S1E4: Bringing Clinical Trials Closer to Home (ft. Akhil Chawla, Northwestern Medicine)
Healthy Uptime Podcast Akhil Chawla (Northwestern Medicine) _ Jordan Cooper (Rackspace)-20260911_160522-Meeting Recording
September 11, 2026, 8:05PM
20m 18s
Jordan Cooper started transcription
Jordan Cooper 0:03
today with Akhil Chawla, the Vice Chair of Surgery for Regional Integration at Northwestern Medicine and an Associate Professor of Surgery at Northwestern University Feinberg School of Medicine and a surgical oncologist at the Lurie Comprehensive Cancer Center. Akhil, thank you for joining us today.
Chawla, Akhil 0:20
Thank you for having me.
Jordan Cooper 0:21
So for those listening, Northwestern Medicine is a health system headquartered in Chicago, Illinois, with 2,000 beds and 11 hospitals supported by 4,000 physicians of whom Akhil is 1. Today, Akhil, we're going to be discussing system integration, bringing clinical trials closer to home,
an example of that work specifically grounded in your pancreatic cancer and early detection projects looking at biomarkers like ctDNA. So please, Akhil, welcome and tell us more about that program.
Chawla, Akhil 0:55
Yeah, thanks again for having me and it's a privilege to be here. You know, as I think about integration, it's a discussion that would certainly surpass the time that we have, but it's really unifying the patient experience. I think about it at the patient level. What does a patient experience when they walk into
Jordan Cooper 1:14
Mhm.
Chawla, Akhil 1:16
one of our Northwestern Medicine hospitals. What kind of access to care? And as a surgical oncologist thinking about cancer, what does a cancer patient feel, for example? What kind of doctors do they see? What kind of familiarity with their disease process do they have? And if a person has a need for a certain level of care or certain subspecialty expertise, how does that patient get handed off?
to the other physician. I think the patient experience is not underrated because the patient experience is very closely correlated, actually, with how patients actually do from their disease. And that's data-driven. You think about, you know, what makes patients go back and rate our hospital system, you know, the best in Chicagoland.
It's actually what makes what makes Northwestern Medicine special. It's the ability to actually provide high-level care close to home, regardless of whether you present to Kishwaukee Hospital, Palace Hospital, or, you know, Northwestern Memorial Hospital.
Jordan Cooper 2:22
So, Akhil, I know you're building an integrated surgical program across a very large health system that is Northwestern Medicine. Can you tell our listeners about how you're thinking about standardizing care, improving access to subspecialty expertise, and determining the right site of care across academic and regional hospitals?
Chawla, Akhil 2:43
Yeah, so, you know, within our 11 hospital system, we have really two tertiary level hospitals and one quaternary level hospital. And we've kind of split it up by regions based off geography. But the reality is, if there's a patient that's far out west, they may not need to travel, you know, an hour and a half.
to get to Northwest Memorial Hospital in Streeterville. Those patients should be seen for a very high level care at Central DuPage Hospital, which is a 400 bed hospital with very strong, you know, vascular surgery, cardiovascular surgery, thoracic, surgical oncology. So part of that experience is not just the fact that we can offer care at those locations and operate on patients,
but the delivery of that care in a very high quality manner. So understanding that a patient comes in and feels and understands that the outcomes are going to be very similar to what they would be at our academic medical site. I think that's key.
Jordan Cooper 3:40
So what are some of the technical challenges that your team has had to overcome in order to facilitate this kind of funneling of patients into the most appropriate and convenient site of care?
Chawla, Akhil 3:55
Yeah, great question. You know, I think a problem that we deal with, with I think, which I think most health systems across the country are actively dealing with, is capacity. You know, how do we care for all patients that present to our doors, regardless of where they are? I mean, a patient doesn't know if a hospital is full.
So some of the things that we have leveraged is technology and understanding, you know, the OR capacity and the number of hours utilized for a certain type of case and what could be done in potentially lower level of care, potentially a hospital that's not a tertiary level hospital or an ambulatory surgery center.
Jordan Cooper 4:15
Okay.
Chawla, Akhil 4:35
Understanding what could be done in those areas and those locations and settings without compromising quality is one of the areas that we're most focused on. But that's a very matrixed type of decision-making process where we really want to highlight also the programs that we shine in, right, like cancer care,
cardiovascular care. We want to be able to offer that to all the patients in Chicagoland if possible.
