Although the utility of genetic testing and genomic data in health care is well established, there hasn’t been a standardized process when it comes to inputting the data, making it difficult for physicians to be aware of it or locate it in electronic health records (EHR). Nor can the data be integrated meaningfully with other data in the EHR. That’s about to change with the rollout of the Epic Genomics Indicators Module (EGIM).

Partnering with colleagues and subject matter experts throughout Michigan Medicine and the College of Pharmacy, Precision Health’s Health Implementation group has been working behind the scenes for nearly a year to make EGIM a part of MiChart, the EHR system used by Michigan Medicine.

Subject matter expert Anthony Scott, MD, PhD, a clinical assistant professor of internal medicine, explains the significance of EGIM: “The Epic Genomic Indicators Module integrates a patient’s genetic health information into their electronic health record to tailor their medical management. This initiative advances Precision Health by providing data into how genetic information improves individualized health care delivery. With the patient-facing indicators available on the patient portal, we can further explore how patients understand and engage with the implications of personalized health care.”

Currently, patient genomic data are communicated via nonstandardized methods, ranging from scanned media to text-based documentation. This means genomic information is fragmented, which can result in variable communication, gaps in clinical decision support, an inability to capture trends in research, and a lack of awareness of how genetics could impact a patient’s care across medical specialties and over a patient’s lifetime.

Epic’s Genomics application helps providers manage structured genetic data, to go beyond a PDF report and meaningfully integrate genomic data into the EHR. Such integration can prevent problems that arise from buried genomic data, such as clinical management errors, duplicate testing, and missed research opportunities. A key advantage to genetics data integration is the clinical decision support it provides in selecting the most effective medications for a patient.

As results are converted to discrete data elements, the EGIM can automatically translate results and add indicators to the patient chart, providing clear information in specified areas of the EHR and improved reporting for clinical and research applications.

Following is an announcement from Precision Health’s Implementation group:

We would like to inform the Precision Health community that the Epic Genomics Indicator Module (EGIM) was part of the October 23 MiChart upgrade.

To review, the EGIM is an Epic-derived functionality with multiple aspects. It includes primarily a genomics indicator, which will indicate that a patient may be at risk of having and/or has a genetic condition and provide management recommendations based on that. These will correspond to patient-facing information articles, available to the patient via MyUofMHealth patient portal. There is also the opportunity for genetic testing results to be integrated into the results tab like any other laboratory value.

Initially, this will have the most impact on pharmacogenomics. Certain pharmacogenomics test results are readily integrated into a patient’s EHR, and the corresponding indicator will allow prescribers to be notified that a patient may have significantly slower or faster medication metabolism, allowing for personalized medication adjustments and/or alternate drugs. Pharmacogenomic notifications are being drafted in collaboration with prescribers based on Clinical Pharmacogenetic Implementation Consortium guidelines, FDA pharmacogenetic recommendations, and medication indication. For example, interventional cardiology has helped draft notifications for clopidogrel and CYP2C19 in acute coronary syndrome patients. New pharmacogenetic notifications using EGIM are anticipated on a rolling basis to stay up to date with clinical recommendations.

In medical genetics, we are moving forward with a multidisciplinary approach to building these indicators with buy-in from appropriate subspecialists. For example, we are interfacing with cardiology teams for familial hypercholesterolemia (FH), using this module to flag patients with elevated LDL levels who may benefit from testing for FH. Next steps will be to solicit feedback on new modules for hereditary hemochromatosis, alpha-1-antitrypsin deficiency, and other genetic conditions that are easily identified by certain patient characteristics (namely, lab results).

The utility of this module will increase as clinical laboratories move toward seamless electronic reporting of results into the Epic results tab. This will allow genetic test results to be associated with corresponding indicators—namely, treatment recommendations. Specifically, this includes Tempus (pending approval of a data transfer agreement) as well as internal laboratories (pending spring 2023 SOFT upgrades).

We hope that the use of these indicators will provide research opportunities into patient engagement via the patient-facing indicators, improved medication prescribing patterns, increased uptake of genetic testing referrals by PCPs, and other insights into precision health via the EHR. As these data begin to accumulate, we are working on validating them in Epic to make them available for researchers.

An overview can be found at this knowledgebase article: https://michmed.service-now.com/kb?id=kb_article_view&sysparm_article=KB0020035 (Level-2 login required).