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Synoptic Reporting in
Anatomical Pathology:
Concept and Applications
Anil V Parwani, MD., PhD
Department of Pathology
Division of Pathology Informatics
UPMC Shadyside Hospital
University of Pittsburgh Medical Center
Pittsburgh, PA

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Session Objectives
 What is synoptic reporting, advantages to clinicians,
advantages of storing discrete data elements vs free text.
 Synoptic data entry as methods of producing standardized
reports, leading to improved pathology reports for
distribution to health care teams and cancer registries.
 Worksheet entry in the LIS and its incorporation into
existing pathology reports.
 Experience with the implementation of CAP cancer
protocols and checklists and its impact of information
gathering in the cancer registry.

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Medical Information Digitization of


Overload ROLE OF Healthcare
PATHOLOGIS
T IS RAPIDLY
EVOLVING

Personalized Patient Involvement


Medicine
Slide 4
Informatics & Workflow
 As enabler of
 People

 Processes

 Outcomes
 Reliability

 Safety

 Efficiency

Advance for Adminstrators of Laboratory. April 1, 2010 - volume 19, number 4


http://laboratory-manager.advanceweb.com/ebook/magazine.aspx?EBK=AL041210#

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Synoptic Reports in Pathology
• Gross and microscopic examination of surgical specimens, particularly
large resections, yields comprehensive information of immense value to
treatment decisions such as adjuvant therapy, radiation, chemotherapy
and other interventions.
• Traditionally, narrative descriptive reports have been used to convey this
valuable information to the patients and their health care teams.

Slide 6
Synoptic Reporting: Background

• Traditional narrative and descriptive reports in free text


format have significant variability because different
pathologists use a multitude of different reporting styles to
describe their findings.
• More often such variability results in pathology reports
missing important data elements such as margins,
lymphatic invasion etc.
• Synoptic Reporting, either as part of the pathology report
or replacing the free text component, has uniformity with
standardized data elements in forms of checklists thus
ensuring the pathologist makes note of these findings in
their reports.
Slide 7 What is synoptic pathology reporting?

Synoptic pathology reporting uses an electronic


report in discrete data field format (i.e., each type of
information has a specific place and format in the
report) that allows for the standardized collection,
transmission, storage, retrieval and sharing of data
between clinical information systems.

Slide 8 Synoptic Reporting: Background

• The College of American Pathologist Cancer Protocols and


Checklists were created with the objective of improving the
quality and uniformity of information in pathology reports.

http://www.cap.org/apps/docs/cancer_protocols/protocols_ind
ex.html

• Currently, most 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.

• The latter arrangement results in the presentation of


pertinent pathology data in a cumbersome and difficult to
access format.

Slide 9 Synoptic Reporting: Background

• The College of American Pathologist Cancer Protocols


and Checklists were created with the objective of
improving the quality and uniformity of information in
pathology reports.

http://www.cap.org/apps/docs/cancer_protocols/protocols_
index.html

SNOMED Terminology Solutions has enhanced the checklists


by placing them in XML format beginning in January 2009,
and encoding question and answer term with SNOMED
Clinical Terms® (SNOMED CT®).
Slide 10 Cancer Registry
Categories of Data Collected

Patient
Identification
Cancer
Identification

Outcomes

Stage of Disease
At Diagnosis
First Course
Of Treatment

Slide 11 Common Data Elements Between Pathology


and Cancer Registry - direct (CAP) or derived
values
•primary site •date of 1st positive biopsy
•laterality •date of initial diagnosis

Cancer •histology •perineural invasion


Identification
•tumor behavior •lymphatic invasion
•grade/differentiation •margin involvement
•place of diagnosis •diagnostic confirmation
APLIS
•tumor size/depth of invasion •dx & staging procedures
•extension to regional •metastatic site(s)
/distant tissues •progression/recurrence
Stage of Disease
At Diagnosis •TNM, AJCC Stage Group •date(s) of pathologically confirmed
•# regional nodes removed mets or recurrence
•# regional nodes positive •microscopic confirmation

Slide 12 The Commission on Cancer (CoC) of the


American College of Surgeons (AcoS)

Beginning in 2009, Accredited Cancer Programs are


not only encouraged, but required, by the ACoS
Commission on Cancer to report cancer pathology
cases as synoptic reports in order to receive a
Commendation for the pathology reporting standard .
Slide 13 The Commission on Cancer (CoC) of the American
College of Surgeons (AcoS)

•For Standard 4.6, "programs will continue to include the


scientifically validated data elements in the CAP protocols
in the pathology reports generated by the facility.
•The Commendation for standard 4.6 is based on the
reporting of the scientifically validated data elements using
the appropriate synoptic format."
•"Note that the Commendation for standard 4.6 is now
based on the use of a synoptic format in the pathology
reports...
•Surveys performed in 2010 will review pathology reports
for synoptic reporting produced in 2009, which reflects this
new requirement and the Commendation"

Slide 14
Text Based Pathology Checklists

 Text-based synoptic outlines in use since


1992 to enhance full text reporting
 Limitations to text-only format:
 Entry of key data elements
 Presentation on reports
 Data retrieval by distinct elements

Slide 15 Synoptic Reporting: Text-based Outline


Slide 16 Synoptic Reporting Tool

• At our institute, we have used a “synoptic reporting” tool


(Cerner CoPathPlus) to incorporate the CAP checklists as
discrete data elements, allowing for storage of data elements
in a relational table within the LIS.

