Molecular Services and EMR-Lab Integration Application (ELIA) for Reducing Healthcare Disparities in Cancer Patients

Precision Medicine in oncology requires the application of molecular diagnostic reporting to inform clinical decision making. However, its implementation has been slow and inefficient. Recent studies have demonstrated that contrary to new established standards of care and guidelines, eligible patients are often not getting the appropriate testing and test results are not being used appropriately to identify optimal therapies. This is especially true in the community oncology setting, resulting in healthcare disparities.

The investigators believe that the lack of efficiency and adoption of precision medicine is caused by "leakage" in the process of deploying genomic testing and reporting. Leakage is defined as a failure or inefficiency of the system that leads to dropped or lost testing, reporting or action (including drug selection). Evidence suggests that leakage occurs at many steps of the process, and it is much more common in the community setting. A great deal of leakage occurs in the handling of ordering, retrieving, and tracking of external testing for necessary molecular diagnostic tests, the lack of integration between ordering facility and the laboratory, and a lack of expertise with understanding the complex reports.

This study aims to supply a community oncology practice with expertise, best-in-class testing, and integrative solutions to try to reduce leakage and reduce care disparities between the community clinic and large academic cancer centers.

This study will include a retrospective component, where the investigators will measure leakage (a predefined series of metrics)at a community cancer center over a six month period.

The investigators will then deploy a series of tools and services, including:

• Molecular Genetic Pathology expertise for tumor boards and case support
• Access to a best-in-class molecular test (TSO500)
• A software solution to improve data access between the clinic and lab (EMR-Lab Integration Application, ELIA) that was especially designed to reduce leakage in the community cancer care setting.

These services will be implemented for at least one year. The investigators will then remeasure the metrics over a year and see if there is a decrease in leakage.

It is expected that the deployment of expertise, improved testing, and improved data access and communication will reduce leakage and lead to improved patient care and outcomes. It is hoped that this will serve as a model to decrease healthcare disparities in cancer patients in the community setting.

Inclusion criteria

• newly diagnosed or change in status Advanced Cancer patient (recurrent, refractory, metastatic, or high grade)
• Cancer patient for whom genomic testing (comprehensive genomic profile (CGP)) is recommended by relevant guidelines

Exclusion criteria

• Patient does not seek additional treatment
• Patient younger than 18 years
• Treatment provided at a tertiary medical center
• CGP testing already performed and there is no change in patient cancer status