Jordan Cooper 4:59
So I want to ground this conversation in a concrete use case, right? Because many of our listeners understand that you're trying to provide the patient the most affordable, like lowest level of care, while also allowing providers to practice at the top of their license. That's very familiar.
kind of mental construct in many health systems. But you're working with translating innovation into clinical practice with your work with pancreatic cancer and circulating tumor DNA and other precision oncology tools. So when you have a cancer patient, obviously some of those tools are only going to be available in your tertiary and quaternary care centers.
Other oncology patients may be able to get their chemo potentially administered in an ASC. So please, let's use a pancreatic center use case. What are you thinking here?
Chawla, Akhil 5:51
Yeah, so I think pancreas cancer is a great example because it's something I work in with every day. So a patient presents to Kishwaukee Hospital, which is one of our far west hospitals. We have great medical oncologists that are part of our broad GI tumor board that we then are able to evaluate and determine the strategy of care.
Jordan Cooper 6:06
Mhm.
Chawla, Akhil 6:11
During that tumor board, actually, we're able to understand, you know, what can be offered close to home, for example, the chemotherapy and if a patient needs radiation. Well, we know that their Whipple operation is going to need to happen at Central DuPage Hospital, which is, you know, probably the closest tertiary level hospital that patient has.
But one of the other areas that I focus on is bringing clinical trials close to home. It is not acceptable that that patient should not have access to the same circulating tumor DNA trial that we have open in one of our other campuses. In fact, we have set up that infrastructure such that our clinical trials office actually has purview and sends clinical research coordinators to those sites to enroll those
patients on trial. And actually, we're able to then apply those results in a much more broad way. You know, we're not only, you know, examining or identifying patients that can enroll on clinical trials that have the access to come to Streeterville to be part of those trials.
Jordan Cooper 7:14
Mhm.
Chawla, Akhil 7:14
It makes the results of those clinical trials much more applicable when a patient who lives 30 minutes west of Kishwaukee Hospital and two hours from Streeterville to be enrolled in a trial to then have those results be applicable to a broader population.
Jordan Cooper 7:30
So clearly, patient access is a top priority for Northwestern. And in order to kind of emphasize and facilitate improved patient access, you're trying to bring clinical trials closer to the patient so it's more convenient for them, while also enabling care coordinators
to ensure that when they do need, for example, a Whipple operation, that they're able to get to the tertiary care. But that doesn't mean that all their care is at that tertiary hospital, but that they can get some closer to their own community. I'm wondering, with care happening in all these different locations, what technical challenges are you seeking to address or have you addressed in order to ensure
that the record is comprehensive, that the care provided in different settings is that all providers in the care team are aware of all the care provided in different settings, that the primary care provider is aware of what clinical trials the patient may be eligible for, you know, what sort of kind of infrastructure is required in order to facilitate this improved patient access, which is ultimately
business outcome you're looking for.
Chawla, Akhil 8:36
Yeah, so, you know, going back to the example of pancreas cancer care, you know, I think navigating the patient, navigation is key. And many of our programs have navigators, even in our Bloom Cardiovascular Center, for example, having a touch point for a patient to be able to then be a warm transition such that they're meeting the surgeon at the time of diagnosis,
Jordan Cooper 8:54
Mhm.
Chawla, Akhil 8:57
but they're not going to meet them again until they're done with their chemotherapy, such that when it's time for surgery, they then have to travel. We have all the other resources in place, such as social work, other additional supportive services that can allow patients to help get to a place if they need to. But I do think that there's a huge disparity that exists in the United States. That's no question about that. And within our Northwestern
Jordan Cooper 9:14
Mhm.
Chawla, Akhil 9:22
medicine catchment, we see that disparity every single day in the ability for patients to get routine primary care. And so one of the things that we've done is really implemented the ability to have frequent touch points even after surgery is completed, such that it would reduce the chance of a patient falling off or needing a readmission.
I think navigation in some of these very extremely complex areas is key to allowing that patient to get all the care that they deserve.
