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Referring Physicians

Partners Online Second Opinions (POSO) offers referring physicians and their patients remote second opinions by the world-class specialists of Partners HealthCare. We realize no one knows your patient better than you. That's why we strive to support your relationship with your patient and ensure he or she receives the best care possible close to home.

A Name You Can Trust

A Name You Can Trust

Patients and referring physicians around the world have turned to POSO since 1997.

The Harvard Connection

The Harvard Connection

Affiliates of the Partners HealthCare system include Harvard Medical School teaching hospitals.

The Best Of The Best

The Best Of The Best

The Partners HealthCare doctors providing second opinions are leaders in medicine, research and training.

How it Works

POSO is a physician-to-physician service. That means we require the primary doctor treating the patient to take part in the consultation process.

Please see below for details on how to enter a new case. If you have any questions, call 888-456-5003 (international callers: +016177249295) or email consultsinfo@partners.org. Our team is available between 8:30 a.m. and 5 p.m. ET, Monday through Friday.

Step 1
Step 1
Register as a referring physician.

You will receive a letter from your patient asking for your participation along with instructions for registering at our website and the patient’s unique 10-digit reference number. After completing your registration, you may start the consultation immediately or return to the site at a more convenient time.

Step 2
Step 2
Request the consultation.

You will enter the patient’s reference number and detailed information about his or her medical history. In addition, you will indicate what materials you will submit as part of your consultation request and include any questions you would like answered. Please be clear and specific in your questions, as they will determine which type of specialist provides the consultation and help the specialist give you and your patient the answers you seek.

Step 3
Step 3
Send in medical records and test results.

You or your patient will gather and submit medical records as well as relevant imaging and/or pathology reports and materials. For an additional fee, your patient may use Health Advocate, a third-party service that will manage the collection and submission of these materials. In that case, a Health Advocate representative may contact you.

Step 4
Step 4
We review the diagnostic reports and assign the case to a specialist.

Our team will have a pathologist and/or radiologist review any diagnostic materials that you provide. We will then match the case with an expert specialist from within the Partners HealthCare system. Specialists typically complete a second opinion within 10 business days. Our case coordinators will keep you and your patient updated on the status of the consultation throughout the process.

Step 5
Step 5
Receive the completed online second opinion.

Our team will review and approve the consultative report and then post it on our website for you to view. Once you have accessed it, your patient will receive an email informing him or her that the opinion is ready to view. You should discuss the contents of the specialist's opinion with your patient.

Get Started

You are only a few steps away from starting the second opinion process. Sign up as a referring physician.

Meet Our Specialists

We offer access to Partners HealthCare doctors across nearly all adult and pediatric specialties.

You work hard to earn the trust of your patients. But it's only natural that some will feel concerned about certain diagnoses or treatment plans, particularly if a serious illness is involved or surgery is indicated.

When patients need reassurance about their medical care, Partners Online Second Opinions (POSO) is here to help. Since 1997, we have provided thousands of patients globally with formal reviews of their imaging, pathology and medical records. We were the first service to deliver second opinions remotely—and continue to set the standard in the field of connected health.

Our services include:

Identifying the most appropriate expert specialists in our network to comment on particular diagnoses

Conducting imaging and biopsy reviews to affirm, adjust or change original diagnoses

Confirming treatment plans, therapies and interventions—or recommending alternatives

Providing guidance on medication management and pain management strategies

With POSO, your patient can avoid the time and expense of traveling to receive the very best specialty consultation.

Plus, you will both have the confidence that comes with our diagnosis and treatment plan reviews, thus avoiding unnecessary testing and procedures.

World-renowned Hospitals

We are part of Partners HealthCare, one of the world's elite healthcare systems. The Partners mission begins with delivering the highest-quality patient care possible.

Affiliated institutions include Brigham and Women's Hospital, Massachusetts General Hospital, the Spaulding Rehabilitation Network, the Dana-Farber Cancer Institute, McLean Hospital and Massachusetts Eye and Ear—all of which are affiliated with Harvard Medical School.

Each hospital hosts cutting-edge research, technologies and treatments, and is active in driving the future of medicine.

