Implementing a smart workflow for molecular testing: Improving precision oncology delivery across a multi-site adult outpatient cancer center.

588 Background: Precision oncology offers transformative potential in cancer care for patients and their families by enabling personalised treatment based on molecular testing. However, the implementation and scaling of molecular testing presents logistical and workflow challenges. We identified inefficiencies in test ordering, communication, billing and sample tracking, risking delays and inequity in access. Burdensome data extraction made key performance indicators difficult to monitor and report on including patient outcomes. Methods: A multidisciplinary working group conducted a review of current-state processes and mapped gaps in testing workflow. Key issues included lack of visibility across teams, manual communication between departments, variable understanding of testing pathways, and inconsistent billing practices. To address these issues, we designed and implemented a workflow pathway that was integrated within our electronic management system with the following components: Integrated smart forms for test ordering, estimate requests, and appointment scheduling; a smartboard to visualise and track workflow in real time; automated communication using quality checklists (QCLs) to automatically notify and update relevant teams including nursing, customer care, pharmacy and finance teams; standardised documentation processes for sample collection, sample shipping and result receipt; training was provided to staff across multiple roles and departments; data items are automatically extracted for analysis. Results: Early implementation across pilot sites showed marked improvements in process visibility and timeliness. Key quality indicators observed to date: cost estimate turnaround time reduced; missed billing events have declined through automated QCL generation; sample tracking compliance is now a key performance indicator we can report on and improve as required; enhanced equity: standardisation enabled consistent test access regardless of treatment site. Conclusions: This initiative demonstrates the value of structured digital workflows in supporting precision oncology implementation. Embedding molecular testing processes within existing clinical systems enabled cross-functional collaboration, reduced variation and improved transparency. Challenges remain in integrating external stakeholders (e.g. test providers, pathology laboratories, insurers) and streamlining consent for diverse cultural needs. Continued iteration based on user feedback and outcome data is planned. Integrating a structured smart workflow into routine oncology practice significantly improved the quality and equity of molecular testing delivery. This model may serve as a scalable blueprint for other multi-site cancer care networks adopting precision oncology.