The NHS Genomics Medicine Service (GMS) is a world leader in genomics. Its work helps diagnose conditions faster, identify inherited risks and guide personalised treatments. But to exponentially increase benefits to patients, the service identified it needed to be at the forefront of the data and digital revolution, ensuring genomic data can be interpreted and informed by other diagnostic and clinical data. 

To accelerate services into clinical settings it required a Genomic Order Management service. This would involve the digitisation of genomics test ordering and reporting within the whole of NHS England. It would be a central national capability, standardising the data associated with each genomic test request and communication standards, and focus on the relevant data flows between organisational boundaries.

This would enable clinical users in the NHS to create requests for genomics tests, track status updates to tests and retrieve interpretation reports. Users in NHS Genomics Laboratories would be able to access genomic tests; manage send aways; update genomic tests; create, manage and re-assign tasks, provide status updates on test progress and upload interpretation reports. 

Challenge

Due to the complexity of the service and systems involved, this plan was a huge challenge, as a significant number of Trusts needed to digitise. The process to request a genomic test today varies hugely. It is also predominantly done using paper forms, which can be lost, has no validation, creates duplication, and gives labs no advance warning. 

Furthermore, even when digitised, data would need to flow between organisational boundaries, across more than 400 NHS Trusts in England, all operating within their own domain space and multiple EPRs. 

Solution

As a national solution, it was essential the GMS programme established common standards and core foundations, to ensure robustness and avoid breaking existing downstream systems or processes, including target architecture, master datasets and digitisation of the test directory.

With this foundation in place, its seamless approach to order management would be crucial. For this the GMS with Aire Logic to create a National Broker that supports the end-to-end genomics test order and reporting process.  Clinicians can order genomics tests as listed in the genomics test directory. They can manage sample collection and track the test status via the central broker — either directly from their EPR or via the Genomics Test Order Portal, both of which connect into the broker. The broker supports routing the test requests to the appropriate genomic lab and allows lab staff to track the test request, samples and provide the test report.  

Given the complexity of systems and datasets, the team used integration and interoperability engine AireGlu from Aire Innovate. It provides the transactional, validation, routing and operational monitoring layer of the genomics broker, allowing a wide variety of complex systems to connect with one another. This includes the NHS Trusts, test labs, auxiliary services and a web portal for organisations with low digital maturity. 

Using a simple, low-code interface, AireGlu enabled the team to create, manage, monitor, and troubleshoot FHIR based APIs and integrations without specialised coding skills. 

Results

The NHS England Genomic Medicine Service Digitisation is on track to achieve its vision and specifically, the Genomic Order Management is in Alpha phase, on track to launch Beta in Summer 2026. 

The programme recently tested the overall architecture, working with NHS North Thames Genomic Medicine Service, Imperial, GOSH and The Royal Marsden. Despite a wide variety of systems, workflows, versions of EPIC and Cerner, they all successfully connected to the National Broker with only minor changes planned in future phases to cope with additional use-cases.

A blueprint will be shared with all Trusts to adopt when seeking to achieve a similar order management, such as in radiology. 

The next step in the process is to streamline the ordering process, and scale the number of  EPRs and lab systems with native interoperability into the National Broker, so that any clinician doesn’t have to log into another system to access test information.