Quest Diagnostics has integrated its Haystack MRD test and Comprehensive Genomic Profiling services into Flatiron Health's OncoEMR electronic health record (EHR) system. The integration, launched as a pilot program with American Oncology Network (AON) and other community oncology providers, is designed to streamline the ordering workflow for complex molecular tests. This move positions Quest as the largest clinical reference lab to integrate oncology tests within OncoEMR using the Molecular Profiling Integration (MPI) ordering feature.

The pilot enables select providers to order Quest's oncology tests and receive results directly within their EHR workflows. Once fully implemented, the integration will provide access to Quest services for 4,700 clinicians across the Flatiron network of 1,600 community-based cancer care locations in the United States. The OncoEMR MPI feature is specifically built to handle the specialized ordering requirements of comprehensive molecular tests, which often involve hundreds of genetic biomarkers.

Strategic Collaboration

Flatiron Health, a healthtech company focused on oncology point-of-care solutions, collaborated on the integration to reduce administrative burdens for clinicians. "By integrating Quest's advanced oncology services directly into existing workflows, we're making it easier for physicians to access critical testing insights without adding complexity to their day," said Quincy Weatherspoon, Chief Network Officer, US Point of Care, Flatiron Health.

American Oncology Network, a community oncology leader with over 350 providers across 21 states, is a key participant in the pilot. Nearly 200 AON sites currently have access to the OncoEMR MPI capability. "Empowering them to use OncoEMR MPI via Quest Diagnostics is an important step in that mission," said Dr. Brian Mulherin, Medical Director at AON.

Service Portfolio

Providers participating in the pilot gain access to Quest's advanced cancer diagnostics, including:

Quest plans to launch the full OncoEMR MPI integration to providers nationwide in the second half of the year. This initiative aligns with the company's strategy to simplify testing through specialized IT and EHR technologies, following the previous integration of its Haystack MRD test with the Epic Aura platform.

Quest Diagnostics announced that the New York State Department of Health's Clinical Laboratory Evaluation Program (CLEP) has approved its Haystack MRD test for use in identifying residual or recurring disease in patients with solid tumor cancers. This approval authorizes the test for patient testing in all 50 U.S. states. The test, a circulating tumor DNA (ctDNA) liquid biopsy, was developed under CLIA regulations and has been available for clinician ordering since late 2024 in 49 states and the District of Columbia.

New York requires formal technical review and approval of laboratory developed tests before they may be offered to patients. With this approval, Haystack MRD meets the state's rigorous clinical laboratory oversight standards. Dan Edelstein, Vice President and General Manager for Haystack Oncology, a Quest Diagnostics company, stated that the approval represents the culmination of years of work to deliver a highly accurate test that can improve patient care.

Haystack MRD's clinical utility was demonstrated in a landmark study of non-operative management of patients with locally advanced mismatch repair–deficient solid tumors. The study, led by Dr. Andrea Cercek and colleagues at Memorial Sloan Kettering Cancer Center, was published in The New England Journal of Medicine in May 2025. The study found that ctDNA testing using Haystack MRD was a reliable liquid biopsy surrogate that identified clinical complete response at a median of 1.4 months, compared to more than 6 months using imaging methods.

Key Details of Haystack MRD Approval

Haystack Oncology, a wholly owned subsidiary of Quest Diagnostics, developed Haystack MRD. The test is a tumor-informed, next-generation MRD test that detects ultralow levels of ctDNA. The FDA granted Haystack MRD Breakthrough Device Designation in 2025 for use in Stage II colorectal cancer. Haystack Oncology also offers the test for clinical trials as an investigational device in laboratories located in Baltimore, Maryland; Hamburg, Germany; and Helsinki, Finland.