From Qualitative to Quality Impact Heather Bryant, MD, PhD Health System Use Summit February, 2016

The stages of development of synoptic reporting 2 TranslationTransactionTransformation

Step 1: Translation Translation 3 Developing clinical consensus on the key indicators to be collected for clinical and analytic use; translating them to uniform reporting standards

Step 2: Transaction Transaction 4 Developing systems and formats that maximize the impact on each patient care episode by improving the quality and/or timeliness of the information

Step 3: Transformation Transformation 5 Developing agreement on what data, if analyzed and reported to systems and/or practitioners, would have a positive impact on patient care and/or system delivery

6 Translation: Standardizing the format and content of pathology reports. Translation Narrative, hence data not divided into question/answer pairs Narrative Report True Synoptic Report Specimen type left modified radical mastectomy Tumour site left outer upper quadrant Tumour size 3 x 2 x 1 cm Histologic type ductal, NOS Histologic grade 2/3 (modified SBR) tubules – 2/3; nuclei – 2/3; mitoses – 2/3 Margins uninvolved by invasive carcinoma Distance to closest margin 1 cm to deep margin Number of nodes examined 9 Each diagnostic or prognostic parameter pair listed on a separate line Synoptic Report Translation

Translation: Establishment of key fields Clinical Standards College of American Pathologists Cancer protocols ( are the pan-Canadian content standard for all cancer pathology reportingwww.cap.org Through CPAC and CAP-ACP there is Canadian input into CAP protocols Needs to support key clinical decisions, quality analyses, and coding in cancer registries Informatic Standards ICD-O3 (clinical standard) SNOMED CT (clinical standard) HL7 v 2.3 x (messaging standard) 7

8 Transaction: Impacts to Completeness Source: Srigley JR, McGowan T, et al.: Standardized Synoptic Cancer Pathology Reporting: A Population-Based Approach. J. Surg. Oncol. 2009;99:517–524 Transaction

Transaction: acceptability Physician survey confirmed preference for synoptic reporting of cancer pathology 9 By transferring synoptic data directly to registries, coding time drastically reduced; also allows for more timely general reporting

Transformation Key issue is to decide on those questions that would actually drive patient care and the system forward….. Not every indicator is valuable in and of itself 10 Transformation

Data Source: Cancer Care Ontario Prostate margin rates can be analyzed without manual audits 11 Data use: Informing indicators to change practice Report by period in Time Report by hospital

Development cycle for indicators 12 Identified relevant indicators Literature review to define content & map to CAP Clinical input Refined content & mapping to CAP Validated CAP alignment Clinical validation & form consensus

Transformation: What are the questions that would drive us forward? (3 examples) 13 BreastColorectalLung Histologic Type Distribution Stage DistributionHistologic Type Distribution Histologic Grade Distribution Quality of TMEStage Distribution Tumor Size Distribution Radial MarginsMargin Status Lymph Node Status Lymph Node Retrieval Lymph Nodes Examined Lymph-Vascular Invasion MMR Immunohistochemi stry Lymph Nodes Positive

Transformation: What are the questions that would drive us forward? 14 BreastColorectalLung Histologic Type Distribution Stage DistributionHistologic Type Distribution Histologic Grade Distribution Quality of TMEStage Distribution Tumor Size Distribution Radial MarginsMargin Status Lymph Node Status Lymph Node Retrieval Lymph Nodes Examined Lymph-Vascular Invasion MMR Immunohistochemi stry Lymph Nodes Positive

Electronic Synoptic Pathology Reporting Initiative Since 2010, the Partnership has been collaborating with the pathology community across the country to: 1.Advance the discrete collection of electronic synoptic pathology resection reporting for breast, colorectal, lung, prostate and endometrial cancers 2.Maintain and promote the adoption of pan-Canadian pathology protocol standards 3.Advance the use of standardized data to measure data quality and derivable clinical indicators Partnership funded Ontario & New Brunswick Partnership funded six provinces: 1. Alberta 2. British Columbia 3. Manitoba 4. Nova Scotia 5. Prince Edward Island 6. Moncton, NB Demonstrating feasibility of using ESPRI data for clinical indicators By 2017, ~ 850 out of 1263 pathologist in Canada will be generating reports

Other related CPAC initiatives Synoptic surgery reporting – Currently developing standards and looking to further implementation Collection and analysis of patient-reported outcomes using standardized scoring tools for cancer patients – Screening for distress now used in 8 provinces, and groups meeting to agree on key indicators and reporting 16

Questions? Partnershipagainstcancer.ca