75. Clinical implementation of a precision medicine consultation service

Aly Abdelkareem

Abigail Finer

Abby Finer, MS, LCGC, is the first genetic counselor in the Pathology Department at Massachusetts General Hospital. Her work has focused on building and running the Molecular Consultation Service at the Center for Integrated Diagnostics at MGH. The Molecular Consultation Service is a precision medicine-oriented resource designed for clinicians to request interpretation and contextualization of molecular results—primarily from tumor testing—at varying levels of complexity. She received her Master’s degree as part of the inaugural class in Genetic Counseling at the Massachusetts General Hospital Institute of Health Professions, and received her Bachelor’s degree in Philosophy with a concentration in Mind, Brain, Behavior from Bard College.


Abigail Finera, Andrea Pannoneb, Adam Bardb, Ursula Greenb, Esther Baranovb, Lauren Ritterhouseb, Dora Dias-Santagatab, Jochen Lennerzb

aMassachusetts General Hospital, Cambridge, MA, USA; bMassachusetts General Hospital, Boston, MA, USA

Objectives: To realize precision medicine, clinicians need to apply a growing number of diagnostic tests. Each test result relies on specific domain expertise; however, integration across a variety of diagnostics poses unique challenges-including financial sustainability of the consultation service. Recent 2022 billing code updates emphasize the value of consultations. Here, we present the design and implementation of a clinical pathology consultation workflow.

Methods: The core design team consisted of 3 board-certified molecular-genetic pathologists, 1 board-certified genetic counselor, and 1 high-complexity medical technologist. Additional team members included billing operations, electronic medical record (EMR) support staff, compliance, departmental, hospital, and network leadership. The team focused on a modular, EMR-based design with laboratory information management system integration, and compliant documentation and billing practices.

Results: The 7-month design process consisted of weekly 30-90 min meetings of the core team supplemented by various meetings with additional team members (estimated total effort ~170h or ~10% of a full-time position). The workflow consisted of 7 modules: (1) physician order, (2) triaging module, (3) e-reply no bill, (4) written documentation (limited, without billing), (5) written EMR documentation (comprehensive, with effort-based billing), (6) denial/appeal module, (7) direct patient question module. Since go-live in early 2022, we managed 22 consultations (n=6 comprehensive; n=16 billing-related questions) from 3 network sites.

Conclusions: Realizing a precision medicine consultation workflow required significant effort from an interdisciplinary team. The workflow accounted for various administrative and compliance-related aspects and future work will focus on reimbursement, utilization, provider adoption, and optimization of workflows.