Access to Top Doctors

Partners HealthCare physicians are clinical and research leaders in their respective fields whose reputation and skills draw patients from around the globe.

Most also hold faculty positions at Harvard Medical School. No one else offers access to this level of physician expertise across such a wide range of specialties (nearly all adult and pediatric specialties in the Partners HealthCare network).

A Team That Cares

Our team includes highly committed case coordinators who bring years of experience working with specialists throughout the Partners HealthCare network. They are here to guide your patient and their family through every step of the consultation process.

With a dedication to customer service, they will do all they can to answer your questions and ensure the second opinion includes the precise information you and your patient need.

Here is a look at pricing for the services available through Partners Online Second Opinions. Patients are responsible for all charges.

Specialist Opinion
$800

This is the base cost for a medical second opinion. We encourage you and your patient to provide specific questions that you would like the reviewing doctor to address in the consultation letter. Doing so is helpful to the reviewing doctor and ensures you receive useful input and recommendations. Please note: There is an additional fee if an imaging and/or biopsy review is requested, more than four questions are included for the reviewing physician or the patient uses the Health Advocate medical record collection service. See below for details.

Imaging Review
$325 each

An imaging review involves an interpretation of imaging examinations, such as computed tomography (CT or CAT) scans or magnetic resonance imaging (MRI) scans. Pricing depends on how many different parts of the body are being reviewed. Each imaging site is considered a separate study.

Biopsy Review
$375 each

A biopsy review involves an interpretation of pathological specimens, which may take the form of slides or blocks. Pricing depends on how many different parts of the body are being reviewed. Each biopsy site is considered a separate study. Please note: There is an additional fee for reviews of blocks or unstained slides, or if special staining of slides is required for interpretation.

Health Advocate Medical Record Collection Service
$265

In order to make the consultation process as easy as possible for your patient, we have partnered with Health Advocate. This third-party service will manage the collection and submission of all medical records and test results required for the second opinion.

Additional Charges

Posting more than four questions (including multi-part questions) in your request will incur an additional fee. Clarification questions are allowed after a consultation, but there is an additional fee for follow-up questions.

Also, the following fees apply for medical records with more than 50 pages:

Pages Charge
51 - 75$25
76 - 100$50
101 - 125$75
126 - 150$100
151 - 175$125
176 - 200$150
201+Contact us to discuss

If you have any questions about costs, please contact us at consultsinfo@partners.org.

Partners Online Second Opinions (POSO) works with specialists throughout the prestigious Partners HealthCare system to provide consultations. These doctors, among the best in the world in their fields, have typically earned multiple honors and awards. Many hold leadership positions in their hospitals and/or medical associations.

Furthermore, only Partners HealthCare physicians who are fully tenured and licensed as well as board-certified are eligible to consult through our service. Interns, residents and fellows cannot participate.

Please see below for an example of the quality and level of detail of a POSO consultation.

September 7, 2016
Jane Doe
5/5/1965
Female
10384

Dear Dr. XX:

Thank you for referring Ms. Female Patient to Partners Online Second Opinions.(1)


The patient is a 51-year-old with a history of uterine myomas (fibroids), presenting with abdominal discomfort. She has undergone imaging by both pelvic ultrasound and MRI and has been recommended surgery for possible uterine sarcoma. I am not able to offer an opinion on the imaging given that it is outside my scope of practice as a gynecologic oncologist and I am not a radiologist. My opinion is based on the available ultrasound report enclosed with the documents available for my review.(2)


Uterine sarcoma accounts for 3 to 9 percent of all uterine malignant neoplasms. Uterine sarcomas arise from dividing cell populations in the myometrium or connective tissue elements within the endometrium. Compared with the more common endometrial carcinomas (epithelial neoplasms), uterine sarcomas, particularly leiomyosarcomas (connective tissue neoplasms), behave aggressively and are associated with a poorer prognosis.(3)


Risk factors for uterine sarcoma include: black race (for leiomyosarcoma, but not endometrial stromal sarcoma), long-term use of tamoxifen (five years or more), and pelvic radiation. Genetic conditions associated with uterine sarcoma are hereditary leiomyomatosis and renal cell carcinoma (HLRCC) syndrome and hereditary childhood retinoblastoma. Uterine sarcomas typically present with vaginal bleeding, pelvic pressure symptoms (eg, pressure, urinary frequency, constipation), or abdominal distension. On pelvic examination, the uterus is often enlarged.

