October 05, 2021
TriHealth is in an elite group as one of twelve health organizations nationally to achieve both use of Epic Genomic Module and EMR integration of genomic data. The integration of genetic information includes both tumor profiling and hereditary cancer testing. The goal of this work has been to enhance the workflow for physicians and improve patient care. The integration brings in discrete, accessible genomic data which drives clinical decision support, helps identify targeted cancer therapies or cancer preventive and screening recommendations, and matches patients to research clinical trials. TriHealth clinicians will see these improvements in the EMR in two main ways:
- The most common cancer genetic tests now report back into Lab tab, rather than Media
- “Genomic Indicators” will trigger passive best-practice alerts for patients with cancer predisposition gene mutations
Providers can now more easily find and discuss genomic results with their patients at the point of care. This brings the highest quality care to patients and families in our region facing a diagnosis of cancer.
DNA sequencing is an essential component of comprehensive cancer care and prevention
The Precision Medicine team at the TriHealth Cancer Institute has been ordering tumor DNA sequencing tests for over six years in order to identify the optimal treatment for patients with advanced cancers. No two tumors are alike. The genetic markers identified in a patient’s tumor can give crucial information about the ideal personalized treatment to battle each patient’s cancer. In 2020, over 600 TriHealth patients underwent what is called “next generation sequencing” of their tumor’s DNA and the volume of testing has nearly doubled in 2021. Results can be powerful, linking specific mutations to a specific drug or establishing eligibility for a clinical trial.
Making integration a reality requires highly collaborative teams
For over a year, members of the TriHealth Information Services (IS) team, which includes Adam Liette, Leah Vasiliadis, Nicholas Goettl, John Wintersteen, Sean Hubbard, Bradd Lehmann and Barb Ivey, partnered with the team at Tempus laboratories to take cancer genomics to the next level. Tempus laboratory is “making precision medicine a reality with the power and promise of data and artificial intelligence” taking large data files and summarizing the findings to support clinical decision-making. Until now, patient’s results from the 648 gene tumor profile test were saved in the chart as a static pdf file scanned into the medical record. On December 15, 2020, TriHealth launched integrated Tempus orders and results. Now patient results are saved as discrete variables that can be easily searched or reported. Clinicians have the genomic data they need at their fingertips, allowing genomic consideration in decision support. Integrated test ordering has reduced result turnaround time which is crucial for starting a treatment as soon as possible. In the summer of 2021, TriHealth also integrated with Ambry Laboratory to coordinate germline, or inherited, DNA results within the EMR. The team intends to extend integration to other genetic labs going forward, such as pharmacogenomics, to allow a seamless delivery of care for patients and easier access for clinicians.
TriHealth also purchased the Genomics Module for Epic giving additional power to expand medical care using genomic results in other specialties. For example, TriHealth Precision Medicine is currently expanding genetic care in cardiology, pharmacogenomics, population health and connective tissues disorders. Additionally, patients with specific actionable gene mutations can trigger a clinical “Best Practice Alert” that ensures the genetic risks are addressed, keeping genomics at the forefront of care.
The Precision Medicine and Genetic Counseling program is overseen by Manager Courtney Rice, who is also a Genetic Counselor. Courtney’s partnership with the IS Team was instrumental in moving this Epic integration forward. The program acknowledges generous support of the Good Samaritan Foundation and bi3 in developing these world class applications.
A dynamic team, the “Precision Oncology Genomic Workgroup,” comprised of Medical Oncology, Genetic Counselors, Pathology, Lab, Information Systems, IT, Administration meets regularly to vet new technology and laboratories to ensure the highest quality of testing for TriHealth patients. Karen Huelsman is the Precision Oncology Lead for TriHealth, and she also coordinates the Molecular Tumor Board, a forum for multidisciplinary discussion of complex tumor profiling cases. Karen is also a Genetic Counselor with 19 years of clinical experience in cancer genetics. The Epic integration allows the Precision Oncology team to identify patients for specific therapy and clinical trial matching on a level never before possible. James Maher, MD, PhD is the Physician Executive and Medical Oncologist leader for Precision Oncology.
For more information, please see Precision Medicine on Bridge and Precision Oncology on TriHealth.com.