Patients and referring physicians around the world have turned to POSO since 1997.
Affiliates of the Partners HealthCare system include Harvard Medical School teaching hospitals.
The Partners HealthCare doctors providing second opinions are leaders in medicine, research and training.
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 email@example.com. Our team is available between 8:30 a.m. and 5 p.m. ET, Monday through Friday.
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.
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.
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.
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.
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.
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.
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.
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).
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.
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.
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.
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.
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.
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:
|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 firstname.lastname@example.org.
Please see below for an example of the quality and level of detail of a POSO consultation.
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)
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.
"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 was extremely satisfied with my POSO case coordinator. She was very caring and empathetic — a great asset to the program. She is an excellent communicator — something you don't always find in modern medicine. Plus, she offered her availability by phone or email should any additional questions come up. I am now much more accepting of my condition and have a more positive outlook, even though it is a degenerative condition."
"I can't tell you how much I appreciate your opinion, time and consideration. Your consults were detailed, direct and comprehensive. I, of course, wanted my mother to come to Dana-Farber for her care from the beginning, but I am thankful that the online consult service is available and easy to use. I think the entire consult service is an outstanding service."
"Our local doctor was adamant about me receiving radiation, but your specialist argued that the small intestine was now resting on the bed of the tumor and thus impossible to radiate. The original hospital had already said radiation was not needed, but no one would talk with us unless we made a visit. Getting a second opinion through POSO was less costly than traveling to the hospital for a consultation, and your specialist addressed all of my questions and concerns thoroughly."
"Your service was wonderful. The staff's follow-up and follow-through were far superior than what my family received from any facility local to our home. Though the outcome was not good for my father, your superb professionalism and attention to detail were far superior to the care my father had received elsewhere."
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.
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.
Please refer to the website of the physician’s hospital to view his or her profile.
The first step is to register as a referring physician. See this page for more details.
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.
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).
You and your patient may submit up to four questions; any further questions will incur an additional fee. Visit this page for more details.
Please refer to our Consultation Guidelines (PDF) for details.
You can share records and imaging/biopsy materials with POSO in a variety of ways.
Electronic options include:
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.
Please visit this page for details.
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.
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.