The findings on examination and imaging for uterine sarcoma are nearly identical to those for benign uterine leiomyomas, as well as for atypical leiomyoma variants. Thus, the diagnosis of uterine sarcoma is often made after myomectomy or hysterectomy. That is, there is no way to make a definitive diagnosis of this highly malignant tumor other than by surgical removal of the “fibroid” or by removal of the uterus. Unfortunately, imaging studies cannot reliably differentiate between a uterine sarcoma and other uterine findings (eg, leiomyomas, adenomyosis). The diagnosis of uterine sarcoma is based upon histologic examination. Data regarding diagnostic accuracy of serum markers, biopsy, or imaging are limited in this rare disease.(4)


Thus, given the concern for a sarcoma raised by the ultrasound and the fact that it is not medically possible to make a definitive diagnosis of sarcoma without surgical tissue, I agree with the recommendation for surgery and would recommend a total hysterectomy and removal of both ovaries and fallopian tubes given that the area of concern extends to the adnexal region, which would also include the ovaries and the fallopian tubes. The operation should be done so as to allow removal of all of these structures as a whole, without morcellating or cutting the tissue. The choice of treatment after surgery depends entirely on the final pathology. There are data to support use of chemotherapy in the setting of advanced-stage leiomysarcoma but the final recommendation regarding post operative treatment is entirely dependent on the surgical histologic findings.(5)


REFERENCES:(6)

