A screening and navigation platform for hepatocellular carcinoma


Hepatocellular carcinoma (HCC) is the most common type of liver cancer in adults.

There are approximately 6,000 patients at risk for HCC at Penn Medicine at any given time. In order to catch this cancer at a treatable stage, such patients should be screened every six months with an abdominal ultrasound. However, as many as 60 percent of patients are diagnosed too late to be cured.

A significant driver of low screening rates is that patients at risk for HCC are challenging to identify. A typical primary care physician with a patient panel of approximately 500 might have only one patient eligible for HCC screening. Identifying that individual is not a simple task, as there are more than 20 factors involved.


LiveAware is a digital platform designed to increase screening rates for patients at risk for HCC. It eliminates the burden on physicians to know who is eligible for screening, streamlines ordering, and supports patients to follow through.

LiveAware leverages a customized Agent dashboard to identify eligible patients. Once a patient is identified, a pended screening order is created and pushed to EPIC for the physician to sign. All orders are filed as standing orders, which means they are automatically placed every six months.

After orders are placed, patients are notified through myPennMedicine that they are due for a screening. And for those who have upcoming appointments, same-day screening is offered.


By removing unnecessary burdens and making the right choice the easy choice, LiveAware can reduce the number of late-stage HCC diagnoses, thereby improving patient outcomes and quality of life and reducing expensive downstream care.  

During the first phase of piloting, 82 percent of orders were signed by physicians – a 22 percent increase from the baseline - and screening rates among at-risk patients increased by 26 percent. At scale, this translates to more than 2,000 at-risk patients being “caught” by LiveAware, who might otherwise have been missed.

LiveAware is currently being used across the Primary Care Service Line for all downtown practices.

Phase 2: It does work

Tessa Cook, MD, PhD
Darco Lalevic
Charlie Chambers

Innovation leads
Mike Begley, MA
Matt Van Der Tuyn, MA
Catherine Shi, MSN, RN
Shivan Mehta, MD, MBA, MSHP

Innovation Accelerator Program

Innovation Methods

Fake back end
It is essential to validate feasibility and understand user needs before investing in the design and development of a product or service.
A fake back end is a temporary, usually unsustainable, structure that presents as a real service to users but is not fully developed on the back end.
Fake back ends can help you answer the questions, "What happens if people use this?" and "Does this move the needle?"
As opposed to fake front ends, fake back ends can produce a real outcome for target users on a small scale. For example, suppose you pretend to be the automated back end of a two-way texting service during a pilot. In that case, the user will receive answers from the service, just ones generated by you instead of automation.
Fake back end

Before developing and delivering an automated system to create pended orders, we manually placed orders to identify what information physicians needed to determine whether a patient would benefit from screening.


Pitch Day 2019