Integrating EMRs and Pharmacy Operations to Optimize Biomarker-Driven Cancer Care

In an interview with Pharmacy Times at the 2026 Community Oncology Alliance (COA) Conference, Syed Zia Khan, PharmD, BCSCP, Director of Pharmacy at the START Center for Cancer Care, discusses the importance of leveraging electronic medical records (EMRs) to integrate biomarker data with treatment pathways and support real-time clinical decision-making. He highlights the need for seamless coordination across care settings—including specialty pharmacy, infusion centers, and supportive care—to prevent treatment delays. Khan also emphasizes the critical role of inventory management and payer contracting in ensuring timely access to targeted therapies while maintaining financial sustainability.

Pharmacy Times: You’ve played a key role in optimizing EMRs and integrating clinical decision support tools—how can these systems better support biomarker-driven treatment decisions in NSCLC at the community level?

Syed Zia Khan, PharmD, BCSCP: So EMRs in practice are not just meant to be a resource to store patient information, test results, and things like that. They should be more integrated into practice. When you’re looking at pathways, the most essential part an EMR can play—beyond just data—is to take that data or chart notes, integrate it with biomarker test results, and then follow that up with pathways that we’ve built for treatment options for patients.

Imagine the best way an EMR should function: you have the patient’s molecular profiling and biomarker testing results coming in, and with that information, it allows for a match with, let’s say, an NCCN protocol for treatment-guided decision-making for the physician. In that way, the EMR is designed to implement and enhance workflow.

Pharmacy Times: With your experience developing preferred pathways within Flatiron Assist, how do standardized treatment pathways help streamline care while still allowing for personalization based on biomarker results?

Zia Khan: This is very much related to your first question. Standardization is really important so you have a structure and a basic framework for treatment decisions, but it ultimately comes down to the biomarker results and the physician’s autonomy to decide how they want to proceed for the patient.

In essence, it allows the physician to act and perform their clinical function while utilizing a complex tool—an EMR—that brings that information directly to them. It’s at their fingertips, because they are very busy during clinic, and if they have to go through guidelines and resources to identify treatments, it will cause delays. Ideally, the physician knows, based on clinical judgment, what pathway they want to take, and within the EMR, there is a pathway that connects directly to the patient’s test results and provides treatment options. The physician can then decide how to proceed, choosing 1 option over another based on factors like NCCN category differences or individual patient considerations. So the EMR should provide structure while still allowing flexibility.

Pharmacy Times: You’ve worked extensively across infusion, retail, and medically integrated pharmacy services—how can aligning these areas improve efficiency and access to targeted therapies for patients with NSCLC?

Zia Khan: Ultimately, the goal is to ensure the patient is taken care of. Every part of the system plays a role in providing the best treatment possible. Whether it’s retail pharmacy providing supportive care medications, an integrated specialty pharmacy dispensing targeted therapies, or infusion centers administering supportive treatments like fluids or IVIG for hypogammaglobulinemia or infections, all of these components must work together to prevent delays in care.

This coordination is possible, but if these systems don’t communicate—because they are often not part of the same ecosystem—then the patient suffers. It becomes incumbent upon pharmacists, physicians, and nurses across these settings to collaborate and ensure everyone understands the patient’s needs at any given moment.

Pharmacy Times: From inventory management to payer contracting, what operational strategies are most critical for ensuring timely access to biomarker-driven therapies in community oncology practices?

Zia Khan: With biomarker-driven therapies, more and more treatment options are becoming available. It’s important that pharmacies stocking these medications maintain proper inventory, ensure they can procure medications through contracting, and have agreements not only with manufacturers but also with payers. This ensures they can bill and dispense these therapies appropriately. You don’t want a situation where a medication is available but cannot be dispensed, or where dispensing leads to financial loss.

Contracting must be effective and efficient while also being equitable for both the patient and the practice. Inventory management is equally important. When multiple targeted therapy options are available, it’s critical to determine the best option—not just from a contracting standpoint, but also based on clinical value. You should never sacrifice clinical benefit for a contracted drug. Inventory and contracting must work together to ensure optimal patient care.