Penn Medicine IT teams have developed a way to allow clinicians and genetic counselors to enter orders within the EHR and electronically interface them with an outside lab. The interface then transmits discrete results into the EHR, segregating genetic variants, which allows clinicians to make better informed clinical decisions.
For their work on this genomics data challenge, the Penn Medicine information services team is a semifinalist in the 2021 Healthcare Innovation Innovator Awards program. In a recent interview, Jeffrey Landgraf, corporate director for information services, described the challenge he and his colleagues sought to overcome.
Penn Medicine had implemented Epic’s Genomics Module in summer 2019 and began interfacing with outside genetic laboratories, which set the foundation to enable genetic tests for ordering outside of the EHR with results going to an outside system. The results, in PDF format, were then scanned into the EHR by genetic counselors. Although that was progress in terms of getting genetic data into the EHR, counselors and ordering physicians still found it difficult to link the orders placed in one system with scanned results in another system, Landgraf explains. “The reports were scanned into the EHR, but that still made it very tough for our genetic counselors and our providers to have a place to go to specifically look at a patient's genetic results, because they were integrated with all other lab results,” he says.
To tackle this problem, in February 2020 the Precision Medicine and Abramson Cancer centers teams worked with Information Services to incorporate direct ordering and discrete genomic results in the EHR.
Solving this business problem integrates the clinical data and enables clinicians to review results as part of the chart. “We became one of the first organizations in the country to enable the import of discrete genetic test results into our EHR, working alongside Epic,” Landgraf says.
The IT team created a Precision Medicine tab in the EHR where clinicians could go and just with a click, be in a particular patient's genetic workspace. They worked with the clinical teams to set up the ordering work flow and interfaces to the outside labs. “The first one that we integrated with is Ambry Genetics. Being able to integrate orders and then discrete results coming back into the EMR was a huge win because now our counselors can go in and look at the breakdowns of a particular test and make clinical decisions based on those results,” Landgraf says. “We are building clinical decision support around that as well.”
Landgraf says the project required working closely with several partners to come up with a “spec” to tell the labs what they need sent back. “We worked in partnership with Epic and our operational partners to ask what they want to be able to see when a result comes back into the EMR to make decisions.”
Although they haven’t put a dollar figure on it, there are cost savings in the time spent in the EHR because clinicians spend less time trying to find something. “We now have incorporated this data into the daily workflows of our clinicians,” says Anna Schoenbaum, D.N.P., M.S., R.N.-B.C., associate vice president of information services applications. “So they don't have to literally hunt and peck. They have a workflow where it always displays and they can leverage it, so I think it's added efficiency. They have all the information in a more comprehensive view to treat the patient or have action steps in order based on the results, so it's really improved the care of our patients.”
Overall success of this project is being measured through clinician adoption rate of placing orders and the return of results. Penn Medicine tracks the number of associated orders and results that file into the EHR and Precision Medicine tab. They also measure the number of departments entering orders. So far, 22 different departments have placed orders. To date, in the Genomics Module, there have been almost 1,650 orders interfaced, with 1,168 total results and 980 discrete results.
The storage of discrete genetic results within the EHR has other benefits. Streamlining the ordering process and results into the EHR enables genetic counselors to work at the top of the scope of practice, rather than handling administrative tasks.
It also allows for queries of genetic results using Epic’s data analytics function. This feature opens new ways to identify patients with specific genetic variants, as targeted clinical trials and new therapeutic options become available. Prior to this project, each department needed to individually keep records of patients with certain genetic variants — a cumbersome and highly variable system between the departments. Very few healthcare institutions have implemented genetic testing results into the EHR, and Penn Medicine now has several outside laboratories lining up to complete integration of genetic lab tests within its EHR and other health systems have asked how they completed this project in a relatively short time frame.
This informatics work around genomics is something that is just going to keep growing, the Penn Medicine team says. “As our genetic counselors and our operational partners get deeper into this space around genetics and genomic medicine, we're going to grow along with them,” Landgraf says. “There is definitely more to come. I think it's got fantastic momentum. And one of the things I am proudest of and I think Anna can also say this is when we talk to our clinical partners, they're so excited about it, and they love talking about it themselves. It really gives them the confidence as they go forward with their research and their grants that we're right there in step with them, and are supporting them.”
