Background: Limited data exists on next-generation sequencing (NGS) testing rates, utilization of single gene tests for therapy matching, use of liquid biopsies in therapy selection, or physician-perceived barriers to testing in hospital-based cancer centers. Initial project goal is to establish a baseline for such metrics. Methods: 700 patient records of various solid tumor types were assessed as part of a quality improvement project at three different cancer centers over a six-month period: 1) a regional IDN, 2) an NCI center, and 3) a community cancer center/affiliate of an NCI center. This was combined with qualitative surveys on current state practices and barriers to NGS testing completed by thirty (30) respondents from these institutions (97% physicians, 3% nonphysicians). Site specific Physician champions were recruited to identify additional interventions to be implemented at their respective site(s). Results: Baseline findings show 45% of advanced cancers received any biomarker tissue testing, with testing rates of 53%, 25%, and 66% in lung, pancreas, and colon cancers, respectively. Broad-based panel testing made up 59% of tests, and 31% of patients continue to receive single gene testing only. Approximately one third of patients who developed recurrent disease had biomarker testing (38%) compared to patients with an initial diagnosis of advanced cancer where more than half received testing (51%). Use of liquid biopsies was limited, representing 4% of biomarker testing, but 71% of the time it was incremental to completed tissue testing. Three types of testing barriers were identified by survey respondents: 1) 63% cited limited quantity of tissue available, 2) 53% cited reimbursement concerns including “potential cost to patient,” and 3) 44% cited cumbersome process due to delays and long turnaround times for authorization, ordering, and/or delivery of results. Conclusions: 1) A lower number of patients with disease recurrence are obtaining broad panel NGS compared to patients with de novo metastatic disease; 2) There continues to be low utilization of liquid biopsies for patients with advanced cancers; and 3) Single gene tests continue to be used for therapy matching in a large number of patients with advanced cancers. Improving testing rates including use of broad panel tests and liquid biopsies appropriately will require ongoing education and/or automated reminders to cancer care teams. Further education needs to focus on reimbursement concerns at an institutional level and on testing patients who recur after initial cancer diagnosis and therapy.