubhai Chauhan, 71M
Virpur · 360380
44
Ring 3
🔴 Multi-flag
🔴 Angiogram Req.
🔴 PSA Critical
Lata Trivedi, 55F
Gondal · 360311
66
Ring 2
🟡 Thyroid Low
🟢 Normal
🟡 BRCA Pending
TOP BIOMARKER FLAGS
HbA1c > 7.5%38%
BP Hypertensive31%
Lipid Panel Abnormal27%
Cancer Screening Overdue44%
CRP Elevated (>3 mg/L)22%
RISK STRATIFICATION
Cancer RiskHigh · 18%
CardiovascularMod-High · 31%
Metabolic / T2DMHigh · 38%
Neurological / CognitiveLow · 9%
PIN CODE LQ HEATMAP · SAURASHTRA REGION
Average Longevity Quotient by location
PILOT PHASE
Bubble size indicates relative cohort size · Click pin code to drill down
DISTRICT HEALTH SUMMARY · RAJKOT DISTRICT
74
AVG DISTRICT LQ
500
CITIZENS ENROLLED
23%
HIGH RISK (<60 LQ)
5
PIN CODES ACTIVE
DISEASE RISK DISTRIBUTION · PILOT COHORT
Metabolic / Diabetes38% high risk
Cardiovascular31% moderate+
Cancer Risk (screened)18% flagged
Hormonal / Thyroid14% abnormal
Renal / Hepatic9% flagged
PROGRAMME COMPLIANCE — % SCREENED PER RING PER PIN CODE
PILOT PHASE · 500 CITIZENS
PIN CODE / LOCATION
ENROLLED
RING 1 %
RING 1 PROGRESS
RING 2 %
RING 2 PROGRESS
RING 3 %
AVG LQ
STATUS
360370 · Kagvad / Jetpur
124
94%
61%
12%
72
IN PROGRESS
360311 · Gondal
98
100%
78%
22%
78
ON TRACK
360380 · Virpur
88
82%
39%
4%
65
LAGGING
360320 · Navagadh
112
97%
83%
28%
81
AHEAD
362001 · Junagadh (urban fringe)
78
67%
28%
2%
58
INTERVENTION REQ.
📊 Overall pilot completion: Ring 1: 88% · Ring 2: 58% · Ring 3: 14%Last synced: Today 03:45 PM · ABDM data bridge
SCALE-UP GATE · PHASE 2 TRIGGER
Phase 2 expansion (5,000 citizens · 25 pin codes) unlocks when pilot Ring 1 compliance reaches ≥80% across all pin codes AND government authority CMO sign-off is received. Current status: 3 of 5 pin codes at threshold.
Getwell Cancer Hospital is equipped as a comprehensive tertiary oncology centre. This section maps every clinical capability to its corresponding Onco-CoE platform module, derives the technology requirements each demands, and positions all capabilities within the phased implementation roadmap.
12A · HOSPITAL CAPABILITY BLUEPRINT
🔬
Diagnostics Wing
IMAGING · ENDOSCOPY · INTERVENTIONAL
Digital X-Ray
DICOM
Fluoroscopy
DICOM
Ultrasound
DICOM
Mammography
SCREENING
CT Scanner
DICOM · AI
MRI
DICOM · AI
Endoscopy Suite
VIDEO
⚛️
Radiation & Nuclear Medicine
LINAC · BRACHY · PET-CT · SPECT
Linear Accelerator (LINAC)
DICOM-RT
CT Simulator
RT PLAN
Brachytherapy Unit
BRACHY
PET-CT
SUV · AI
Gamma Camera / SPECT
NM DOSE
Paediatric Sedation Prep Room
PEDS
🔪
Surgical Wing
OT · DSA · RECOVERY
Operating Theatres
OT MGMT
Minor OT
PROCEDURE
Pre / Post-Op
RECOVERY
DSA Suite
IR · DICOM
Endoscopy Recovery
WORKFLOW
🛏
Inpatient Wing
ICU · WARDS · SPECIALIST BEDS
SICU / HDU / ICU Beds
CRITICAL
Ward + Palliative + Paediatric
CENSUS
Clinical Trial Beds
CTMS
Immunocompromised Section
ISOLATION
Radioactive Iodine Beds
RAI · SAFETY
💉
Daycare & Chemotherapy
CHAIRS · BEDS · INFUSION
Chemotherapy Chairs
CHAIR SCHED
Chemotherapy Beds
INFUSION
Other Daycare Beds
DAYCARE
Radiology RT Recovery
RECOVERY
🚑
OPD & Emergency
CONSULTING · URGENT CARE · TRIAGE
OPD Consulting Rooms
EMR · QUEUE
ER / Urgent Care
TRIAGE AI
Teleconsultation
VIDEO
BED CAPACITY SUMMARY
ℹ️ Bed counts below are indicative placeholders — to be confirmed with hospital planning team before external distribution.
