In health recordkeeping, when fully electronic processes replace paper-based processes, good things happen.
“Administrative burdens are lifted, opportunities for waste and error are curbed. Data that were stranded in PDFs can take their place in the health record as discrete variables, allowing much quicker reference for clinicians and opening opportunities for center-wide analysis and automated decision support,” said clinical informatics specialist and oncologist Travis Osterman, DO, MS, associate professor of Biomedical Informatics and Medicine (Division of Hematology and Oncology), associate vice president for Research Informatics, and director of Cancer Clinical Informatics at Vanderbilt University Medical Center.
In a project spearheaded by Osterman, VUMC has begun adopting a new electronic system for ordering genetic tests from external reference laboratories, replacing a manual paper-based process that had been a long-standing source of administrative burden.
The new system operates directly through Epic, VUMC’s vendor for electronic health records (EHRs). Epic’s Aura platform, introduced by the company in 2023, allows clinicians to order genetic tests through the patient’s health record and receive results electronically, streamlining what had been a cumbersome workflow requiring paper requisitions and manual uploading of results.
“Everything was a manual process before,” says Leigh Ann Saucier, PhD, MS, senior IT project manager in VUMC’s Clinical Genomics Project Management Office. “They would have to fill out paper requisitions, select the test manually. Everything was on paper.”
In October, VUMC began using the new system for electronic integration with Natera, a California-based reference lab that processes approximately 7,000 genetic tests annually for VUMC’s women’s health service. These include carrier screening tests that can identify genetic variants that might be passed on to children, as well as various prenatal genetic tests. The tests may involve blood samples from prospective parents or analysis of tissue samples in cases of pregnancy loss.
“The new integrated process improves perinatal genomics ordering workflows, eliminating paper and double-ordering, with results directly sent to the clinician’s in-basket and to the patient via the My Health at Vanderbilt portal,” said Daniel Biller, MD, MMHC, professor of Clinical Obstetrics and Gynecology. “We have not only seen a significant decrease in clinician and team tasks, but also an immediate improvement in resulting turnaround, which has led to quicker patient consultation and referral and management of abnormal results. We are grateful for our teammates in Health IT, including Teresa Pletch, who has provided excellent project management, and to Martha Dudek, Caitlin Mann and Sam Stover for their perseverance and leadership.”
A second implementation, scheduled for mid-November, will connect VUMC with Tempus, a Chicago-based lab that processes about 2,500 cancer tests annually for VUMC. These tests analyze genetic changes specific to cancer cells, helping inform treatment decisions.
Under the old system, genetic counselors would complete paper requisitions and arrange for samples to be packaged and shipped to reference labs. Results would return as PDFs that had to be manually uploaded into patients’ electronic health records.
Saucier said that in the new system, many fields in the ordering form are auto populated, and built-in guardrails prevent incompatible selections.
Results now flow back electronically as structured data rather than PDFs, making them immediately available in patient charts and easier to analyze. The data automatically populates Epic’s genomics module, which allows for sophisticated storage and analysis of genetic information.
Under efforts to advance personalized medicine, VUMC for many years has been performing in-house genomic testing to look for potential gene-drug interactions.
“We have more structured genomic data in our EHR than any other place in the world right now,” said Osterman. “We only see this getting bigger and bigger.” He notes that VUMC currently sends genomic tests to 62 different reference laboratories and most of these still operate under the old paper-based system. The initial large implementations of electronic ordering deal with the bulk of VUMC’s outside genetic tests, paving the way for further modernization.