Jordan Cooper 9:51
Now, if a patient is looking to use a digital front door, for example, MyChart or Northwestern specific app or the website or, you know, there's various digital portals through which the patient is trying to access this care and get this coordination. It could be a phone call, it could be the app, it could be the website.
Are you leveraging artificial intelligence at all? Is there any kind of AI platform or governance strategy that is helping facilitate and coordinate all these different access points for the patient?
Chawla, Akhil 10:25
You know, we really think at Northwestern Medicine that there's a space for technology to help patients have high quality outcomes, but nothing is really going to replace the human touch and the ability to actually relate with a patient. So we really leave a lot of our services for our, particularly the more complex ones, to actually
Jordan Cooper 10:38
Mhm.
Chawla, Akhil 10:46
have a touch point, a navigator that could potentially help a patient to get where they needed to be. Now, as it relates to things like capacity and understanding complexity in terms of, you know, OR utilization and transfers, certainly we're leveraging the technology, machine learning to better understand where the leverage points exist, where the opportunities exist.
We're already under the same health electronic medical record system throughout our entire health system. That's been the case for a very, very long time. So we're leveraging the use of Epic to actually better understand that patient flow so we can catch patients from presenting late for certain things. So understanding
you know, potentially what the primary care is seeing and potentially intervening sooner.
Jordan Cooper 11:33
So, Akhil, obviously you are a physician. You're the vice chair of surgery for regional integration. Now, if you were to be speaking to the C-suite, particularly the CIO or CTO at Northwestern, you know, maybe, and I'm not sure about Northwestern specifically, but many CIOs or CTOs,
do not spend the majority of their time with frontline clinicians as you are and your colleagues are. And I'm wondering if you have any message for a more technical audience listening to this podcast, potentially a CIO of your or a peer organization or a CTO, what kind of requests would you make of that audience?
Because for them, they may be considering their data center strategy, a cloud strategy, may be figuring out where Epic is hosted and what kind of latency issues and how to avoid downtime and what sort of vendors and AI applications could be most useful in order to achieve, as you say, the improved clinical outcomes.
the improved quality of care, the improved access for patients. That's the clinical and business outcomes that you care about. From a technical perspective, when you're speaking to technical leadership, what requests would you make of them or what would you want them to know as they make those business decisions?
Chawla, Akhil 12:51
Yeah, no, that's a great question. I think for somebody who sits with different hats as a clinician and researcher and administrator, I think that it's important to really think about how we integrate care. I think it's very easy to get lost in spreadsheets and see that there's an opportunity in terms of utilizing technology
to fill a gap.
But there's also a patient behind that. There's a program, a program that has been built to, you know, really leverage the expertise that we have with our physicians at Northwestern. And I think aligning the strategic component with the high quality care, along with what we can leverage from a technology standpoint and capacity,
I think bringing all three of those things together is key. And our individuals that sit on the tech side within our leadership are very much in tune with that. It's because we have leaders like myself that actually don't just sit in one lane. We're actually purview to, you know, what it looks like on the patient's side and what the challenges are for a surgeon to get into the OR for,
Jordan Cooper 13:51
Mhm.
Chawla, Akhil 13:58
you know, booking a full day case and thinking about, you know, where a patient should be in terms of getting high quality care. And also, how do we leverage our health system to be able to get to more patients where access to care may not be so easy for those patients?
Jordan Cooper 14:14
A lot of times, Akhil, when you speak about kind of improving patient access, enabling clinical trials to be delivered in many different settings of care, a lot of times there are challenges that are logistic challenges. There are political, organizational, governance challenges, but also there are technical challenges.
As we wrap up this podcast, are there any technical challenges that you've encountered in the past few years while operating, for example, the pancreatic cancer workflows that we've been discussing? And if so, how have you addressed any of those? Or how would you recommend a listener encountering similar challenges might address those technical
obstacles that you are able to overcome.
Chawla, Akhil 14:57
Yeah, I think one thing as we looked at the data, we realized that there were clinical trials that are available to patients, but in some sites, there's lower enrollment. And so we have a program called Cancer Insights where we utilize patient data to better understand what trials they're eligible for. So we are able to then cue the physician to then see, hey,
this patient may be eligible for trial A, B, or C. That's really using technology to leverage the ability to get as many patients as possible to at least consider a clinical trial. And I think as we kind of exit the COVID era, we realize there's a lot of ability to work remotely.
