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Table 5 Synoptic reporting tool (SRT) implementation in each of the cases

From: Multi-level factors influence the implementation and use of complex innovations in cancer care: a multiple case study of synoptic reporting

Case

Description

Nova Scotia Breast Screening Program

Synoptic mammography reporting began in the mid-1980s at one academic hospital. The impetus was to develop a database that facilitated radiologists’ abilities to track patients subsequent to suspicious imaging to ensure they received appropriate and timely follow-up care. The initiative was started as a research project, with funds from a local research foundation to purchase computing software and hardware. One individual developed a diagnostic SRT with self-taught computing skills. Within a few years, it was implemented at a nearby community hospital. At the time, the concept of synoptic reporting was unprecedented, with the developer having no knowledge of a similar system nationally or internationally. After establishment of the Nova Scotia Breast Screening Program as a provincial program in 1991, the program developed and implemented a similar SRT to report and capture data on all screening mammography in the province. The Nova Scotia Breast Screening Program also became the host of the diagnostic SRT, essentially creating one system to capture all mammography (screening and diagnostic) in Nova Scotia. The capabilities and functions of these SRTs position them somewhere in the middle of the evolution of synoptic reporting technology [1]. The end report that is generated is not synoptic in nature, but rather consists of a series of standardized paragraphs, separated by structured headings, which reads similar to a traditional narrative report.

Though the Nova Scotia Breast Screening Program hosted and operated these SRTs, it could not mandate their implementation and use in individual hospitals across the province. As a consequent, their expansion across the province occurred in a gradual, largely unplanned, manner. By October 2008, all hospitals in the province had implemented the screening SRT. This was in response to a governmental policy established several years earlier related to screening mammography standards. By 2010, the diagnostic SRT had been implemented at all diagnostic imaging departments in the province that perform mammography, yet, at the time of this study, radiologists in three health districts continued to refuse to use this SRT to report diagnostic mammography.

Colon Cancer Prevention Program

Synoptic colonoscopy reporting was implemented with the rollout of the Colon Cancer Prevention Program,a beginning in Spring 2009. The impetus for including synoptic reporting in the program was quality improvement, with leaders believing that measurement was critical to improving colonoscopy performance and to following up participants in the screening pathway. The endoscopy reporting software and database from the Clinical Outcomes Research Initiative (CORI), developed at Oregon Health and Science University, was selected as the SRT. The application was modified as little as possible, though some customization was necessary. The software’s capabilities positioned CORI at the advanced end of synoptic reporting technology [1]. The final report is in narrative form: although the data are entered synoptically, CORI takes the responses and creates them into standard sentences and paragraphs.

SRT implementation was phased in over a two-year period across the entire province (nine health districts) and funded by the provincial Department of Health. To participate in the Colon Cancer Prevention Program and perform screening colonoscopy (the recommended investigation following a positive fecal immunochemical test), endoscopists were required to sign an agreement stating they would use the SRT for all colonoscopies, screening and diagnostic, with the goal of having a single database capturing all colonoscopy in the province. Funding arrangements ensured that endoscopists used the SRT for screening colonoscopy-they would not get paid for these procedures otherwise. However, by the end of data collection, endoscopists in most districts were not using the SRT for diagnostic colonoscopy. The reason provided by most endoscopists was the lack of integration with existing hospital information technology systems,b leading to additional work for endoscopists and endoscopy unit staff.

Surgical Synoptic Reporting Tools Project

Surgical synoptic reporting was implemented in Nova Scotia between 2010-2011 at three hospitals (two academic, one community). The Surgical Synoptic Reporting Tools Project began as a pilot project for breast and colorectal cancer surgery, funded and led by the Canadian Partnership Against Cancer, a national organization leading the implementation of Canada’s cancer control strategy. The project was based on the successful development and implementation of synoptic reporting for cancer surgery in one Canadian province, which led to a national collaboration to expand surgical synoptic reporting to other Canadian jurisdictions. The SRT was the Web-based Surgical Medical Record (WebSMR), originally developed in Alberta [25]. The WebSMR was adapted to meet provincial and local hospital contexts. Its features and capabilities placed WebSMR at the cutting edge of synoptic reporting technology [1]. The final operative report is synoptic in nature, presented in a checklist-like format. The tool was fully integrated with each hospital’s existing information technology systems, allowing seamless transfer of information across systems, including transfer of the final operative report into the patient’s electronic medical record immediately on completion.

As a pilot project, a small number of surgeons (nine) were selected to participate across disease sites and hospitals. Planning and implementation occurred over a 3.5-year time period. The team had neither the authority to mandate SRT use nor the capacity to influence use through organizational or provincial policies.

  1. aThe Colon Cancer Prevention Program is the provincial population-based colorectal cancer screening program.
  2. bBy the end of data collection (Winter 2012), the SRT was interfaced with hospital information technology (IT) systems in one health district, allowing seamless transfer of information (e.g., patient demographics, colonoscopy report) across systems (e.g., patient registration systems, electronic medical records). For the remaining eight districts, the SRT was not interfaced with existing hospital IT systems (the work to complete this goal was ongoing) and a variety of interim processes were used to transfer the colonoscopy report to the patient’s medical record.