Almost any type of cancer can spread to the brain — what doctors call “metastasis.” In fact, the vast majority of brain cancer cases are due to cancer metastasizing to the brain from another part of the body, rather than originating in the brain.

Historically, patients with metastasized brain cancer had low odds of long-term survival because of limited treatment options. With each passing day a brain tumor goes untreated, the patient’s chance of survival diminishes. In order to help patients survive, a team of medical professionals from diverse specialties must pool their knowledge to devise a treatment plan as soon as possible.


The Problem

Doctors Joseph Bovi and Christopher Schultz at Froedtert & the Medical College of Wisconsin developed a protocol grid to provide standardized treatment recommendations for every type of brain metastasis. The protocol was based on a complex algorithm that took into account myriad factors and contained vast amounts of information, making it thorough but also complicated to navigate. Drs. Bovi and Schultz recognized that they needed a digital solution to make their algorithm more easily navigable for doctors, nurses and medical students.

Additionally, the App Brewery’s developers recognized that doctors need to quickly communicate with each other in order to save patient lives. Traditionally, medical specialists representing many disciplines would have a designated meeting each week — called a “tumor board” — in which they collectively review the hospital’s new brain metastasis cases and come to a consensus on a treatment plan. The App Brewery staff suggested that a virtual communication feature would help the tumor board’s members review cases, allowing some patients to begin treatment days earlier.

The Solution

Digital protocol grid

The NIMBLE app organizes the brain metastasis protocol using a branching structure, much like a choose your own adventure book. The protocol grid’s algorithm has dozens of potential outcomes, but the app easily organizes the information with four questions, each having multiple possible answers. Based on the user’s answers to each question, the app narrows down possible treatment options until it is able to present a treatment recommendation for any given case.

Keeping track of patients

An app user can create a profile for a patient after entering the patient’s information into the protocol grid. The user can then submit the profile to the tumor board, expediting the review process and possibly allowing treatment to begin days earlier. The app’s profiles are encrypted to ensure patient privacy in accordance with HIPAA regulations.

Virtual tumor boards

Members of the tumor board can review cases in the app at any time. NIMBLE creates an encrypted group chat for each patient submitted for review. The members of the tumor board can digitally discuss treatment solutions without having to schedule time to meet as a large group, and the app use push notifications to keep all members up to date with the conversations. Whether doctors are making rounds, working in their offices or eating in the hospital cafeteria, they can act swiftly to decide on a treatment plan.

NIMBLE is in full operation at Froedtert & the Medical College of Wisconsin and is available for doctors through the app stores for iOS and Android platforms. The app works on smartphones, tablets and desktop computers. Brain metastasis patients traditionally stayed in the hospital for seven to eight days, but preliminary tests have shown that NIMBLE’s data-driven approach has reduced average hospital stays to a mere three days, saving patients’ time, money and lives.

About the Medical College of Wisconsin

With a history dating back to 1893, the Medical College of Wisconsin is dedicated to leadership and excellence in education, patient care, research and community engagement. More than 1,400 students are enrolled in MCW’s medical school and graduate school programs in Milwaukee, Green Bay, and Central Wisconsin. MCW’s School of Pharmacy opened in 2017. A major national research center, MCW is the largest research institution in the Milwaukee metro area and second largest in Wisconsin. In the last ten years, faculty received more than $1.5 billion in external support for research, teaching, training and related purposes. This total includes highly competitive research and training awards from the National Institutes of Health (NIH). Annually, MCW faculty direct or collaborate on more than 3,100 research studies, including clinical trials. Additionally, more than 1,600 physicians provide care in virtually every specialty of medicine for more than 2.8 million patients annually.