Headquarters: Salt Lake City, UT

Type: Not-for-profit, integrated health system

Hospitals: 22

Physicians: 1,200

“The entire process, from the time a test is ordered all the way through the generation of a report and then even capturing the outcomes, is managed through Syapse.”

Lincoln Nadauld, MD, PhD
Medical Director, Cancer Genomics

Summary

Recognizing the growing use of genomic information to tailor treatment to cancer patients’ individual molecular profiles, Intermountain’s leadership believed that they had a medical duty to rigorously study the clinical utility and cost effectiveness of precision medicine. From its unique position as a leader in evidence-based medicine, Intermountain made an enterprise-wide commitment to formalize the practice of precision oncology and measure clinical outcomes and costs. The Intermountain Precision Genomics service was launched in July 2013 at a single site, with the intent that the program would be rolled out system-wide only if it demonstrated both clinical and cost-effectiveness.

Building a formal precision medicine program presented Intermountain with many problems. Its physicians wanted to use tumor sequencing to identify molecularly targeted therapies for cancer patients, but were ordering inadequate, inappropriate, and duplicative tests from multiple send-out labs. Test results were stored in the EMR as scanned faxes or PDFs and could not be queried to inform clinical decision support tools or for quality improvement. Many physicians were not equipped to make clinical decisions based on genomic data. Even when a clinician did order a targeted drug based on test results, the procurement rate was poor.

Intermountain decided to launch a comprehensive precision oncology program to provide advanced cancer patients with molecularly targeted therapies informed by an in-house tumor sequencing test (the “ICG100”). Syapse provided the IT infrastructure to enable web-based test ordering and results delivery, Molecular Tumor Board case review, interactive clinical decision support, and drug procurement. In addition to streamlining Intermountain’s clinical workflow, the centralized capture of clinical, molecular, treatment, and outcome data in Syapse enabled Intermountain to demonstrate that its systematic application of precision oncology doubled progression-free survival of advanced cancer patients without increasing cost of care.

Challenges

  • Physicians at Intermountain needed assistance in making decisions about ordering appropriate molecular diagnostics tests and taking action based on test results.
  • Intermountain’s IT systems were incapable of capturing structured molecular data, making integrated queries of patient clinical and molecular data for quality improvement impossible.
  • Procurement rates of targeted therapies from specialty pharmacies were very low, blocking delivery of potentially lifesaving drugs to patients in need.

Solutions

  • Intermountain used Syapse software to power its precision medicine clinical workflow, enabling community oncologists to make treatment decisions informed by genomic data and track these decisions’ clinical impact.
  • Using Syapse software, Intermountain empowered a Molecular Tumor Board to provide decision support to clinicians by recommending targeted therapies and clinical trials.
  • Through Syapse’s streamlined drug procurement workflow, Intermountain increased its drug procurement rate 5-fold, to 82%.
  • Syapse software enabled Intermountain to scale its precision medicine program and improve outcomes over time, increasing progression-free survival of advanced cancer patients by 92% with no increase in total cost of care.
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