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Roche-GE Partnership Integrating Molecular Data Into Navify Tumor Board

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CHICAGO – Later this month, Roche Diagnostics will release version 2.2 of Navify Tumor Board, the first iteration of the product to automate the integration of molecular data. The next planned release, tentatively set for January, will allow the system to pull in structured data from Foundation Medicine genetic test reports automatically.

While Roche has owned Foundation Medicine since 2018, the Swiss company eventually wants to support direct integration of data into Navify from molecular, laboratory, imaging, and electronic medical records sources, whether the information is structured or not, according to Ketan Paranjape, Roche Diagnostics' vice president of diagnostics information solutions.

Some of the integration is in place already, courtesy of a partnership between Roche and GE Healthcare that was formed early last year

Introduced in 2017, Navify is clinical workflow and decision support software that optimizes decision-making for cancer patient case reviews in the clinic, on tumor boards, or in multidisciplinary team meetings. Navify Tumor Board is the first manifestation of that, serving as a hub for performing clinical decision support based on electronic health records, laboratory, pathology, and imaging information systems, genomics, and administrative datasets.

At the end of May, just before the start of the annual American Society of Clinical Oncology (ASCO) conference, Roche and GE unveiled Navify Tumor Board 2.0, the first commercial product of their partnership.

Version 2.0 brings new integration with digital imaging, particularly picture archiving and communication systems (PACS), building on GE's strength with in vivo technology such as imaging and patient monitoring. Roche Diagnostics, meanwhile, specializes in in vitro technology.

The incremental updates represent a "phased approach" to bringing structured molecular data to Navify Tumor Board, a product that currently is a hybrid of automation and human abstraction, Paranjape said. 

"I think the biggest thing for us on the genomics side is to make sure that we are able to absorb structured fields in, number one by September, and then by January, an informatics report should actually be able to just feed right in," Paranjape said. 

"Down the road, we will make sure that we will be able to read out in a structured field a whole bunch of genomic reports," he added. "We still don't know which ones, which companies, but we want to be as agnostic as possible."

Meanwhile, Roche Diagnostics Information Solutions Chief Medical Officer Okan Ekinci noted in a recent interview that "when 2.2 comes out, you will be able to pull up that structured information and just display it right here, so you don't have to pull up a PDF file anymore. Alterations and therapies will pop up."

In July, the University of Missouri Health System (MU Health Care) went live with Navify Tumor Board version 2.0. 

MU Health Care adopted Navify Tumor Board in April 2018 as the first US user of the Roche-developed system. The organization completed the integration of Tumor Board with its Cerner electronic medical record later that year, then jumped to 2.0 and the more recent 2.1 this summer.

At the heart of the integration in Navify Tumor Board version 2.0 and beyond is GE Healthcare's medical imaging viewer, Centricity Universal Viewer Zero Footprint. With Zero Footprint — so named because the web-based viewer takes up no space on local computers — users can pick images and videos from any PACS that follows the Digital Imaging and Communications in Medicine (DICOM) standard or from PDF files, which is exactly what MU Health Care is doing.

Roche also relies on a system called the Data Integration Platform, technology developed as a result of a two-year-old partnership with Accenture to support precision medicine. 

"Our biggest value proposition when it comes to getting significant amounts of data in a structured fashion into the Tumor Board environment is probably the integration that we do with all of the EHR vendors in the markets where we are active in. We do not focus on one single EHR vendor, but rather have Accenture as our global IT partner, who has experience with all of EHRs in the markets where we are active," Ekinci explained.

"The [Navify Tumor Board] software has the ability to integrate with our EMR and automatically populate with much of the patient information, including pathology reports and radiology reports," said Richard Hammer, vice chair of the Department of Pathology and Anatomical Sciences at MU Health Care. He also is director of hematopathology and codirector of the diabetes diagnostic laboratory there.

In addition to its Cerner EMR, MU Health Care has a McKesson PACS. Despite the different vendors, the organization can use the GE Zero Footprint viewer built into Navify to pull up images directly from the PACS.

"Typically in a tumor board, we have to flip back and forth between multiple screens and multiple systems to get to the information," Hammer said. "Now it's all in one place."

Hammer said he has been very satisfied with version 2.1 in the hematopathology tumor board in the short time it has been in place.

"The goal is for everything in Navify to be integrated with the EMR and it pulls all the essential information out automatically," Hammer said.

In the past, people had to hunt down clinical notes and imaging reports manually, then scan the documents into presentations for tumor boards.

"Now, it's all automatic," Hammer said. "All I have to do now is enter a patient's name in our EMR like we would any other lab test." When he assigns the patient to a tumor board, data automatically flows from the EMR and lab systems into Navify so all the relevant information is there for the board to consider the case.

Roche now is trying to integrate Navify with other EMR systems. The company recently identified two undisclosed sites to integrate the technology with an Epic Systems EMR.

Roche has plans to explore integration with Flatiron Health's OncoEMR as well. "But we just want to spend some time making sure Cerner is up and running correctly," then take the same deliberate approach with Epic, Paranjape said.

"Our goal is to create scale down the road and that's why we're spending a lot of headcount on the Data Integration Platform because if I can get the platform squared away correctly, it really doesn't matter what standard of information that comes in," he said. "I don't mind spending a few extra months trying to get all that squared away first."

The 2.X series of releases between Roche and GE is intended to make tumor boards more efficient and effective, as well as open up the option of "virtual" tumor boards involving clinicians at large medical centers and satellite locations alike, according to both Ekinci and Tom McGuinness, president and CEO of GE Healthcare's imaging business.

The GE-Roche partnership and Navify Tumor Board 2.X are about creating what McGuinness referred to as "integrated diagnostics platforms" to enable more personalized cancer treatments. It does so by pulling in data and images from multiple locations and IT systems within a healthcare organization.

"Today, most of this data exists in different places and databases around a typical hospital," McGuinness said.

"When you normally prepare for a tumor board, a large portion of the task is assembling the information and preparing that data, both the in vivo data as well as the imaging data, so that all of the members of the tumor board are prepared to do the decision-making they do case by case, patient by patient," he explained.

Several abstracts presented at ASCO highlighted improvements in efficiency and in decreased preparation time for pathologists, radiologists, and nurse navigators from using Navify Tumor Board. Two pertained to Mizzou, including one that highlighted a 20 percent gain in board efficiency when discussing breast and gastrointestinal cancers after the EMR was integrated into Navify Tumor Board.

"What we've seen is pretty dramatic," said McGuinness, who credited the fact that patient information and diagnostic test results were readily available in one place.

Another Mizzou-related abstract will be presented at the ASCO Quality Care Symposium in September.

"Ultimately, the objective is to help the tumor boards discuss and review more patients so that therapies can be brought to those patients," McGuinness said.

Ekinci said that Roche Diagnostics sees potential with Navify in acute care as well. "You saw a tumor board. Why can't this be a sepsis board? Why can't this be a transplant board?" he said.

The goal is to be a "one-stop shop" for patients battling cancer or some acute condition, "You could now build analytic tools on top of that, but you have got to have all the data in one place," Ekinci said.


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