TBD
Census Beds (Ward + ICU + Specialist)
TBD
Daycare Capacity (Chairs + Chemo Beds)
TBD
Supportive Beds (Palliative + Trial + Paeds)
500
Total Planned Capacity (All Bed Types)
12B · EIGHT FUTURISTIC PLATFORM CAPABILITIES
Each of the eight capabilities below is unlocked by a specific clinical infrastructure item at GCH. The platform must be purpose-built to support these — they are not generic hospital IT features, but precision oncology workflow engines.
Adaptive Radiotherapy Intelligence Engine — integrates with TPS (Treatment Planning System) via DICOM-RT to enable AI-assisted auto-contouring of tumour volumes and organs-at-risk.
FEATURE
AI auto-contours GTV/CTV/PTV from CT Sim data. Fraction scheduling tied to patient pathway. Brachytherapy implant workflow with dose logging. Adaptive plan modification alerts when anatomy changes mid-course.
Patient Outcome:Reduces contouring time from 2–4 hours to under 20 minutes. Adaptive planning reduces radiation toxicity by up to 30% in published trials.
☢️
Nuclear Medicine Intelligence
CLINICAL TRIGGER · PET-CT + Gamma Camera / SPECT
MODULE
Nuclear Medicine Workflow Automation — SUV (Standardised Uptake Value) trending engine with AI metabolic response assessment across treatment cycles.
FEATURE
PET-CT results auto-ingested into patient pathway. SUV baseline vs post-treatment delta calculated and flagged. SPECT dose map integration. Radioisotope inventory management with expiry and regulatory compliance tracking.
Patient Outcome:AI metabolic response assessment detects treatment failure 6–8 weeks earlier than conventional imaging — enabling faster pivot to alternative regimens.
🏥
Real-Time Bed & Resource Orchestration
CLINICAL TRIGGER · All bed types — Census + Daycare + ICU + Specialist
MODULE
Unified Bed Intelligence Dashboard — single real-time view of all 500 beds across every wing: ICU, HDU, chemo chairs, clinical trial, immunocompromised, RAI isolation, palliative, paediatric, and daycare.
FEATURE
AI-driven bed demand forecasting (48-hour horizon). Auto-escalation when ICU capacity <20%. Chemo chair scheduling engine with infusion pump integration. Bed-type-specific infection control protocols triggered at admission.
Patient Outcome:Real-time bed visibility reduces average patient placement time by 40%. Prevents inappropriate placement of immunocompromised patients in standard wards.
Paediatric Cancer Navigator — a dedicated care pathway engine for patients under 18, with age/weight-adjusted drug dosing, guardian consent management, and school/education coordination.
FEATURE
Weight-based chemotherapy dosing calculator (BSA/Calvert formula). Sedation pre-assessment workflow linking to prep room readiness. Paediatric-specific toxicity grading (CTCAE Paeds). Guardian-facing app with Gujarati language support. Long-term growth and development tracking post-treatment.
Patient Outcome:Weight-based dosing reduces chemotherapy dosing errors — a leading cause of paediatric oncology adverse events — by over 60% in digital-first centres.
🧪
Clinical Trial Management System (CTMS)
CLINICAL TRIGGER · Clinical Trial Beds + Research Platform
MODULE
Integrated CTMS — AI-powered eligibility screening against active trial protocols, automated Serious Adverse Event (SAE) reporting, and sponsor data export pipeline.
FEATURE
Active trial registry with inclusion/exclusion criteria engine. Patient EMR auto-matched to eligible trials at diagnosis. Protocol deviation alerting. eConsent with guardian workflow for paediatric trials. IND/CTRI registration tracking. GCP audit trail. Sponsor data transfer via CDISC ODM.
Patient Outcome:AI trial matching increases clinical trial enrolment by 3–5× — giving patients access to cutting-edge therapies while generating revenue and research credibility for the hospital.
Patient Outcome:Automated neutropenic fever protocols reduce infection-related mortality in immunocompromised oncology patients by up to 25% in digital surveillance programmes.
☢
Radioactive Iodine (RAI) Patient Management
CLINICAL TRIGGER · Radioactive Iodine Beds + Nuclear Medicine Unit
MODULE
RAI Protocol Engine — end-to-end management of I-131 therapy: dosimetry calculation, isolation countdown timer, radiation clearance verification before discharge, and AERB regulatory compliance reporting.
