Incorporating genomic data module into EHR adds ‘a lot of transparency’
Rush University Medical Center has taken precision oncology to a new level through an electronic health record module that incorporates genomic sequencing data into oncologists’ daily workflows.
The module, part of EHR company Epic’s software, enables physicians to access a patient’s genomic test results and tailor that patient’s care at a molecular level.
“Prior to this, we would receive genomic results from internal and external testing labs as a PDF document that would need to be downloaded and scanned into the medical record,” Mia Levy, MD, PhD, Sheba Foundation director of Rush University Cancer Center, told Healio. “It would be stored in a media tab as an image file that couldn’t be computed. This also made results difficult to find again, which made it difficult for the entire care team to be aware of the results in managing the patient’s care.”
Levy spoke with Healio about the improved accessibility and other benefits of the Epic module, even for physicians with limited knowledge of genomics.
Question: How does the module integrate genomic information into a clinician’s workflow?
Answer: We have created a process for placing the order for genomic testing electronically and having that order go to our genomic testing partner, Tempus Inc. They then return a digital version of those results that is HL7-compliant, which goes directly into the EHR in a structured format that loads in our normal way of receiving results of any test. From a physician’s workflow perspective, there is a lot of transparency that has not been achieved with any vendor before. I think oncologists will appreciate the significance of this, because it’s been a huge pain point for the past decade.
Q: How will the module assist in clinical decision-making?
A: We have created several clinical decision support rules within Epic using the results of the genomic tests. For example, for patients with germline findings, we created a rule that states, “If the patient’s results show germline findings that are pathogenic or likely pathogenic, notify the genetic counselor in the cancer center.” The genetic counselor then reviews each case that comes through to ensure that appropriate follow-up is taken. They verify that either confirmatory testing has already occurred and nothing more needs to be done, or that confirmatory germline testing is still needed. If additional testing is indicated, they reach out to the ordering physician and help arrange for that patient to be seen in the hereditary cancer clinic for next steps.
Q: How might a physician with limited background in genomics benefit from the module?
A: The test reports themselves include a significant amount of information on how to interpret the results. This interpretation might include clinical trials that the patient might be eligible for, as well as therapies the patient might benefit from.
We’ve created decision support rules within the EHR that use the genomics results and structured interpreted report data to identify patients who might be eligible for a clinical trial at our institution. Within the EHR, these rules notify our clinical trial coordinator of a potential matching case. The clinical trial coordinator subsequently reviews the case in more detail and if the patient meets eligibility criteria, they reach out to the managing physician to inform them of the potential opportunity for the patient to enroll. For those therapies that may be relevant, we have clinical decision support rules that go to the clinical pharmacist in our precision oncology program. These alerts can state, “We’ve identified a rare mutation in this patient that might make them eligible for this drug.” The pharmacists then review the case and notify the physician, because not all physicians have expertise in using drugs that are for rare indications.
As part of the ordering process, we’ve enabled physicians to request a molecular oncology tumor board referral and/or a molecular oncology consult clinic referral. That service is available to physicians outside our system, as well. We’re happy to take referrals when physicians feel they could use some guidance on results they’re not sure how to handle.
Q: Could your module potentially help increase the number of patients who enroll in cancer clinical trials?
A: That’s what we’re hoping. Even within an organization that has a robust clinical trials portfolio, often there are studies you don’t know about as a physician. Being able to provide that decision support is important. We will also look for clinical trials outside of our organization. We’re not limited to the idea of patients staying within our organization; if there’s a good opportunity for a patient and they are able to get into that study, we will recommend that.
Q: As the first to implement this module, has your institution had a good experience with it so far?
A: Absolutely. Everyone has been so thrilled to get this information as part of their routine workflow. We also uploaded over a thousand old cases into the system so that our physicians could benefit from more easily finding the results of those patients who have had previous testing. There’s always some proof-of-concept work that you need to do to work out of the kinks when you are the first organization to go live with a new product. The advantage is that now that we’ve done it, other institutions can do it.
For more information:
Mia Levy, MD, PhD, can be reached at Rush University Cancer Center, 1725 W. Harrison St. #1010, Chicago, IL 60612.