
Digital Test Ordering and Patient Intake for a Genetic Testing Lab Network
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Overview
What we built
A genetic testing lab network with 16 draw sites across the US was still receiving most physician orders as faxed requisitions, and staff re-keyed every one of them by hand. We built a digital ordering and intake platform, and requisitions arriving incomplete fell from 21% to under 4% within one quarter.
In plain terms: physicians ordering a genetic test mostly faxed a requisition to one of the 16 draw sites, and someone in the lab had to type every field of that fax into the lab system by hand. Around 21% of those requisitions arrived with a patient or insurance detail missing, which meant the sample could not be processed until a coordinator tracked down the clinic or the patient by phone for a signature or a consent form. Samples sat on hold in the meantime, and reports reached physicians later than they needed to.
We built a digital ordering and intake platform: a physician portal with guided, validated requisition forms, a patient-facing mobile intake for demographics, consent and insurance, and e-signature throughout, all flowing straight into the lab information system over an HL7 integration. Automated SMS and email prompts now chase any missing item before the sample ever arrives. Incomplete requisitions fell from 21% to under 4% within one quarter, manual re-keying was eliminated for 85% of order volume, samples held awaiting paperwork dropped by 63%, and coordinators recovered roughly 30 hours of phone-chasing a week across the 16 draw sites.
The Problem
Faxed requisitions, incomplete patient forms
Physicians ordering a genetic test for a patient at one of the 16 draw sites mostly faxed the request in. Every field on that fax then had to be re-keyed into the lab system by hand, a manual step that added time and risk to every single order before any testing work could even begin.
Around 21% of those faxed requisitions arrived with a patient or insurance detail missing. When that happened, the sample could not move forward until a coordinator chased down the referring clinic or the patient directly by phone, hunting for the missing signature or consent form needed to proceed.
That chasing was a constant drain, and it was invisible to physicians waiting on results. A sample could sit on hold for days while paperwork was tracked down, and every hour a coordinator spent on the phone at one of the 16 draw sites was an hour not spent moving other orders forward.
Faxed requisitions, re-keyed by hand
Physicians mostly faxed orders to one of the 16 draw sites, and staff had to re-key every field into the lab system manually before testing could begin.
High incomplete-order rate
About 21% of faxed requisitions arrived missing a patient or insurance detail, stopping the sample from moving forward until someone chased the gap down.
Phone-chasing for signatures
Coordinators regularly called clinics and patients directly to track down missing signatures and consent forms before a held sample could proceed.
Samples stuck on hold
Samples sat on hold awaiting paperwork rather than being processed, delaying the reports physicians across the 16 draw sites were waiting to receive.
What it was costing them
Every faxed requisition meant staff time spent re-keying data by hand, and the 21% that arrived incomplete meant a coordinator's time spent chasing clinics and patients by phone instead of moving other samples forward. Held samples meant delayed reports for physicians, and the chasing itself consumed hours every week across all 16 draw sites, time that never went toward processing the tests already sitting in the lab.
The Solution
End-to-end digital ordering intake
We built a digital ordering and intake platform to replace the fax and re-keying routine entirely. A physician portal presents guided, validated requisition forms, so an order cannot be submitted with a required field left blank, and a patient-facing mobile intake captures demographics, consent and insurance directly from the patient rather than through a coordinator.
E-signature runs throughout both the physician and patient sides, so signatures and consent no longer depend on a phone call to collect. Every submission flows straight into the lab information system over an HL7 integration, eliminating the manual re-keying step that used to sit between a fax and the lab system.
Automated SMS and email prompts now chase any missing item on their own, reaching the physician's office or the patient directly before the sample ever arrives at one of the 16 draw sites, rather than after it has already been placed on hold.
Key decisions
Replace faxes with a portal
A physician portal with guided, validated requisition forms replaced the fax routine, so orders arrive already complete instead of needing to be re-keyed by hand.
Move intake to the patient
Patient-facing mobile intake captures demographics, consent and insurance directly from the patient, rather than routing that information through a coordinator on the phone.
E-signature throughout
Signatures and consent forms are captured electronically on both the physician and patient sides, removing the need to chase a signature by phone.
Integrate directly over HL7
Submissions flow straight into the lab information system over an HL7 integration, eliminating the manual re-keying step for the vast majority of orders.
Chase gaps automatically
Automated SMS and email prompts now flag and chase any missing item before a sample even reaches one of the 16 draw sites.
Measurable Impact
What changed after launch
Requisitions arriving incomplete fell from 21% to under 4% within one quarter of rollout, and manual re-keying was eliminated for 85% of order volume as portal adoption spread across referring clinics. Samples held awaiting paperwork dropped by 63%, so reports reached physicians roughly a day earlier on average.
Coordinators got their time back too: phone-chasing dropped by roughly 30 hours a week across the 16 draw sites, hours that now go toward moving samples through the lab instead of tracking down a missing signature.
Order intake
Physicians faxed requisitions, staff re-keyed by hand
Digital portal submits validated orders directly
Incomplete requisitions
21% of requisitions arrived incomplete
Under 4% of requisitions arrive incomplete
Held samples
Samples held awaiting missing paperwork
Samples held dropped by 63%
Coordinator phone-chasing
Coordinators phoned clinics and patients for signatures
Roughly 30 hours a week recovered
Headline results
Requisitions arriving incomplete fell from 21% to under 4% within one quarter of rollout
Manual re-keying eliminated for 85% of order volume as portal adoption spread across referring clinics
Samples held awaiting paperwork dropped by 63%, releasing reports to physicians a day earlier on average
Coordinator phone-chasing time cut by roughly 30 hours per week across the 16 draw sites
Tech & Tools Used
What powered the build
Every tool below earned its place in this engagement. Here is the part each one played.
Next.js
Powers the physician portal and patient-facing mobile intake, presenting guided, validated requisition and consent forms across all 16 draw sites.
Node.js (NestJS)
Runs the intake API that validates incoming requisitions and routes patient demographics, consent and insurance data toward the lab information system.
PostgreSQL
Stores requisition, patient and consent records, giving coordinators one place to check the status of any order across the network.
Mirth Connect (HL7)
Carries validated submissions from the intake platform straight into the lab information system over HL7, removing the manual re-keying step.
DocuSign eSignature API
Captures e-signatures from physicians and patients throughout the ordering and consent flow, replacing signatures previously chased by phone.
Twilio SMS
Sends the automated prompts that chase any missing patient or insurance detail before a sample reaches one of the 16 draw sites.
SendGrid
Delivers the automated email prompts that follow up on missing requisition items alongside the SMS chase sequence.
Redis
Caches requisition and intake status so coordinators see which orders are complete and which are still missing information in real time.
AWS S3 + ECS
Stores uploaded consent and insurance documents and runs the intake platform's services across the 16-site network.
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