Industry Spotlight: An mTuitive Approach to Synoptic Reporting for MEDITECH Hospitals

The Commission on Cancer (CoC) is the accreditation arm of the American College of Surgeons. "The CoC is a consortium of professional organizations dedicated to improving survival and quality of life for cancer patients through standard-setting, prevention, research, education, and the monitoring of comprehensive quality care." For cancer programs, this designation is as important as accreditation from The Joint Commission (JCAHO).

For several years, the CoC has required that surgical pathology reports for cancer patients follow protocols and checklists developed by the College of American Pathologists (CAP). Cancer centers were encouraged to submit reports in the synoptic or checklist format provided by the CAP, but until now, there was no requirement to do so.

Beginning in 2009, Accredited Cancer Programs are no longer encouraged, but required, to report using the synoptic format. The goal is to standardize cancer reporting at the time of diagnosis to improve outcomes analysis for cancer treatment and research.

The difference between synoptic and structured data reporting is a source of constant confusion. The difference may appear to be a question of semantics, but is more importantly one of the usefulness of information. Synoptic simply means to provide a summary or “synopsis” of the pertinent findings. A structured report captures data that can be readily stored in a database for analysis or use in other functions, such as decision support. The alternative to a structured report is narrative, free text that will require abstraction for use in a database. A synoptic report does not have to be structured, it can be free text, but it loses it value as structured data.

Most clinical reports including pathology are narrative text with no structure. The text can be copied into a file which can be parsed or mined for data elements, but in an unstructured format it loses the power of a searchable database. Structured data by definition is information ready for entry into a database. Structured data has far more value than text in providing relevant, searchable information. Structured databases allow the task of data abstraction to be relegated to search queries rather than the manual task of report dissection and inspection in text driven systems. In text systems, a certain percentage of the data is completely missed by text parsers. Structured data reporting carries the distinct advantage that 100 percent of data is captured and reported. Time and resources are saved and data integrity and patient safety are increased. Structured data reporting facilitates coordination of care and reduces the chance for medical/clerical errors.

Structured data also provides the ability to create data driven rules or make derivations for decision support. For example, in pathology, structured data can be used to automatically grade or stage tumors. In turn this data can be re-used to derive treatment alternatives. Eventually structured data is necessary to measure outcomes. Which therapies or treatments work best on specific cancer diagnoses.

mTuitive, a Massachusetts software company, has developed a synoptic/structured reporting system to be used by pathologists for compliance with the CoC requirement. Interestingly, the application was designed by Dr. William O’Toole, who was MEDITECH’s first customer back in 1969. Dr. O’Toole was the chief of pathology at Cape Cod Hospital for many years until founding mTuitive five years ago.

The application, xPert for Pathology, works with all pathology and laboratory systems, but most of its users are MEDITECH customers. This is due in part to an innovative program sponsored by Cancer Care Ontario (CCO), a provincial agency responsible for continually improving cancer services. With one of its many initiatives to automate the reporting of cancer pathology data across Ontario, CCO encourages synoptic reporting among its provincial hospitals. MEDITECH is the preeminent HIS vendor for Ontario hospitals, but those hospitals have had little success using MEDITECH questionnaires to build synoptic forms which meet the CCO data standard. mTuitive’s xPert for Pathology application provides customers access to all 71 CAP Cancer Checklists.

xPert for Pathology can be used with any hospital or lab information system (LIS), and even as a stand alone application (without an LIS) to perform synoptic reporting. mTuitive is one of only four vendors certified by CCO to comply with its standards. To date, 13 Ontario hospitals have successfully implemented mTuitive’s synoptic reporting solution. There are also 3 hospitals that have implemented Sunquest CoPath Plus whose synoptic reporting capability is provided by mTuitive.

The software is easy to install, works with both MAGIC and Client Server architectures, and can be readily interfaced. In addition to delivering CoC compliance, many customers report that the software actually pays for itself by reducing transcription cost and accelerating pathology report delivery. Customers have measured an average reduction in turn-around-time of two days.

Dr. Paul Cook, director of pathology at the Phelps County Regional Medical Center, was mTuitive’s first MEDITECH customer. Phelps installed the software in preparation for their initial certification inspection required to be designated an accredited cancer treatment center. After the inspection, Dr. Cook stated "the mTuitive program is simple to use and adds comprehensive value to our reports. The AJCC inspector was most impressed with our path reports. With the help of this software we are now an accredited cancer program."

To learn more about mTuitive, call them at (508) 771-5800 or visit them online at www.mtuitive.com/.