EHR Integration: Effective Practices to Facilitate Timely and Comprehensive Biomarker Testing

 J Clin Pathways. 2024;10(1):31-32.

In the age of precision medicine, health technology perfor­mance and interoperability has quickly become one of the most pivotal areas of oncology practice management and op­erations. In 2023, with support from AstraZeneca and Genen­tech, the Association of Community Cancer Centers (ACCC) and its project partner LUNGevity launched an education pro­gram titled EHR Integrations: Effective Practices to Facilitate Timely and Comprehensive Biomarker Testing. In the first phase of this education program, ACCC conducted a landscape analysis on the current state of health technology performance and interoperability.¹ This landscape analysis identified key challenges, including:

• Lack of access to computerized order entry in electronic health record (EHR) systems for biomarker testing
• Lack of clarity and ability to track multiple types of tests (eg, somatic vs germline, tissue vs blood, predictive vs prognostic)
• Inefficiencies in communication between departments
• Logistical challenges related to entry and retrieval of results within EHR systems

As cancer programs and practices ramp up clinical and tech­nological infrastructure, this landscape analysis underscored a need for greater EHR integration—in the form of add-on modules, integration with reference labs, customizations, and other workarounds—to overcome these hurdles and better serve patients with cancer. Cancer programs and practices will then need to know how to vet these solutions, prioritize IT projects, and demonstrate return on investment.

Another component of this education program was an invi­tation-only EHR Working Summit held October 4, 2023, at the ACCC 40th National Oncology Conference in Austin, Texas. At this forum, provider and industry participants were asked to identify barriers to integration and explore effective practices and workaround solutions for streamlined biomarker test ordering and results management—the next necessary step for optimized cancer care. During the opening round­table discussion, participants were asked, “What single barrier, if removed, would most enable effective use of EHR for com­prehensive biomarker testing?” Responses included:

• Insurance authorization
• Privacy rules and regulations
• Use of multiple labs
• Secondary use of data

Discussion included numerous solutions or ideas for improv­ing comprehensive biomarker testing, including adoption of a universal platform and naming convention and improved EHR capabilities and automated processes to make it easier for pro­viders to order tests and receive testing results back from labs. As Christopher McNair, PhD, associate director for Data Science at Sidney Kimmel Cancer Center at the Thomas Jefferson Univer­sity Health System, summarized, “Providers and care teams are looking for standardization in biomarker testing while balanc­ing the growing testing landscape—who to test, when to test, what to order—rather than a ‘wild west’ of testing.”

Through a series of case study presentations, breakout groups, and action-planning activities, participants gauged their organizations’ current state of EHR integration, explored barri­ers and pain points, and brainstormed actionable steps and solu­tions to take to move the needle forward on EHR integration.

The need for precision medicine advocates or champions at cancer programs or practices was a recurring theme in summit discussions. This need aligns with ACCC’s Precision Medicine Stewardship education program, which explores how some cancer programs have designated a precision medicine stew­ard—a navigation lead who serves as the point person for re­moving barriers so all eligible patients are appropriately tested.² Precision medicine stewards may be certified genetic counsel­ors, nurses, navigators, advanced practice providers, or other members of the multidisciplinary cancer care team who act as the central liaison between oncologists, patients, pathology, and reference labs to ensure timely and appropriate biomarker testing. Most precision medicine stewards will be responsible for tasks such as:

• Evaluating insurance coverage
• Completing necessary prior authorizations
• Helping eligible patients complete financial assistance applications
• Streamlining and simplifying the test ordering process for ordering providers
• Coordinating tissue transport and tracking to the reference lab, including liquid biopsy orders if ordering concurrent liquid and tissue testing
• Retrieving test results from the lab portal and entering them into the EHR
• Informing the ordering provider that results are ready³

At the summit, Jennifer Johnson, MD, PhD, FACP, asso­ciate professor in the Departments of Medical Oncology and Otolaryngology and codirector of the Precision Medicine Ini­tiative at Sidney Kimmel Cancer Center at the Thomas Jeffer­son University Health System, spoke out in support of these types of advocates: “Multidisciplinary decision-making is nec­essary—make a precision medicine committee with representa­tion from all disciplines. Bring together champions and align [this] with other institutional priorities.”

Building on Dr Johnson’s comments, Crystal Enstad, MBA, BSN, RN, OCN, oncology nurse manager at Sanford USD Medical Center Sanford Cancer Center, emphasized the need for a “roadmap from health care systems that have implement­ed, streamlined, and are now leveraging their EHR systems for others who are just beginning the process.”

Those who have been successful at making inroads with EHR integration had plenty of advice to share. Karen Huelsman, MS, LGC, precision oncology lead and genetic counselor at TriHealth Cancer and Blood Institute, presented a case study that outlined TriHealth’s integration process. Huelsman noted that “strategically aligning their genomics module implemen­tation with their first EHR integration worked very well.”

Customizations and enhancements began immediately after their “go live” date and included tools like a genomics order fil­ter, which enables teams to pull up genomic orders in the Epic EHR system rather than relying only on the media tab to view scanned PDFs, as well as the use of smart phrases rather than copy and pasting or manually typing.

Wendi Waugh, RT(R)(T), CMD, CTR, administrative di­rector of Cancer Services and Community Health and Wellness at Southern Ohio Medical Center, also presented a case study on her center’s experience with biomarker testing processes and integration, which features a series of well-orchestrated steps for the entire biomarker testing process as well as a dedicated navi­gator to support testing. But rapid advancements in biomark­ers have not come without challenges. “There have been huge changes in biomarkers in such a small period of time . . . [bio­marker testing] is now a standard of care, yet the incorporation of testing lags behind in both clinical and payer environments, in addition to the administrative burden,” said Waugh. Aggre­gating information has also been one of the most challenging as­pects at Southern Ohio Medical Center, as its current process in manual and data quality management is still a work in progress.

While EHR integration is complex, ACCC and its partners are committed to providing the education, tools, and resources necessary to promote innovation and a clear path to optimized biomarker testing. As a result, ACCC and its partners aim to release an EHR Integration Roadmap along with a comprehen­sive resource library in early 2024, with plans to develop other resources to help guide cancer programs and practices on solu­tions and effective practices for facilitating timely and compre­hensive biomarker testing.