1. Nordal RR, Thoresen SO. Uterine sarcomas in Norway 1956-1992: incidence, survival and mortality. Eur J Cancer 1997; 33:907.
2. Tropé CG, Abeler VM, Kristensen GB. Diagnosis and treatment of sarcoma of the uterus. A review. Acta Oncol 2012; 51:694.
3. Bell SW, Kempson RL, Hendrickson MR. Problematic uterine smooth muscle neoplasms. A clinicopathologic study of 213 cases. Am J Surg Pathol 1994; 18:535.
4. Silverberg SG, Kurman RJ. Tumors of the uterine corpus and gestational trophoblastic disease. In: Atlas of Tumor Pathology - Armed Forces Institute of Pathology, electronic fascicle version 2.0, Washington DC.
5. Kurma RJ. Pathology of the Female Genital Tract, 4th, Springer Verlag, New York p.499.
6. Sandberg AA. Updates on the cytogenetics and molecular genetics of bone and soft tissue tumors: leiomyosarcoma. Cancer Genet Cytogenet 2005; 161:1.
7. Sandberg AA. Updates on the cytogenetics and molecular genetics of bone and soft tissue tumors: leiomyoma. Cancer Genet Cytogenet 2005; 158:1.
8. Morton CC. Genetic approaches to the study of uterine leiomyomata. Environ Health Perspect 2000; 108 Suppl 5:775.
9. Bodner K, Bodner-Adler B, Kimberger O, et al. Estrogen and progesterone receptor expression in patients with uterine leiomyosarcoma and correlation with different clinicopathological parameters. Anticancer Res 2003; 23:729.
10. Wade K, Quinn MA, Hammond I, et al. Uterine sarcoma: steroid receptors and response to hormonal therapy. Gynecol Oncol 1990; 39:364.
11. Moinfar F, Azodi M, Tavassoli FA. Uterine sarcomas. Pathology 2007; 39:55.
12. Karpathiou G, Sivridis E, Giatromanolaki A. Myxoid leiomyosarcoma of the uterus: a diagnostic challenge. Eur J Gynaecol Oncol 2010; 31:446.
13. Oliva E, Clement PB, Young RH, Scully RE. Mixed endometrial stromal and smooth muscle tumors of the uterus: a clinicopathologic study of 15 cases. Am J Surg Pathol 1998; 22:997.
14. Kir G, Gurbuz A, Karateke A, Dayicioglu V. Stromomyomas of the uterus-- importance of total circumferential evaluation of the margin. Eur J Gynaecol Oncol 2004; 25:489.
15. Clement PB, Scully RE. Mullerian adenosarcoma of the uterus: a clinicopathologic analysis of 100 cases with a review of the literature. Hum Pathol 1990; 21:363.
16. Krivak TC, Seidman JD, McBroom JW, et al. Uterine adenosarcoma with sarcomatous overgrowth versus uterine carcinosarcoma: comparison of treatment and survival. Gynecol Oncol 2001; 83:89.
17. Toro JR, Travis LB, Wu HJ, et al. Incidence patterns of soft tissue sarcomas, regardless of primary site, in the surveillance, epidemiology and end results program, 1978-2001: An analysis of 26,758 cases. Int J Cancer 2006; 119:2922.
18. Brooks SE, Zhan M, Cote T, Baquet CR. Surveillance, epidemiology, and end results analysis of 2677 cases of uterine sarcoma 1989-1999. Gynecol Oncol 2004; 93:204.
19. Ueda SM, Kapp DS, Cheung MK, et al. Trends in demographic and clinical characteristics in women diagnosed with corpus cancer and their potential impact on the increasing number of deaths. Am J Obstet Gynecol 2008; 198:218.e1.
20. Norris HJ, Taylor HB. Mesenchymal tumors of the uterus. I. A clinical and pathological study of 53 endometrial stromal tumors. Cancer 1966; 19:755.
21. Sherman ME, Devesa SS. Analysis of racial differences in incidence, survival, and mortality for malignant tumors of the uterine corpus. Cancer 2003; 98:176.
22. Mourits MJ, De Vries EG, Willemse PH, et al. Tamoxifen treatment and gynecologic side effects: a review. Obstet Gynecol 2001; 97:855.
23. Yildirim Y, Inal MM, Sanci M, et al. Development of uterine sarcoma after tamoxifen treatment for breast cancer: report of four cases. Int J Gynecol Cancer 2005; 15:1239.
24. Wysowski DK, Honig SF, Beitz J. Uterine sarcoma associated with tamoxifen use. N Engl J Med 2002; 346:1832.
25. Wickerham DL, Fisher B, Wolmark N, et al. Association of tamoxifen and uterine sarcoma. J Clin Oncol 2002; 20:2758.


Sincerely,

Gynecologic Oncologist

1 The specialist who wrote this consultation is a gynecologic oncologist and professor of obstetrics, gynecology and reproductive biology at Harvard Medical School.
2 The specialist provides a detailed summary of the information sent to her.
3 Many Partners HealthCare physicians work at teaching hospitals, so educating the patient and referring physician comes naturally. Here and immediately below, the specialist offers relevant information about the patient's condition, including etiology and risk factors.
4 The specialist outlines how uterine sarcoma is diagnosed, stressing that a histologic examination—rather than imaging studies—is the only way to reach a definitive conclusion.
5 The specialist explains why she agrees with the referring physician's recommendation for surgery. She also offers guidance on how to approach the operation and on postsurgical treatment options.
6 All POSO consultations are grounded in evidence-based medicine. Here, the specialist provides a list of articles that the patient and referring physician can review for more detailed information on the condition and treatment options. Please note: Not all consultations include references.

Patients and families who have received consultations through Partners Online Second Opinions (POSO) express how our service has touched their lives.

"I wanted an outside-looking-in opinion to confirm what my son's local neurologists had already determined — that he would not be an ideal candidate for brain surgery. The service was outstanding, and the quality of the opinion was exceptional. I was able to help drive the process along despite being out of the physician-to-physician privy. It meant the world to me to not be completely shut out of the process. I wouldn't hesitate to use this service again."

"I would like to give a special thanks to our case coordinator, who helped me a lot in this process. I really appreciated her kind help in this matter — it was very important in connection with an international second opinion like mine."

"I did the online consultation because of the drugs that my doctor was recommending as my next course of treatment. The side effects are quite harsh, and I wanted to find out if there were other treatment options available to me. I was very pleased with the results of the consultation in that it both confirmed the treatment proposed and gave me more options."

