With Tempus Test Integration, CureMD Wants Genomics to Inform Oncology Clinical Decision Support

NEW YORK – When CureMD Healthcare announced a partnership with Tempus last week to integrate cancer genomic test workflows into its electronic health records system, it marked a new focus on genomics for the maker of EHRs and other IT for specialty medical practices.

"As genomics becomes increasingly prevalent … we knew that expanding our reach in this area was of critical importance," said Ben Reynolds, CureMD's assistant VP of sales for oncology. "The Tempus engagement was really part of an evolving [strategy] of allowing us to ingest that data and making it meaningful and actionable at the point of care."

This is actually the second integration CureMD has created with a commercial genetic testing firm, but the first that the EHR vendor has publicly announced. The company integrated with NeoGenomics in August 2021 but never issued a press release, according to Wasif Toor, CureMD's VP of oncology.

This time, though, CureMD is signaling its intention to work with large genetic testing laboratories and to catch up with major EHR vendors like Epic Systems, Oracle Cerner, and Meditech in terms of supporting precision medicine, albeit in a single specialty.

CureMD was founded in 1997 and launched an oncology division in 2012 that operates semi-autonomously within the company, with its own software developers, technology support, and sales team.

The New York-based vendor serves about 35 different specialties, a number that continues to grow, according to Reynolds. In addition to EHRs, CureMD makes practice management and revenue-cycle management software and offers medical billing services for specialty practices.

While CureMD Oncology is geared toward community-based oncology groups, Reynolds said that it is also suitable for hospital-owned practices.

"Our mission statement is to enable these community oncology practices to have access to genomic data for actionable insights," Toor said of the oncology division.

The company wants to solve the "logistics problem" of incorporating genomic testing into diagnostic processes and treatment plans by making it easy for oncologists to order tests and receive results within their standard EHR workflows, according to Toor. Without the interface, practitioners have to leave their EHRs to log into a separate portal for each lab in order to place orders and view results.

"Our first goal is to solve the logistics of this entire process," Toor said. Later, the company wants to produce insights to inform its clinical decision support system, but that will not be possible until results come back in a structured, machine-readable format.

Initially, CureMD users will be able to order tests from Tempus directly through the EHR. Future integration will support the return of results as discrete data to inform clinical decision-making and risk assessment.

The first phase — ordering — should be complete in the fourth quarter of this year and immediately made available to all CareMD Oncology customers, according to Toor. The company has not yet come up with a timeline for the results-return phase.

CureMD is essentially building an application programming interface (API) so it will eventually be able to connect its EHR to any genomic laboratory. There is still some customization required today because commercial labs are not all using the same data standards, Reynolds noted.

Toor said that the "majority" of reports from molecular oncology testing do include structured, discrete data these days, often drawing on Memorial Sloan Kettering Cancer Center's Oncology Knowledge Base (OncoKB) and National Comprehensive Cancer Network (NCCN) guidelines. But sometimes, the results are still in unstructured PDF files.

For the second phase of the integration, CureMD is looking into the possibility of converting reports to JavaScript Object Notation (JSON) format. That would allow the company to "pull out these insights to feed our clinical decision support systems to narrow down treatment options further," Toor said.

Information initially will be sent between CureMD and Tempus as Health Level Seven (HL7) messages. Later, CureMD will embrace the HL7 Fast Healthcare Interoperability Resources (FHIR) standard. "That would enable a JSON-based payload coming back to us," Toor said.

Chicago-based Tempus' menu of oncology tests includes gene panels for solid tumors and hematologic cancers, RNA sequencing, a liquid biopsy test, immunohistochemistry, a germline gene panel for hereditary cancers, and a whole-exome test.

Toor said that the decision to "prioritize" Tempus for integration came from customers. Discussions with the sequencing firm started earlier this year and accelerated at the annual American Society of Clinical Oncology (ASCO) conference in Chicago, when CureMD got a chance to see many of its customers in person, tour Tempus' headquarters, and meet with pharmaceutical firms. The partnership came together quickly after that June conference.

Notably, Toor and colleagues met with Daiichi Sankyo, which codeveloped antibody-drug conjugate Enhertu (trastuzumab deruxtecan) with AstraZeneca. The appropriateness of the therapy, currently approved for breast cancer, gastric cancer, and non-small cell lung cancer, is generally dependent on HER2 expression.

Toor said it is important to capture HER2 status in the EHR to prompt alerts to clinicians when Enhertu is a therapeutic option for a patient. "It is really dependent on capturing this data discretely, making those insights available for providers, so that they can make an informed decision in a timely fashion," he said.

While the oncology division is semiautonomous, CureMD is looking to extend its integration with genomics labs to other specialties. Still, the bulk of interest is coming from oncology practices because genomic testing is more prevalent in cancer diagnostics and care than other areas of medicine.

"Mostly this is driven by our customer base throughout all specialties," Toor said. "Right now, the majority of that need is coming from oncology, but obviously we foresee that changing as more adoption occurs in [pediatrics] and in nephrology and other specialties."