• We have modified the CAP checklists into these synoptic


worksheets for select organ systems and malignancies such as
prostate, melanoma, breast and lung.

• We have also used CAP checklists created by Cerner DHT


to supplement the library of checklists available for use in
pathology reports.

Slide 17 Synoptic Reporting: Entry Design


Synoptic entry design
 Simple UI for entry/selection of DE’s

 Provides controls on data integrity


 required elements and multiple answers

 Variable formatting capabilities

 Integrates with workflow

 CoPathPlus: Synoptic Worksheets

Slide 18 Synoptic Reporting: DE Structure

Data element structure


 Provides organization

 Defines distinct concepts

 Relation to data entry

 CoPathPlus
 Synoptic Values
 Synoptic Categories
 Synoptic Worksheets
Slide 19 Synoptic Reporting: Dictionary Structure

Synoptic Categories Synoptic Values Synoptic Worksheet

< 5% of specimen involved by


invasive tumor

Extent of Tumor 5 - 25% of specimen…

> 25% of specimen…

Unknown or N/A

Yes, high grade PIN, NOS

Yes, HG PIN, 1-2 foci in


region of tumor
High Grade PIN
Yes, HG PIN, 1-2 foci away

Yes, HG PIN, multifocal

No, high grade PIN absent

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Slide 24 CoPathPlus: Synoptic Worksheet


Slide 25 Synoptic Reporting: Workflow, Primary Entry

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Slide 35 Synoptic Reporting: Workflow

Integration into workflow


 Gross data entry activities

 Diagnosis entry - transcribed or voice-entered?

 Availability at sign out

 Access for “special procedures”, et al?

Slide 36 Synoptic Reporting: Reporting

Synoptic data on reports


 Formatting, replacement text

 Location in reports

 Replacing final diagnosis


Slide 37 Synoptic Reporting: Workflow

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Slide 40 Synoptic Reporting
Experiences and Lessons Learnt

 Enhanced leveraging of data


 Data mining
 Monitoring of data usage
 CAP/Regulatory
 Facilitate data transmission to Public Health Repositories
 Cancer Registries
 Clinical Databases
 Research Data Repositories
 Enhance Patient Safety through standardized pathology reporting
 Future Directions
 Creating Comprehenisve Disease Specific Synoptics

Slide 41 Synoptic Reports of Molecular


Testing

Slide 42 SYNOPTIC REPORT WITH PROGNOSTIC


AND THERANOSTIC DATA
 Pathology Report
 COMPREHENSIVE THERANOSTIC
SYNOPTIC
 K-ras codon 12/13 mutation: Positive
 EGFR Exon 19 mutation: Negative
 EGFR Exon 21 mutation: Negative
 EGFR Amplification: Negative
 EML4/ALK translocation: Positive
Slide 43 Synoptic Reporting: Content

Data content and maintenance


 Editing and version capabilities

 Compliance with CAP checklists


 American College of Surgeons Commission on Cancer
requires for approval of cancer programs

 Annual updates from CAP

 Pre-built worksheets available from Cerner

Slide 44
Synoptic Reporting: Leveraging Data
 Data mining/searching capabilities

 Usage monitoring

 Transmission of synoptic data

 Cancer registry databases

 Research databases

 Biobanks

 Patient Outcome databases

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Slide 47 Synoptic Reporting: Leveraging Data

 Quality Assurance

 Data mining/searching capabilities

 Usage monitoring

 Transmission of synoptic data

 Cancer registry databases

 Research databases

Slide 48 Synoptic Reporting: Data Mining


Slide 49 Synoptic Reporting: Data Mining

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Slide 51 Specimen Inventory System


Biospecimen Information
Slide 52

Synoptic Data Relational database

MINING SYNOPTIC DATA FOR BIOSPECIMEN MANAGEMENT

Slide 53 QA: USING


SYNOPTIC REPORT
FOR EVALUATION
OF PERFORMANCE

Slide 54 Benefits of synoptic Reporting:

•Standardizes pathology reporting


•Improves overall report completeness
•Easier to decipher than narrative or paragraphs
•All important diagnostic and prognostic factors are
laid out in a structured list or table with headers
and responses rather than being buried in text fields
•Improves communication among healthcare
providers
Slide 55 Benefits of Synoptic Reporting (Continued):

•Facilitates decision-making for treatment


•Can improve pathology report turnaround time
when paired with voice-recognition software
•Facilitates secondary uses of pathology data for
purposes such as tumor registries, quality reporting,
stage capture, quality management and evaluation,
patterns of care and outcome analysis.

Slide 56 SUMMARY

In this session,
•Importance of using standardized reporting in
anatomical pathology.
•Current standards and ACOS requirements
•Our experience in using synoptic tools with the
overall goal of standardizing the pathology reports.
• Promoting easy data sharing between the Anatomic
Pathology LIS, Cancer Registry and other Clinical and
Research systems in Oncology.

Slide 57

QUESTIONS???????
COMMENTS?????