IR procedure scheduler with cross-check against anticoagulation status and renal function (contrast safety). Pre-procedure checklist automation. Intra-procedure DICOM image capture to PACS. Post-procedure recovery bed assignment. TACE / TARE / embolisation procedure notes templates. Complication tracking and 30-day outcome follow-up.
Patient Outcome:Automated contrast safety screening eliminates preventable contrast-induced nephropathy — a risk in up to 15% of oncology patients with compromised renal function.
Every clinical capability maps to a specific technology stack, a Onco-CoE platform module, and a deployment phase. This matrix is the basis for vendor selection, RFP specifications, and phased budget allocation.
CAPABILITY × TECH STACK × PHASE · FULL MATRIX
Click a phase to filter · Click again or select All Phases to reset
12 capabilities
CAPABILITY
EQUIPMENT
Onco-CoE MODULE
TECHNOLOGY STACK
PHASE
READINESS
Bed & Resource Orchestration
All Bed Types · 500-Bed
Unified Bed Intelligence Dashboard
FHIR LocationHL7 ADTIoT SensorsAI Forecasting
Phase 1
Design Ready
Immunocompromised Isolation
Immuno Section · SICU
Infection Control & Isolation Engine
FHIR ObservationANC MonitorNHSN HAIIPC Bundles
Phase 1
Design Ready
DSA / Interventional Radiology
DSA Suite · Minor OT
IR Orchestration Engine
DICOM SCFHIR ProcedureHL7 OrderEntryContrast Safety AI
A computable clinical decision support layer that embeds oncology guidelines from the National Cancer Grid (NCG) and National Comprehensive Cancer Network (NCCN) directly into clinical workflows — firing at the right moment, for the right patient, with the right recommendation, tagged to India's resource stratification framework and GCH's live capability registry.
13A · FRAMEWORK OVERVIEW — THE CLINICAL INTELLIGENCE PROBLEM
THE GAP
Protocol adherence fails when guidelines live in PDFs, not workflows.
Oncologists across India's hub-and-spoke network manage dozens of tumour types simultaneously. Without embedded decision support, guideline adherence depends entirely on individual recall — leading to variation in staging, treatment selection, and response assessment that directly affects outcomes.
THE SOLUTION
Computable guidelines that fire inside the EMR at each decision point.
The Onco-CoE CDS engine converts NCG and NCCN guidelines into machine-executable rules — delivering contextual, patient-specific recommendations at diagnosis, treatment selection, radiation planning, and surveillance, with every recommendation tagged to India's E/O/O framework and GCH's capability status.
Provides the India-specific adaptation layer: Essential/Optimal/Optional classification, Ayushman Bharat reimbursability tags, equity considerations for the Gujarat catchment, and GRADE-rated evidence summaries contextualised to Indian healthcare infrastructure.
🌐
National Comprehensive Cancer Network (NCCN) — USA
INTERNATIONAL EVIDENCE BACKBONE · CATEGORY 1/2A/2B/3 · ANNUALLY UPDATED · TUMOUR-TYPE SPECIFIC
Provides the international evidence backbone: category-graded recommendations across all tumour types, continuously updated with emerging trial data, and the source framework that NCG itself adapts from. Requires institutional membership for clinical deployment.
📊
Cancer Registry · GCH Real-World Evidence
BIDIRECTIONAL LOOP · LOCAL OUTCOMES · PROTOCOL DEVIATION AUDIT · LEARNING HEALTH SYSTEM
The registry feeds the CDS (which tumour types to prioritise) and the CDS feeds the registry (real-world outcomes for each protocol). Over time, GCH generates its own local evidence layer — deviation rates, outcomes by stage, population-specific response patterns.
GUIDELINE TO PATIENT CARE — TRANSLATION PIPELINE
›
①
NCCN / International Evidence
INTERNATIONAL · CATEGORY GRADED
Published oncology evidence. Category 1 = uniform high-level consensus. Source for NCG adaptation process.
Evidence-based + widely available + cost-justified. If GCH cannot deliver → mandatory referral to Apex Cancer Center (Tier 0). Linked to AB-PMJAY Health Benefit Packages.
OPTIMAL
Evidence-based + cost-effective, requires specialist infrastructure. GCH qualifies for most Optimal recommendations. Requires equipment/expertise confirmation via Capability Registry.
