How do I order Cologuard (stool DNA testing kit) using Athena (electronic health record system)?

How to Order Cologuard Using Athena EHR System

To order Cologuard (stool DNA testing) in Athena, search for "Cologuard" in the order menu, complete the electronic requisition form, and submit the order electronically.

Background on Cologuard

Cologuard is an FDA-approved stool DNA test for colorectal cancer (CRC) screening with high sensitivity for detecting colorectal cancer (92.3%) and advanced precancerous lesions (42.4%) 1. It combines:

• Quantitative molecular assays for KRAS mutations
• Detection of aberrant NDRG4 and BMP3 methylation
• ACTB (β-actin) measurement
• Hemoglobin immunoassay

While Cologuard is more sensitive than FIT testing for detecting CRC (92.3% vs 73.8%) and advanced precancerous lesions (42.4% vs 23.8%), it has lower specificity (86.6% vs 94.9%) 1, 2.

Step-by-Step Process for Ordering Cologuard in Athena

1. Access the Order Module:

   • Open the patient's chart in Athena
   • Navigate to the "Orders" or "Lab Orders" section

2. Search for Cologuard:

   • Type "Cologuard" in the search field
   • Select "Cologuard" or "Stool DNA Test" from the results

3. Complete Required Information:

   • Verify patient demographics are correct
   • Select "Screening" as the reason for testing
   • Confirm patient is average risk (no personal/family history of CRC, no IBD)
   • Include relevant ICD-10 code (typically Z12.11 for colorectal cancer screening)

4. Submit the Order:

   • Review all information for accuracy
   • Submit the electronic order
   • The Cologuard kit will be shipped directly to the patient's home

5. Patient Instructions:

   • Provide patient with information about the test procedure
   • Explain that they will receive the kit by mail with instructions
   • Emphasize the importance of completing and returning the kit promptly

Clinical Considerations for Cologuard Ordering

Appropriate Patient Selection:

• Average-risk adults aged 45+ years 1, 2
• No symptoms suggestive of colorectal cancer
• No personal history of colorectal cancer or advanced adenomas
• No inflammatory bowel disease
• No family history requiring more intensive screening

Follow-up Recommendations:

• Positive result: Schedule diagnostic colonoscopy within 3 months, but no later than 6 months 2
• Negative result: Repeat screening in 3 years (though optimal interval still being determined) 1, 2

Important Caveats:

• Cologuard is not recommended as a replacement for diagnostic colonoscopy in symptomatic patients
• The NCCN notes that appropriate screening intervals cannot be firmly recommended due to limited data 1, 2
• More participants may be excluded due to problems with stool DNA testing (n=689) compared to FIT (n=34) 1

Troubleshooting Athena Order Issues

If you encounter difficulties ordering Cologuard in Athena:

• Ensure the patient's insurance information is up-to-date
• Verify that Cologuard is set up as an orderable test in your Athena system
• Contact your Athena system administrator if the test is not available in your order menu
• Consider contacting Exact Sciences (Cologuard manufacturer) for assistance with electronic ordering integration

Remember that timely follow-up of positive results with diagnostic colonoscopy is essential to minimize the risk of advanced-stage disease 2.