Certainly the workforce has always been a challenge, but the ability to potentially consent a patient that lives or is in a hospital that's an hour from where we are at the academic medical campus, I think those are important things that we need to continue to leverage. It makes no sense to me that we physically have to be in front of that patient in every circumstance to simply go through a consent form. So
Jordan Cooper 15:49
Mmh.
Chawla, Akhil 16:00
That's how we get more out of our staff. And I think those are important components of how we do that utilizing the technology.
Jordan Cooper 16:07
Two follow-up questions. When you say that you queue the physician, are you talking about a best practice advisory alert within Epic? Something like that, a pop-up?
Chawla, Akhil 16:16
Yeah, exactly. So there's a couple of ways. We're working to integrate that through Epic, and there is a workflow through that as well. But there's also a general place that a physician, an oncologist, for example, could go and look and see, hey, I have this patient. What are the trials that are available for my patient at this site today?
And I think that's also key because as you know, those types of information change on a daily basis, right? There may be a trial open today, but the accrual has filled tomorrow. And so.
Jordan Cooper 16:45
And so there's a database lookup that physicians can go into that is separate from the EHR.
Chawla, Akhil 16:49
That lives on.
Correct, and that and that lives on the cloud, correct?
Jordan Cooper 16:54
Okay, and then the other thing I want to just talk about, you did mention COVID and working remotely. I'm wondering, as you're looking to improve access, telemedicine is a topic that many health systems have been grappling with. People have been going one way and the other with hospital at home and kind of trying to be creative about allowing people to get care where they are.
I know that payer reimbursement codes have changed and therefore health system practices have changed. Are you also looking to leverage your telemedicine program to improve access? Or is that something that Northwestern has been exploring?
Chawla, Akhil 17:30
Yeah, absolutely. I mean, for example, the early detection program in pancreas cancer that I lead, there's a lot of patients that we see that have lower risk lesions that can be watched. These are great patients for telemedicine. Now, hospital at home is another area that's kind of next level. And we're starting to do that.
in some of our medical subspecialties. But what does that look like for a surgical patient that potentially doesn't need very high level of care, needs to be in the hospital for a couple of days to just wait for their bowels to wake up, for example? I mean, these are great examples of where we're leveraging the technology to better identify
Jordan Cooper 18:04
Mmhm.
Chawla, Akhil 18:09
which patients are going to be right in the post-operative setting for hospital to home.
Jordan Cooper 18:14
And then, when you mention that the database lookup is separate in the cloud, is that is that what kind of decisions went into, or what kind of benefits are there with it being in the cloud, or how does it interoperate? Is there what kind of interoperability is there with the Epic EHR instance?
kind of what are the implications of having that database look up in the cloud for the organization and for providers.
Chawla, Akhil 18:42
For providers, it's huge. It's kind of going back to what I said earlier. It's really a live understanding of where trials exist, what's open, and can I accrue a patient on that trial today? Are there slots open? So some of our drug trials, that's really crucial to understand at that very moment as a patient could be in the next room ready to be seen. So A clinician could be ready to then enroll that patient onto trial.
But yes, that we're integrating that with Epic such that we're able to then look and see within a patient's chart, these are the trials that a patient could potentially be enrolled in, and then we can have that discussion.
Jordan Cooper 19:19
Well, Akhil, I certainly appreciate your time. Any final thoughts to our listeners about bringing trials closer to home, enabling system integration?
Chawla, Akhil 19:28
Yeah, I think this is integration is an important area probably for every major health system across the United States. I like to think that in Northwestern Medicine, we're one of the best at it, but certainly a lot of room for improvement and growth. I think leveraging the technology is going to be key. How do we look at this in a very highly matrix system with
lot of variables to then understand where we can care for patients as close to home as possible, but in the highest quality way.
Jordan Cooper 19:56
Well, this has been Dr. Akhil Chawla, the Vice Chair of Surgery for Regional Integration at Northwestern Medicine and Associate Professor of Surgery at Northwestern University Feinberg School of Medicine and a surgical oncologist at the Lurie Comprehensive Cancer Center. Akhil, I'd like you to thank you to thank you so much for joining us today.
Jordan Cooper stopped transcription