OPTIONAL
State-of-the-art, purely evidence-driven, no cost ceiling. Typically Phase 3 capabilities. Clinical trials, advanced molecular profiling, immunotherapy combinations.
GRADE EVIDENCE QUALITY — SURFACED AT POINT OF CARE
HIGH
True effect close to estimated. RCT-level evidence. Clinician can act with high confidence.
MODERATE
Probably close to true effect. CDS card shown with contextual caveat for clinical judgment.
LOW / VERY LOW
True effect may differ markedly. Card surfaced as advisory only. Deviation capture mandatory.
GCH CAPABILITY REGISTRY — THE DYNAMIC REFERRAL THRESHOLD
The Capability Registry is a live, structured record of every clinical capability at GCH — updated as equipment is commissioned, staff are trained, and accreditations are received. The CDS engine queries the registry before surfacing any recommendation: if GCH cannot deliver an Essential recommendation, the system automatically generates an Apex Cancer Center referral pathway. As GCH capabilities grow, the referral threshold dynamically recalibrates — without any manual update to the CDS rules.
✓
Full Capability
DELIVER RECOMMENDATION
~
Partial Capability
DELIVER WITH CAVEAT
↗
Refer to Tier 0
AUTO-GENERATE APEX REFERRAL
✓
LINAC · Brachytherapy · CT Sim
RADIATION ONCOLOGY
✓
PET-CT · SPECT · MRI · CT
IMAGING & NUCLEAR MED
~
Whole Genome Sequencing
MOLECULAR PROFILING
✓
Surgery · DSA · OT Complex
SURGICAL ONCOLOGY
~
Proton Beam Therapy
ADVANCED RADIATION
↗
CAR-T Cell Therapy
CELLULAR THERAPY
13B · FIVE TUMOUR PROTOCOL ENGINES — REGIONAL PRIORITY CANCERS
Five tumour types selected based on Gujarat/Saurashtra epidemiology, GCH equipment coverage, and NCG/NCCN guideline availability. Additional tumour types will be incorporated as the cancer registry matures and incidence patterns are confirmed. Head & Neck is presented as the full worked example given its regional prevalence and multi-modal treatment complexity.
🎗
Head & Neck Cancer
#1 REGIONAL BURDEN · TOBACCO/ARECAFULL WORKED EXAMPLE
Oral cavity, oropharynx, larynx, hypopharynx, nasopharynx, thyroid, salivary glands. Most complex multi-modal pathway: surgery + radiation + chemo + brachytherapy + reconstruction + speech rehabilitation. Oral cancer is the leading cancer in males across Gujarat due to tobacco and areca nut exposure.
GUIDELINE SOURCES
NCG Head & NeckNCCN HNCC
6 CLINICAL DECISION NODES — CDS HOOKS FIRE AT EACH POINT
✓ GCH Full Capability — CT, MRI, PET-CT, Endoscopy, Pathology all on-site
2
Multidisciplinary Tumour Board Review
CDS Hook: order-signESSENTIALGRADE HIGHNCCN Cat 1
CDS alert fires if treatment plan is ordered without a documented MDT review for T2+ disease. Blocks single-specialty treatment initiation. Surfaces MDT scheduling module. Minimum quorum: surgical oncologist + radiation oncologist + medical oncologist + pathologist + radiologist. MDT decision recorded in FHIR CarePlan.
FHIR CarePlanMDT quorum checkorder-sign hookT2+ gate
CDS presents treatment pathway options based on: tumour site, T/N stage, HPV status (oropharynx), ECOG performance status, patient age, organ preservation intent. Key decision nodes: early stage (T1/T2 N0) → surgery or definitive RT. Advanced (T3/T4 or N+) → concurrent chemoradiation (cisplatin preferred, NCG Essential). Larynx: organ preservation protocol (RTOG 91-11 schema) vs total laryngectomy.
Surveillance schedule auto-generated in Onco-CoE pathway. Year 1: clinic every 1–3 months. Year 2: every 2–6 months. Year 3–5: every 4–8 months. 5+ years: annually. Thyroid function monitoring (post-neck irradiation, annual TSH). Dental review pre/post RT (osteoradionecrosis prevention). Speech/swallow rehabilitation pathway. Tobacco/areca cessation counselling re-triggered at each visit if use documented at baseline.
Cancer Registry Expansion Gate: Additional tumour types (thyroid, bladder, haematological malignancies, bone/soft tissue sarcoma, CNS) will be incorporated into the CDS framework as the GCH cancer registry matures and local incidence patterns are confirmed. Registry data → protocol prioritisation → CDS build → outcomes back to registry.