"I had gotten two opinions here in New York, and they were quite different. Your specialist's opinion was consistent with the information I had received from one of the two sources and helped me choose what I believe is a better approach for my situation. I am told that my cancer is rare, which makes my choices more complicated. Since most oncologists seemto work primarily from the pathology, it made sense to take advantage of the opportunity to consult with an expert at Dana-Farber without having to travel there."

"I was thrilled with the report from POSO— it was a masterpiece. It was so well-written and gave me reassurance by a party that was not involved in my everyday treatment. The doctor recommended a treatment plan that my care team is comfortable with, and we are implementing it. This service was just what I needed since I couldn't have gotten on a plane after my last round of chemo and risked the infection."

Get Started

You are only a few steps away from starting the second opinion process. Sign up as a referring physician.

Meet Our Specialists

We offer access to Partners HealthCare doctors across nearly all adult and pediatric specialties.

Have a question? Review the FAQ below. If you are still looking for answers, contact us.

Do I need to participate in the consultation process? If so, why?

Yes. Your participation is a legal requirement for a variety of reasons. For example, Partners Online Second Opinions (POSO) must adhere to Health Insurance Portability and Accountability Act (HIPAA) rules and state licensure laws, all of which are designed to protect patient privacy. Also, many of the reports written by our specialists contain medical terminology, so it is important that you first review the second opinion and then discuss its content with your patient.

How do you choose the specialist who will review my records and provide the report?

Our team includes case coordinators with years of experience recruiting and working with physicians at all Partners HealthCare hospitals. They call on their experience to identify the best qualified specialist based on your patient’s medical situation and the questions that you and your patient submit.

How can I review a physician’s qualifications?

Please refer to the website of the physician’s hospital to view his or her profile.

How do I get started, and what are the steps in the process?

The first step is to register as a referring physician. See this page for more details.

Can I request a particular Partners HealthCare specialist to review my patient’s records?

While we make every effort to accommodate requests in these cases, we cannot guarantee that a particular doctor will be available to review your patient’s records. You may, however, request that the reviewing doctor come from a particular hospital. Regardless of which doctor reviews your patient’s case, you can be confident that he or she has highly specialized expertise.

English is not my first language. How can I have my patient’s records professionally translated?

In this case, having patient records professionally translated helps our specialists provide the most accurate and relevant information possible in their reports. While we do not endorse any particular translation companies, we have had good results with Interpreters Associates Inc. (www.interpretersassociates.com or www.interpretersbrazil.com).

How many questions may my patient and I submit for the consultation?

You and your patient may submit up to four questions; any further questions will incur an additional fee. Visit this page for more details.

What types of records are required, and how do I know which ones to send?

Please refer to our Consultation Guidelines (PDF) for details.

How can I send my patient's records to you?

You can share records and imaging/biopsy materials with POSO in a variety of ways.

Electronic options include:

  • Uploading records and materials directly to our site when entering the case
  • Uploading imaging studies with our easy-to-use medical imaging platform
  • Emailing the records to consultsinfo@partners.org
  • Faxing the records to 617-228-4608

You may also mail paper records, as well as imaging discs and pathology slides/blocks, to:

Partners Online Second Opinions
Attn.: Case Coordinator
399 Revolution Drive
Suite 1310
Somerville, MA 02145

Once my patient’s records have been submitted, how long should I expect to wait for the report?

Our specialists typically complete a second opinion within 10 business days. Our case coordinators will keep you and your patient updated on the status of the consult throughout the process.

How much does your service cost?

Please visit this page for details.

Who is Health Advocate, and how do they help with collecting records for patients?

Health Advocate, a third-party service that is available to your patient for an additional fee, can manage the collection and submission of all medical records and test results required for a second opinion.

What is Partners HealthCare?

Partners HealthCare is a not-for-profit healthcare delivery network based in Boston, Massachusetts. Member institutions include prestigious Harvard Medical School teaching hospitals, including Brigham & Women's Hospital and Massachusetts General Hospital, which co-founded Partners in 1994.