In Early NSCLC, Molecular Testing Rates Improve With EMR Nudge

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An EMR-based prompt significantly boosted molecular testing rates and detection of actionable mutations in early-stage, non-squamous NSCLC post-surgery.

An electronic medical record (EMR)-based intervention improved molecular testing rates in patients with early-stage non-squamous (NSq) non-small cell lung cancer (NSCLC) following surgical resection, according to an abstract presented at the 2025 American Society of Clinical Oncology (ASCO) Annual Meeting.

The EMBER-Lung trial was a prospective study conducted within the University of Pennsylvania Health System. The researchers aimed to determine whether an automated prompt could enhance adherence to the National Comprehensive Cancer Network (NCCN) guidelines for molecular testing.

Between July 2021 and November 2023, 460 patients undergoing resection for early-stage NSq NSCLC were enrolled. The study population was divided into two cohorts: 217 patients treated before the EMR-based intervention and 243 patients treated after its implementation.

The intervention was an automated prompt in the EMR during the first postoperative visit. Clinicians were prompted to accept an order for comprehensive molecular testing. If a targetable alteration was identified and histology confirmed NSq NSCLC, an alert with therapeutic guidance was sent to the patient’s care team.

The primary outcome was the proportion of patients who underwent any molecular testing. Secondary outcomes included the rate of comprehensive testing and identification of actionable alterations. Clinical characteristics, including age (median, 68.4 years), sex (64.3% female), smoking history (74.1% current or former smokers), and tumor stage (stage I, 75.9%; stage II, 14.1%; stage III, 10.0%) were comparable between the pre- and post-intervention cohorts.

Molecular testing rates increased significantly following the intervention. In the pre-intervention cohort, 46.5% (101/217) of patients received any molecular testing, compared with 85.6% (208/243) of patients in the post-intervention cohort (P<0.001). The proportion of patients receiving comprehensive molecular testing also rose from 36.9% (80/217) pre-intervention to 81.1% (197/243) post-intervention (P<0.001). The researchers observed this improvement across all stages of the disease.

According to the findings, detection of specific actionable mutations also increased post-intervention. Classical EGFR mutations were identified in 16.9% (41/243) of patients post-intervention, compared with 6.5% (14/217) pre-intervention (P<0.001). No ALK fusions were identified in the pre-intervention group, while 2.1% (5/243) were found in the post-intervention group. KRAS G12C mutations were detected in 13.6% (33/243) of the post-intervention cohort compared with 5.5% (12/217) pre-intervention (P<0.01).

The researchers concluded that a simple, automated EMR prompt implemented during the postoperative visit significantly increased the rate and comprehensiveness of molecular testing in early-stage NSq NSCLC.

“The intervention was feasible, and future research will incorporate this strategy earlier to inform neoadjuvant therapy,” wrote Melina E. Marmarelis, MD, MSCE, and colleagues.