16 Improving Electronic Medical Record (EMR) Documentation of Genomic Test Scores for Patients With Breast Cancer

Elizabeth Ulrich, MD¹; Haythem Ali, MD^1,2; Jessica

Bensenhaver, MD^1,2; Lisa Landvogt, BA¹; Lindsay Petersen,

MD^1,2

¹Henry Ford Health System, Detroit, MI.

²Henry Ford Cancer Institute, Detroit, MI.

Background

Genomic test scores are commonly used for T1b to T1cN0 hormone-positive, HER2-negative breast cancers as a decision aid for systemic chemotherapy recommendations. As these tests are often run by outside labs, they are not automatically listed in a patient’s EMR. They can, however, be included in a patient’s staging tool and subsequently appear in the problem list. Not manually entering genomic test scores leads to lost test results, wasted time, and incomplete discussions when patients are reviewed at multidisciplinary tumor board. The aim of this quality improvement study was to improve genomic test scoring documentation.

Materials and Methods

The Metriq Cancer Registry Department Database at a large multihospital health system was queried for patients with cT1b to T1cN0 hormone-positive, HER2-negative breast cancer from January 2019 through August 2020. Patients who underwent surgery and had genomic testing results were included. Improvement goals in genomic testing documentation were discussed at the Breast Program Leadership Committee of 2020, and reminders were sent via email to physicians, mid-level providers, and other support staff. Epic EMRs were reviewed for the appropriate documentation.

Results

Prior to the goal-setting intervention, 100 patients meeting inclusion criteria were identified in 2019. Fifty-six patients were identified in 2020 after the goal-setting intervention. Following intervention, clinical stage was documented in 95% of cases compared with 91% of cases prior. After the intervention, pathologic stage was documented in 96% of cases compared with 95% of cases prior. After the intervention, genomic test score was documented in 84% of cases compared with 46% of cases prior.

Conclusions

Genomic test score documentation in the pathologic staging tool in the EMR improved from 46% to 84% with intervention being only an initial request with email reminders. This improved documentation will be a quick reference for breast cancer caregivers, add to discussion at multidisciplinary tumor board, and aid with electronic searchable research efforts.