Aligning NCCN criteria with testing workflows using a novel database application (Criterion).

Abstract

e22541 Background: As cost decreases and benefits become more well known, more individuals are seeking genetic testing. Physicians, genetic counselors, and other healthcare professionals play a critical role in explaining the benefits and limitations of genetic testing for hereditary cancer syndromes. Here we discuss our experience creating a web-based application, utilized by a variety of stakeholders, to determine whether patients are likely to meet clinical testing criteria set forth by the National Comprehensive Cancer Network (NCCN). Methods: To address the challenge of efficiently and accurately determining medical necessity for hereditary cancer genetic testing, we developed a pilot study to assess the utility of Criterion beta, a web-based pilot application. A questionnaire was sent to laboratory staff, genetic counselor assistants, genetic counselors, and physicians to assess the accuracy and usability of Criterion beta. 14 respondents each evaluated three mock patient profiles. They were initially asked to determine if the patients met current NCCN criteria for hereditary cancer genetic testing without using any alternative references or resources. Respondents with no prior training using Criterion were then asked to answer the exact same questions using Criterion beta. Results: Results of this pilot study indicate that implementation of Criterion beta leads to more accurate decision-making. Preliminary survey data shows that response accuracy for NCCN criteria determinations improved by 72% with the use of Criterion beta (see Figure 1). In addition, 85% of respondents reported that the application would allow them to routinely make more accurate decisions regarding who meets NCCN criteria for hereditary cancer genetic testing. Conclusions: As the demand for genetic testing increases, accessibility of professional guidelines like NCCN is important for multiple entities involved in the testing process, especially those unfamiliar with the concept of medical necessity. Clinically-based tools like Criteron beta are critical in this process because guidelines can be complex to navigate. In addition, through its ease of use, Criteron beta can better align implementation of genetic testing among high-risk populations. It may also place indirect pressure on industry stakeholders to align their eligibility requirements with clinical standards like NCCN, ultimately serving the best interests of patients in need of preventative care.