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Challenges and Opportunities in the Adoption of CAP Checklists in Electronic Format PowerPoint Presentation

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Slide 1-

Challenges and Opportunities in the Adoption of CAP Checklists in Electronic Format Perspectives and Experience of RPP2 Participant Laboratories NAACCR 2009 Conference Lewis A. Hassell, MD
Slide 2-

RPP2- Participants Pathology Laboratories -City of Hope -UPMC -DCPA -NorDx (MMC) State and Hospital Registries CA, PA, ME LIS and Registry vendors -Cerner -IMPAC -CNexT Others -CDC NPCR -CAP- SNOMED CT
Slide 3-

Project endpoint goals Participant pathology groups report CAP Checklist data in synoptic format for breast, prostate and melanoma Synoptic electronically encoded data captured from report Checklist data transmitted electronically to registry and entered into database
Slide 4-

Pathology-Specific Project Queries Will Pathologists use the CAP Checklists as a routine part of reporting? What barriers exist for registries and laboratories in implementing the CAP Cancer Checklists in electronic format? What unique opportunities might exist for users of electronic checklists?
Slide 5-

Baseline State- Pathology labs City of Hope– Text only reports UPMC- Text diagnoses, Synoptic (text) in a separate section of report for many tumor types DCPA- Text and synoptic (text, locally developed) in diagnosis section of report NorDx- Text and synoptic (local) in diagnosis section of report
Slide 6-

Synoptic Reporting: Implementation Factors Data element (DE) structure Data content & maintenance Synoptic design to facilitate data entry Workflow integration Synoptic data in reporting- where? Monitoring pathologist compliance (!!) Continuous process and quality improvement ADVANCING PRACTICE, INSTRUCTION AND INNOVATION THROUGH INFORMATICS From Winters and Parwani, APIII 2007
Slide 7-

Pathologist Compliance
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Pathologist Compliance Usage highest in sections or practices with “mandate” Resistance encountered in complex situations such as multiple tumors, unusual histology, recurrences
Slide 9-

Synoptic Reporting Barriers- Pathologist Data-entry interface and workflow Traditional view of report ownership Ignorance of expanded audience Resistance to externally imposed standards from authoritative organizations– JCAHO, CAP, ASC-CoC and others Dislike of the rigid, sterile style of synoptic information
Slide 10-

Checklist Data Entry Interface— Easy to use? Easy to access? Easy to update? Flexible?
Slide 11-

21st Century View of the Pathology Report Part of the medical record, often an EMR Read by many– patient, surgeon, oncologist, coders, insurers, public health personnel Diagnosis only one part of total picture of disease, stage, and clinical setting Prescriptive of specific therapy Must meet quality standards for completeness and consistency Electronically encoded discrete data?
Slide 12-

Barriers to Adoption Coded database system complexity -Adaptations require adjustments in IT, registry, LIS vendor, workflow Unevenly distributed costs and benefits between lab, registry, others Institutional boundaries and control Rigidity of the status quo
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Opportunities Streamlined workflow Effort/cost savings Rules-based quality checks Data mining Data sharing with tissue banks, etc. Compliance
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SynWksh defaults on specimen from part type OR attached to case by gross entry staff [in dev] Pathologist dictates changes to synoptic values IF Not editing in on-line SynWksh OR AFTER Specimen is amended Specimen accessioned Resident or Pathologist dictates final diagnosis and synoptic values from SynWksh copy Transcriptionist attaches SynWksh if not done previously Transcriptionist enters values into on-line SynWksh and marks complete as pertinent, sends case to pathologist Pathologist reviews final diagnosis and default SynWksh text, signs out specimen Pathologist enters values into on-line SynWksh, or edits values if needed UPMC Pathology Synoptic Worksheet Processing 2007 Current Workflow- UPMC
Slide 15-

Potential Future Workflow
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Opportunity Potential Time Savings- Registry
Slide 17-

Opportunity- Rules application for consistency
Slide 18-

Synoptic Reporting: Data Mining Data that can be used for QA, credentialing, research, & teaching
Slide 19-

Basic Cutting Edge Reporting level Level 1 Level 2 Level 3 Level 4 Level 5 Level 6 Description From Srigley et al. J Surg Oncol 2009;99:517-524 Pathology Reporting
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Motivators to get closer to Level 6 Regulatory/Accrediting Careful workflow planning and implementation of lean, low cost work methods integrated with e-reporting (LIS vendors, etc.) Catalytic, creative collaboration Political will (EMR-like incentives) or legislative fiat
Slide 21-

Acknowledgements Pathology colleagues at UPMC, COH, MMC and DCPA Anil Parwani, MD Lawrence Weiss, MD Michael Jones, MD Jay Ye, MD Registry Collaborators Molly Schwenn, MD Wendy Aldinger Sharon Winters Castine Verrill Cheryl Moody CDC NPCR Colleagues Ken Gerlach, MPH, CTR Missy Jameson Vendors Cerner IMPAC Other members of the Evaluation Workgroup of RPP2
Slide 22-

Outline of presentation Historical Backdrop of Reporting Pathology Protocols Projects Specific Pathology-related queries Accomplishments Barriers to further implementation Opportunities or strategies
Slide 23-

Traditional Pathologist’s view of the report Consultation for a patient Report is addressed to a clinician giving care, or obtaining the sample, or both Requires style– owned by pathologist Unique The “diagnosis” is the critical thing, the rest is secondary
Slide 24-

Synoptic Reporting in Pathology-Background Pathology reports are data-intense Traditional methods- text only, individual styles numerous Variability of content, quality and consistency Significance of individual items sometimes unclear prospectively Retrospective research required rework
Slide 25-

The College of American Pathologist Cancer Protocols and Checklists goal is improving the quality and uniformity of reports. Many LIS Systems do not support discrete data elements for synoptic data elements thus, the CAP checklists have been incorporated as unstructured text blocks which are embedded in the pathology reports. Text block data presentation is cumbersome to search and transmit to data repositories Synoptic Reporting in Pathology Background
Slide 26-

Synoptic Reporting in Pathology Background Synoptic reporting schemes attempt to address key quality issues -Consistency -Completeness -Comprehensibility Efforts of ADASP and CAP led to consensus development of Cancer Protocols  specific site and specimen type Checklists