Precision medicine refers to tailored innovative treatment options based on an individual's disease type, genes, environment, and lifestyle. It serves to provide the right treatment, at the right time, to the right patient. Today, guideline-concordant biomarker testing is a standard of care for patients with cancer. However, cancer programs and practices face ongoing challenges in staying abreast of swiftly evolving clinical and technological advancements in cancer diagnosis and treatment planning. The rapid development of the US Food and Drug Administration (FDA) approved, biomarker-driven cancer drugs and the rising demand for timely biomarker testing, can present considerable barriers to delivering precision medicine for patients with cancer—including how care teams order tests and how quickly results can be used to guide treatment plans. 

As the complexity of clinical care grows, there is a need to develop systems that will integrate different data sources, provide real-time decision support, and enhance the ability for care teams to impact health outcomes. Certain electronic health record (EHR) vendors have integrated test ordering and results reporting, but these solutions are only available to certain users and may require significant investment to establish and maintain. As a result, EHR integration—in the form of add-on modules, integration with reference labs, customizations, and other workarounds—is needed to overcome numerous hurdles and better serve patients with cancer. 

To further examine this need, the Association of Cancer Care Centers (ACCC)—with its project partner LUNGevity, and with support from AstraZeneca and Genentech—launched an education program called, EHR Integration: Effective Practices to Facilitate Timely and Comprehensive Biomarker Testing. The program seeks to offer successful solutions, resources, tips, and tools cancer programs and practices can utilize to address EHR limitations and optimize care delivery.  

As a part of this initiative, ACCCBuzz had an opportunity to speak with the co-directors of a Precision Medicine Initiative at the Sidney Kimmel Cancer Center at Jefferson Health in Philadelphia, Pennsylvania, about their work in building a team to champion EHR integration to support precision medicine: Jennifer Johnson, MD, PhD, FACP, associate professor in the Departments of Medical Oncology and Otolaryngology and co-director of the Precision Medicine Initiative, and Christopher McNair, PhD, associate director for Data Science and director of Cancer Informatics.

ACCCBuzz: Why is standardization in biomarker testing a necessary next step? What are critical protocols care teams need that would quickly impact biomarker workflows? 

Dr. McNair: Standardization is key. Especially for larger institutions, because you want to have a similar patient experience regardless of where the patient ends up. This means, providing the highest quality of care for everyone that comes in the door, regardless of what door they enter. Creating standard workflows is also needed. You do not want different information coming from different places. Standardization ensures you can provide quality patient care and experiences. 

Dr. Johnson: 100% agree with that. I mean, Jefferson [University Health System’s Sidney Kimmel Cancer Center]'s motto is “care where you live.” We have a big catchment area and want to ensure patients have the same quality of care across our entire enterprise. If we don't have complete data, we cannot pick a treatment path for a patient. [For example,] you would not recommend a treatment without having an American Joint Committee on Cancer 8th Edition staging. Then why would you choose a treatment without standardized molecular data, prognostic and predictive biomarkers—all of which can contribute to consistent care? It's absolutely necessary. Beyond the potential for facilitating standard of care, molecular data can open up the possibility of getting a patient to a novel therapy through a clinical trial. 

ACCCBuzz: Can you recommend some immediate steps cancer programs and practices can take when beginning to think about EHR integration? 

Dr. McNair: Institutional priority is important… and I think it's important to be flexible. It's about being open to the different perspectives of the folks that are making these decisions, and finding people who are passionate about it [precision medicine]. We started with solid tumor testing, but there's a lot of different facets of molecular testing. What we found is that once you start, it's no longer just a black box for the people at the institution. I think finding what is going to be the path of least resistance and not focusing on one specific thing, and only that thing will make life easier downstream.  

Dr. Johnson: I agree, find other people who are passionate. From there, you start finding out how passionate your institution is. Because knowing that you are aligned with institutional priorities is going to get you buy-in from all the rest of the players you will need. For Chris and I, it [began with] the 2 of us, but institutionally, there was a great desire to do this EHR integration and a lot of different intersecting points that we could align with.  

ACCCBuzz: What barriers or challenges are working against EHR integration? What are some common missteps that teams should watch out for? 

Dr. McNair: Everybody thinks that what they are working on is the most important thing ever, right? So, for leadership and everyone involved, they will hear how important an initiative is—but there's only so many resources to go around. There must be a prioritization of these things, and that's where linking existing institutional priorities [to EHR integration] and finding out which lens you need to use to push it forward is so important. Vendors have teams of people who can help to put information and documentation together so that we [the precision medicine team] can just worry about the discussion points. 

Dr. Johnson: There's no shame in taking the path of least resistance. Choose to prioritize a vendor that already has a team that is ready to help you and has experience doing EHR integration. [That vendor] may not be the vendor that you use the most frequently, but you can learn so much going through the process for the first time [with an experienced vendor] that you can apply in future integrations.  

ACCCBuzz: What tools or resources can optimize the EHR integration process to help programs and practices who are just getting started or are stuck in the process?  

Dr. McNair: I think integration is a tool in and of itself. It was also the first step for us moving towards health equity. It is about making sure everyone who qualifies for [biomarker] testing gets it, regardless of any barriers. There is a dearth of tools available because everyone has been doing this in parallel. Start conversations with others who are working in this area to learn from their experiences.   

Dr. Johnson: I think ACCC has done a tremendous job at trying to bring together stakeholders—to literally have conversations and review their own distinct paths through this [EHR integration] process—that is a tremendous help. Because when you are first starting, you don't know what you don't know. Just giving people [cancer programs and practices] a list of who you might want to have on your [precision medicine] team, a list of the institutional priorities that others have had, information that highlights where EHR integration of genetic information has intersected with other institutions, moves cancer care forward. If you can start putting together those experiences, the way that you have already been doing, I think that is what we need.  

To find more tools and resources related to EHR Integration, visit the EHR Integration webpage. 

ACCC’s EHR Integration: Effective Practices to Facilitate Timely and Comprehensive Biomarker Testing education program is made possible with support by AstraZeneca and Genentech. 

Additional Resources

• EHR Integration: Effective Practices to Facilitate Timely and Comprehensive Biomarker Testing – Landscape Analysis 
• ACCC Resource Library: EHR Integration for Biomarker Testing 
• ACCC Roadmap: EHR Integration for Biomarker Testing 
• Highlights from the ACCC Working Summit: Biomarker Testing Solutions for EHR Integration [CANCER BUZZ Mini Podcast Ep 136] 
• EHR Integration: The Next Necessary Step for Optimized Cancer Care 
• Catchment Area Research and Data Science Listserv (CARDs) - Headlines | Catchment Area Research and Data Science Listserv (aaci-cancer.org)