NEW YORK – Medical software company Epic Systems is looking to expand its Orders and Results Anywhere tool to a broader range of laboratories and lab tests.
The expansion could make it significantly easier for hospital labs and other providers to interface with outside labs and diagnostic companies, allowing for more streamlined ordering of tests and returning of results.
In recent years, Epic has inked deals with a number of lab and diagnostics companies — mainly in the specialty genetics space — to integrate their tests into its electronic medical records (EMR) system. In October, for instance, Adaptive Biotechnologies announced an agreement to integrate its ClonoSeq minimal residual disease monitoring assay into Epic's EMR, allowing providers using Epic's EMR to order tests and review results directly as if the tests were being done at the site of care. Several months prior, in July, Caris Life Sciences announced a similar deal integrating its full complement of molecular profiling assays available through Epic's EMR system. Other companies including Myriad Genetics, Guardant Health, Foundation Medicine, and Natera have also arranged with Epic to integrate their tests into the company's EMR system.
Epic's move toward these types of integrations began with a deal the company entered with Exact Sciences in 2018 around that company's Cologuard colorectal cancer screening test.
The integration provided a number of advantages for Exact and Epic's provider customers, said Alan Hutchison, VP of population health and payor strategy at Epic. It streamlined the ordering of Cologuard tests and the return of results, making for a more convenient process for providers and helping drive utilization of the test for Exact. Additionally, it helped providers track and drive quality measures around colorectal cancer screening rates for value-based care programs like Medicare Advantage.
Since this initial project with Exact, Epic has established similar relationships with testing firms in areas including somatic and germline cancer genetic testing and maternal and prenatal screening.
Hutchison said the focus on genetic testing had been driven in large part by the fact that these were the firms that had approached Epic and asked for integrations into its EMR.
"We don't generally reach out to organizations," he said. Instead, if they reach out to Epic saying they work with a particular lab, or if the lab reaches out to Epic, it will respond to them to provide more information about what it does.
That said, "precision medicine, genomics, genetics-based data in the greater patient record has always been important to us as a company," Hutchison said. He noted that, historically, when ordering specialty genetic tests, providers received results back via PDFs.
But even with the PDF scanned into the patient record, a provider may not be able to do work with companion diagnostics, do decision support work, order the correct medicines, or know what research studies a patient is eligible for.
Having the results integrated into the patient's EMR streamlines all of those processes, Hutchison said.
Integrating testing into Epic's EMR system also "significantly reduces the time it takes for our provider organizations to stand up and configure a connection with a [new] lab," he said, noting that establishing an interface between an ordering provider and a lab could take as long as six months. In contrast, standing up new tests using Epic's Orders and Results Anywhere tool can be done in a matter of hours, he said.
Each individual test requires "a little bit of setup," however, Hutchison said. "What we'll be working on over the next year and a half is the ability to stand up hundreds, thousands, tens of thousands of tests without doing that individual configuration every single time."
Hutchison said that once that capability is in place, Epic plans to explore agreements with much larger labs, both in the US and internationally, than the specialty testing firms that have made up the bulk of its integration work thus far.
He said that reference labs, particularly at academic medical centers that are already Epic customers, were a likely target for such integrations.
"You look at the MD Andersons, the Johns Hopkins, the CHOPs, the University of Floridas — many of them offer competitive and/or complementary reference lab businesses. … Some of them are using that nonprofit entity to bolster their nonprofit healthcare system," said Epic Product Manager Nick Trentadue.
Jenna Rychert, a medical director at ARUP Laboratories and an adjunct associate professor at the University of Utah School of Medicine, said that the approach outlined by Hutchison could significantly streamline connections between providers and labs.
"Under the normal state of affairs, when a hospital healthcare client wants to interact with ARUP, we set up a point-to-point interface, and that requires several months of work to make sure we have the connections set, that the security is there, that we can transmit our test orders and results across the wires, so to speak," she said. "It's a lot of work, both on our end and on their end."
As described by Epic, the Orders and Results Anywhere system would provide a central hub connecting labs and providers, Rychert noted. "From the ARUP perspective, we wouldn't have to do a point-to-point with every single client, which would in theory benefit us. And from the client's perspective, if they have multiple laboratories they send out to, they also don't have to do a point-to-point with every single lab."
Setting up a traditional point-to-point connection "can be a pretty major pain," Rychert said. She noted that getting the resources to set up these connections is also an issue for hospital labs.
"The laboratory is already kind of down the priority list, and then having to establish connections to outside laboratories is even further down the backlog of things [a medical center] wants to be doing," she said.
Without some sort of interface, however, hospital systems and outside labs must process orders manually, meaning a back and forth of faxes and PDFs, with much of the administrative burden falling on lab personnel.
One key consideration, Rychert said, is the extent to which the Orders and Results Anywhere system will help labs and providers coordinate differences in test compositions across labs and changes in tests over time.
"When you have a panel test with multiple results in one test, lab A will do it one way and lab C will do it another way," she said. "How do you manage it when different labs want to make their test special instead of standard?"
Additionally, every time a lab changes a test or panel, the client must be able to receive that change.
"How is Epic leveraging interoperability, and how deep will that go?" Rychert said. "Are they going to make it easy for labs to receive changes, and how will they do that? Is the connection just at the lab level or is it at the test level?"
Hutchison said that Epic is working on ways to automate portions of the test update process for ordering providers.