Progress report: Integrating genetic data with EHRs
Foundation Medicine is working with software vendors and healthcare providers to automate ordering tests and obtaining results.
Foundation Medicine, which provides genomic profiling tests for patients with advanced cancer, is working with several electronic health record vendors and healthcare providers to further automate the ordering of tests and receiving of results within EHRs.
In one of the most recent initiatives, Foundation Medicine worked with University of Missouri Health Care to develop an HL7 interface to enable the electronic ordering of tests and obtaining a PDF of the results via its EHR system, Oracle Cerner’s PowerChart. The provider organization has a strategic partnership with Cerner – the Tiger Institute for Health Innovation – that runs much of its IT operations and coordinated the interface initiative, explains Katie Wilkinson, a senior director at the institute.
Previously, the health system relied on submitting paper orders and receiving results via fax and then manually scanning the information into the record, says Richard Hammer, MD, professor of pathology at the MU School of Medicine and vice chair of clinical affairs in the Department of Pathology and Anatomical Sciences.
“Our clinicians now have the ability to seamlessly integrate this new tool into our workflow,” Hammer says. “We can order the patient testing and receive the results within the EHR, and an email will notify us when the information is available. It speeds up the entire process.”
The next step will be to work toward capturing structured data within the EHR, rather than relying on a PDF, he says.
Mia Levy, MD, chief medical officer, Foundation Medicine
"The primary barrier to transacting these genomic testing results with EMRs had been the immaturity of data standards. These data standards have now matured."
Wilkinson describes the progression from paper to automation as a shift from good to better to best practices.
Obtaining genetic test results via paper is a good practice that helps improve the treatment of cancer patients by targeting therapy, she says. A better practice is ordering electronically and receiving results via a PDF to speed up the process. “Best is actually having more discrete genomic test data that you can use for decision support,” she adds.
Advancing precision medicine
“Foundation Medicine is committed to streamlining access to comprehensive genomic testing through efficient and high-quality data-driven insights,” says Mia Levy, MD, the lab’s chief medical officer. “We offer EMR integrations to organizations regardless of their EMR, and we have over 75 customers live on integrations today using six EMR vendors.
Mia Levy, MD, chief medical officer, Foundation Medicine
"Most EMRs have not had robust functionality to make this data valuable at the point of care. However, we are seeing a rapid uptick in EMRs’ ability to support the use of structured test results, and third-party vendors are now offering patient matching, and clinical decision support applications.”
“We are rapidly scaling this functionality to other organizations so that we can bring cancer precision medicine directly into providers’ workflows,” she adds.
In addition to Cerner, Foundation Medicine is working with Epic, OncoEMR, iKnowMed, Allscripts and Meditech, “as well as our partner, Ellkay, which enables us to work with any EMR system,” Levy says.
Foundation Medicine also is “supporting the flow of genomic data to drive advancements in clinical decision support, clinical trial matching and evidence generation across the precision oncology ecosystem,” Levy notes.
The chief medical officer provided an update on Foundation Medicine’s initiative with Epic that was announced a year ago.
“Our integration with Epic offers oncology practices, academic medical centers and other health systems with streamlined and accelerated delivery of actionable genomic insights to help guide treatment planning,” she says. “We are already live with multiple sites using Epic and are onboarding many new organizations in the coming months. Today, orders and PDF results are supported through the integrations, and we will be exchanging structured test results in the near future.”
Meanwhile, Meditech recently announced an enhancement of its records system to make it easier to access patients’ genomic information.
Over the years, automating transactions related to genomic tests has proved to be challenging because of the complexity of the data, Levy says.
“Genomic testing results consist of high-dimensional, complex data types with multiple layers of evidence and interpretation, which are difficult to represent in a standard way,” she explains. “As a result, the primary barrier to transacting these genomic testing results with EMRs had been the immaturity of data standards. These data standards have now matured to the point where EMR vendors can adopt these standards to enable representation of complex genomic testing results and exchange across clinical systems.”
Progress is now being made on providing genetic testing results in a structured format within electronic records, Levy says.
“Structured test results are key to enabling healthcare organizations to drive innovation. Foundation Medicine has been sharing structured results with hundreds of customers for years, yet the challenge has been integrating structured genomic testing results into EMRs in a way that is clinically useful,” she says.
“To date, most EMRs have not had robust functionality to make this data valuable at the point of care,” she explains. “However, we are seeing a rapid uptick in EMRs’ ability to support the use of structured test results, and third-party vendors are now offering patient matching, and clinical decision support applications and services, which are integrated into the EMR.”
The genetic testing firm, Levy says, is “leveraging these recent developments in order to further drive the availability and utility of genomic data and insights across the precision oncology ecosystem. Both the structured data and the PDF interpretive reports will be available in the EMR to inform the optimal cancer care management.”