13C · TECHNOLOGY INTEGRATION ARCHITECTURE
STRATEGIC SUMMARY — FOR HOSPITAL LEADERSHIP & FUNDING AUTHORITIES
Clinical Decision Support is not a single product — it is a capability stack that must be assembled across five distinct layers, each with its own complexity, data requirements, and build timeline. The full CDS framework for five tumour types is an 18–24 month implementation. However, the architecture is designed to deliver clinical value from Month 1 onwards through a phased build: foundational EMR integration and the first Head & Neck protocol engine in Phase 1, expanding to all five tumour types with molecular decision support by Phase 3.
Breast and Cervical protocol engines. BI-RADS AI integration. Brachytherapy workflow CDS. Molecular subtype routing (HER2/ER/PR). FIGO staging CQL logic. MDT deviation audit system.
PHASE 3 · M13–24
GI + Lung + Molecular CDS
GI and Lung engines. RAS/BRAF/EGFR/ALK routing. PD-L1/immunotherapy eligibility. MSI/MMR CDS. Cancer registry feedback loop. NCCN live update pipeline. Learning health system activation.
⚠️ NCCN Licensing Note: Clinical deployment of NCCN guideline content requires institutional membership. GCH should initiate NCCN member institution application as part of Phase 1 procurement. NCG guidelines are freely available under CC BY-NC-ND. Budget line required for NCCN annual membership and content licensing.
FHIR PLANDEFINITION · CQL LIBRARIES · NCG PDF PARSING
NCG and NCCN guidelines converted from document form into machine-executable logic. Each recommendation encoded as a FHIR PlanDefinition resource with CQL (Clinical Quality Language) conditions. Ingestion pipeline: PDF → structured extraction → PICO mapping → CQL authoring → PlanDefinition publish to FHIR server. Triggers: ICD-10 diagnosis codes, SNOMED CT procedure codes, LOINC observation codes.
FHIR PlanDefinitionCQL R1.5SNOMED CTICD-10LOINC
Layer 2 — CDS Hooks Runtime
REST API · HOOK TYPES · EMR INTEGRATION POINT
CDS Hooks (HL7 standard) provides the REST API that fires CDS logic inside the EMR at predefined clinical moments. Hook types used: patient-view (opens patient chart), order-select (clinician selects a drug/procedure), order-sign (signs an order), appointment-book. Each hook sends a FHIR context bundle to the CDS server and receives recommendation "cards" back — rendered inline in the clinical workflow without leaving the EMR.
CDS Hooks 2.0patient-vieworder-selectorder-signSMART on FHIR
Layer 3 — Patient Context Binding
FHIR R4 PATIENT RECORD · REAL-TIME MATCHING · ABHA INTEGRATION
The CDS engine queries the patient's FHIR record at hook-fire time to personalise recommendations. Resources consumed: Patient (demographics, ABHA ID, AB-PMJAY eligibility), Condition (diagnosis + ICD-10), Observation (lab values, ECOG status, biomarker results), MedicationStatement (prior treatment), Procedure (prior surgeries, RT), AllergyIntolerance (contraindications). Genetic markers (EGFR/ALK/HER2/BRCA) stored as FHIR MolecularSequence or DiagnosticReport.
DYNAMIC REFERRAL LOGIC · LIVE CAPABILITY REGISTER · AB-PMJAY TAGS
Before surfacing any recommendation, the CDS engine queries the GCH Capability Registry to check delivery status. Essential recommendation + GCH registry = "refer" → auto-generates Apex Cancer Center referral FHIR ServiceRequest. Optional recommendations tagged with capability phase (Phase 1/2/3). AB-PMJAY eligibility flag injected from patient's ABHA record. Every recommendation card displays: NCG tier, NCCN category, GRADE level, capability status, and AB-PMJAY reimbursability in a single structured banner.
Capability Registry APIFHIR ServiceRequestE/O/O tagsAB-PMJAY flagApex Cancer Center referral path
Layer 5 — Audit, Deviation & Learning Loop
DEVIATION CAPTURE · CANCER REGISTRY FEED · OUTCOMES EVIDENCE
When a clinician overrides a CDS recommendation, the deviation is captured with a mandatory reason code (patient preference, contraindication, clinical judgment, resource unavailability). Deviation rates by protocol, tumour type, and clinician are tracked on the Quality Dashboard. All treatment decisions feed the cancer registry as real-world outcomes. Over time, this creates a local evidence layer: GCH-specific response rates, toxicity patterns, and survival outcomes by protocol — enabling guideline feedback to NCG and informing future adaptations.