Pathology Synoptic Reporting Improving Cancer Outcomes?

Via is your pathology, so is your medicine. - Dr. William Osler

In a great post over on their website, Canadian Partnership Against Cancer (CPAC) reveals the extensive healthcare ramifications of synoptic reporting for pathology in Ontario. The piece, found here, follows a recent study examining the consequences of capturing specified data points in a uniform matter in all pathology reporting. To some, pathology may seem disconnected from other aspects of patient care - but the study clearly shows how what is discovered - and, possibly more importantly, reported - in pathology directly influences treatment administered not just for that patient but for all patients struggling with a similar affliction. Furthermore, CPAC's post shows how something that began in only one province can expand to global proportions.

In 2008, Cancer Care Ontario (CCO), backed by CPAC, began its Pathology Reporting Initiative to ensure that pathologists were uniformly recording their findings in the same manner. The initiative encouraged pathologists to report on cancer cases using the same fields, and enter data using the same group of responses. This did away with inconsistency of reporting, where only some pathologists would report on one element (say "involvement of margins") or else use different terms for the same thing ("positive margins" vs. "involved margins").  

By creating and enforcing standards in reporting, the same information is consistently recorded and discussed. This creates a more complete portrait of the case while providing researchers and other physicians with more data they can use for that case or as one of many on a city, regional, or provincial level. And the standardization of language makes it easier for researchers, comparing and contrasting using the same terms, as opposed to poring over reports and trying to find similar terms or synonyms to apply to their research. And since the information is captured synoptically and electronically, the data is even easier to pull and use for their research. Beyond benefitting the ease of reading reports or extracting important medical data, the study outlines how CCO's initiative had specific real world implications in cancer care.

The paper, published in the Journal of Oncology Practice, is entitled "Closing the quality loop: facilitating improvement in oncology practice through timely access to clinical performance indicators." The authors highlight specific positive consequences that synoptic pathology reporting has had on administering cancer care. For example, 'colorectal lymph node retrieval rates have increased from 76% to 87%, and pT2 prostatectomy margin positivity rates have decreased from 37% to 21%.' The reporting may not directly influence this - it is always hard to delineate between correlation and causation in these cases. But it may indirectly promote this change simply through inclusion of the data field. It raises awareness of these elements by raising their visibility; always seeing the results captured on pathology reports, physicians/surgeons are thinking about margin involvement and node retrieval rates. Standardizing reports such as these - be it in pathology, surgery, or radiology - ends up improving an entire program, and not just one department or research team.

It should be noted that mTuitive's pathology solution is being used at many Ontario sites to capture these standards. On our website, it's been detailed how mTuitive products have assisted our Ontario customers to achieve 90% completeness and synoptic rates for their pathology reporting. We've seen first hand the changes made to CCO checklists to promote inclusion of various fields and data points, and the ease with which electronic synoptic reporting can send that captured data into the necessary repositories for treatment and research. But because mTuitive only deals with a small segment at each of the facilities, we didn't realize the reach of the ramifications of implementing these standards in their pathology reporting.

The paper affirms what we've always suspected and hoped - that establishing required standards in medical reporting elevates and improves treatment through multiple levels. The best way to ensure that these standards are adhered to is through electronic synoptic reporting, making it easy to push required fields or discretely capture important data. That comprehensive, discrete data can then be easily sent into tumor registries and other systems for enhanced research that presents a more informed analysis of a disease or population. All of this inclusion promotes adherence to best practices in other fields that are only tangentially involved with the reporting. And all of this comes together to improve the care that every current and future patient will receive when they go in to a hospital. The quality of care is raised for all patients, especially as other provinces, nations and other organizations begin to adopt and implement these standards, increasing the pool of data and refining what should be required. It's not easy to devise these standards, or to get physicians to use them, but it's clear that the trade-off of improved cancer outcomes for patients is well worth the slight temporary discomfort of trying something new. When we get sick, or a loved one goes for treatment, we all expect the standard of care to be as high as possible; standards of reporting should be held to the same expectations.