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Epic Systems, Myriad Genetics Seek 'Native' Integration of Genetic Tests Into EHR


CHICAGO – Myriad Genetics has been working on nearly 1,000 data integration projects with upwards of 40 different IT vendors, but a new partnership with electronic health records giant Epic Systems is beyond anything it has done before. Likewise, the relationship represents new ground for Epic, which plans on rolling out a comprehensive system that integrates genetic test ordering and results to any of its health system or laboratory customers that want it.

The month-old partnership between Myriad and Epic is deeper than the companies' previous data deals because it is meant to be a "native" integration rather than a point-to-point connection, according to Clinton Maddox, director of clinical interfaces at Salt Lake City-based Myriad. It also will deliver discrete, machine-readable data to the EHR.

"We want discrete representations of those results and other genomic data to flow so that they are usable downstream in the system and they become actionable," said Catherine Procknow, senior software developer at Verona, Wisconsin-based Epic. "Genetic testing results in a PDF, they look nice but aren't actionable."

This will be a bidirectional interface, so clinicians will be able to send orders to Myriad and receive results back through the Epic EHR, Maddox said.

Myriad Chief Technology Officer Kevin Haas explained that earlier integrations have resulted in higher satisfaction and retainment among customers on the heathcare provider side, but they have been "bespoke" efforts for each particular care provider, IT team, and technology installation.

This new partnership will make connections easily scalable by leaning on Epic's Care Everywhere interoperability platform that is available to all of its customers. It also will rely on and expand the capabilities of an optional genomics module that Epic introduced in 2018 to help healthcare providers integrate genetic test ordering and results processing directly into the EHR.

Care Everywhere facilitates connections between providers and labs so Epic does not have to serve as an active intermediary.

Procknow, product lead for Epic's genomics module, said that the module is meant to make data from genetic tests more useful within clinician workflows. For example, the system can inform clinical decision support software or provide educational content for patients based on their genotypes.

Alan Hutchison, Epic's VP of population health, noted that Epic has a series of Health Level 7 International (HL7) and Fast Healthcare Interoperability Resources (FHIR) application programming interfaces, as well as a set of specifications and guidelines for exchanging genetic testing orders and results. The firm has also created what it has dubbed the Epic Specialty Diagnostics Suite of applications specifically for labs.

Labs like Myriad that use Epic's Beaker laboratory information system can tap into the Specialty Diagnostics Suite for functions that include customer relationship management and patient billing. The new piece will allow labs and health systems to exchange genetic test orders and results without needing to build individual point-to-point connections, according to Procknow.

Right now, Epic and Myriad are using the current version, 2.5.1, of the HL7 communication standard to transmit orders and results, and that will continue as the new partnership unfolds. Maddox noted that HL7 2.5.1 supports communication of variant-level genomic information.

He also said that other standards are "on the table," including HL7's FHIR, which has had a genomics add-on since 2019. The Epic EHR's genomics module is a key part of the strategy as well.

"Epic actually gives us the ability to share a lot richer dataset with them," Maddox said. He explained that the partners will be discussing how to deliver additional genomic information to providers to improve treatment decisions and care management.

"Everything that's possible with exchanging orders and results and other genomic data is also possible through standards-based interoperability," Procknow said. The new way is just more streamlined.

Epic is not necessarily trying to eliminate PDF files, but rather augment reports with discrete data that are actionable, she added.

Hutchison said that Epic's lab partners have agreed to send provider organizations more than just discrete data with biomarkers, all the way to full sequences if they so desire. PDFs can still be included, as well, if clinicians prefer such written summaries.

"We've also heard from geneticists that underlying sequence data that's generated during testing is helpful to reference when caring for their patients, but is also valuable for making new discoveries," Procknow added. Notably, she said, they are interested in variants of unknown significance that may have significance in the future.

"In general, we really do believe that broad sharing of genetic data and other health information between labs and providers and patients is what's going to help make new discoveries and improve patient outcomes and ultimately save lives." Procknow said.

Myriad and Epic will begin piloting the integration before the end of the year with a handful of yet-undetermined customers that also run Epic. Haas said they are targeting the first half of 2023 for a general release, as long as the pilots are successful.

Epic expects to be able to offer the Myriad integration to all customers on Care Everywhere by next year, with little additional programming work.

The EHR vendor also will provide services to install and support the software to any health systems and labs that want them.

Haas said that Myriad has "invested heavily in technology" in the last couple of years, particularly around increasing ease of use of ordering systems, with an eye toward boosting testing volume. "I think this Epic partnership is also trying to work within the healthcare community, meeting doctors where they're at," namely inside the Epic EHR, he said.

The lab company is in the midst of a strategic shift to focus its testing business on key indications including cancer, pharmacogenomics, and prenatal testing and make it easier for doctors to order tests and receive results through online interfaces. Earlier this year, Myriad launched an integrated offering with Intermountain Healthcare, called Precise Oncology Solutions, through which doctors can order germline cancer risk assessments, companion diagnostic tests, and somatic tumor profiling with a single order and receive tests via a unified online portal.

Major genomics labs that already use or are in the process of installing Epic's Specialty Diagnostics Suite include Exact Science, Foundation Medicine, Natera, Tempus, Guardant Health, and Caris Life Sciences, according to Hutchison. All will have access to the new functionality Epic is building with Myriad by next year.

Guardant is also currently working on an integration of its cancer tests into the Epic platform, which the company said should be complete this quarter.