Efforts to streamline and improve the integration of germline testing for patients with ovarian cancer have seen significant success with the implementation of an integrated clinical pathway dashboard at Kaiser Permanente in Northern California. The results of the initiative were presented at the 2024 Society of Gynecologic Oncology (SGO) Annual Meeting on Women’s Cancer.  

A multidisciplinary team comprising technology experts, medical genetics specialists, and oncologists developed a SmartSet for the Epic electronic medical record (EMR) system that allowed for seamless, one-click ordering of germline hereditary cancer multigene panel testing within the clinical pathways workflow. The integrated system not only facilitated the ordering process but also automated progress note documentation, eligibility assessment, and informed consent elements. It also automatically dispatched a targeted family cancer medical history questionnaire to patients.

Data analysis from the first full year of implementation in 2021 revealed promising outcomes. Among 176 patients with ovarian cancer for whom germline testing was requested through the integrated EMR pathway, 99% completed the testing. Furthermore, 50% of these patients completed the family history screening, leveraging the accessibility of an electronic messaging portal for questionnaire completion.

Notably, out of 269 ovarian cancer patients diagnosed in 2021, the germline testing rate stood at 65.4%, showcasing a significant improvement in testing utilization, and the rate of positive germline BRCA mutations was 14%, underscoring the clinical relevance of this integrated approach.

The success of this initiative highlights the effectiveness of streamlined order sets within EMR dashboards for facilitating the completion of germline testing for patients with ovarian cancer. By integrating diagnostic pathways into the EMR system, the study aimed to address historical barriers and optimize the utilization of complex diagnostic testing in ovarian cancer treatment.

The authors acknowledged certain limitations of the study, including the lack of comparison with germline testing rates outside the pathways cohort. Additionally, the inclusion of all diagnosed patients with ovarian cancer without evaluating their eligibility for germline testing may have inadvertently included patients who were not candidates for testing, potentially impacting generalizability.

Source: 

Kavecansky J, Duffens A, Brenman LM, Garcia C, Sun H. Germline testing among ovarian cancer patients using an integrated clinical pathway dashboard at Kaiser
Permanente, Northern California. Presented at the 2024 Society of Gynecologic Oncology (SGO) Annual Meeting on Women’s Cancer; March 16-March 18, 2024. San Diego, California.