How does one measure success? How can one know when something is actually working versus just the perception that it is going according to plan? It's a difficult question, with many variables to weigh, especially for the medical community. Right now, in the full swing of "evidence-based medicine" being all the rage for making clinical decisions, it's become the focus of many grants and studies and research opportunities to figure out the efficacy of treatments, the behaviors of diseases, and the best practices for procedures. But in order to determine these findings, there needs to a base of information from which to work. Enter structured data.
This blog has written before about why Structured Data is a great, if underutilized, tool in medicine. While the focus on many minds (those preoccupied with EHRs and implementations) is on "Big Data," Structured Data allows physicians and researchers to instead capture "actionable data" to make informed decisions and complete necessary tasks. (To read more about this, please check out this prior blog post.) And so it is that Structured Data has once again helped shed light on medical treatment in colon care, as outlined by this post from Cancer Care News. The post concerns how tracking specific measures, and outcomes, has led to improved care for patients in Canada. And that is thanks in large part to the way in which physicians are reporting on their cases.
By using synoptic reporting, physicians are able to ensure they aren't just recording the steps they take, but also are reminded of the "right" steps to take to better ensure a successful treatment of colon cancer. Using synoptic reports mean that the same fields show up for all physicians, which means greater inclusion of information (which in turn become data points, but more on that later). By having required fields show up, physicians have to report on them, which reminds them of areas in which they fell short or protocols to which they must adhere. Free-flowing dictation allows for physicians to talk about whatever they want, so there's no structure that enforces what must be reported upon. This means that not only are certain elements excluded (due to forgetfulness or personal preference) from the report by the physician, but also that there's nothing to remind them to pay attention to an element in their procedure. Similar to the "Checklist Manifesto," synoptic reports conjure up memories not just of what's listed but also leads to remembering other vital aspects of a process. As noted in the Cancer Care News post:
Clinicians are now encouraged to use synoptic — or standardized — reporting of surgery and pathology evaluation with the use of an electronic template. Dr. Porter says that traditionally, physicians produced sometimes lengthy narratives about what happened in the operating room or was found in the pathology evaluation. Often the information was unclear or missing key details. By contrast, a synoptic electronic report is “more comprehensive, more complete, more timely. And, it also serves as a reminder around what are those important elements of either the surgery or the pathology report.”
As the post notes, since having to capture and track the number of lymph nodes excised, more surgeons are now removing the correct number with each surgery, which in turn is producing more accurate staging of tumors. Standardized reporting not only ensures a common lexicon of terms used, but also a common set of priorities that the physicians abide by and seek to attain, which, in turn, produces a common set of values for data searching. And that's where the other power of structured data lies in this story, not just in assisting in input of data, but also greatly helping in examining the output of the information. Not only is there more being tracked due to the format of the report, but the format of the information being captured makes it easier to track as well. Increased efficiency abounds with Structured Data, allowing much faster, dynamic reporting on findings without the tired and unwieldy process of abstraction. Previously, using dictation and transcription, researchers would have to comb through reports, first finding the similar reports on the right set of procedures, then they would have to hope that the information was included, and they'd have to pay attention because different physicians say the same process in different ways at different times in their reports. Standardized reporting removes all of these hurdles, ensuring the same term is used across the board, is always included, and can always be found in the same spot. This means less time combing through long reports and more time spent using them as actionable data to target areas where improvement is needed.
Now that we've established how Structured Data and Synoptic Reporting is helping with colon care in Canada, what's next? Where else can people start to reap the benefits of this paradigm shift? California is already beginning to follow suit, albeit in the world of pathology. Using mTuitive solutions, dozens of hospitals in the state are reporting - close to real-time - data points about cancer diagnoses to the cancer registry. Cancer registries typically lag up to two years behind in acquiring case data, and now they can acquire it instantly. Once again, the power of Structured Data is allowing improved outputting of data that will improve understanding of best practices and behaviors of a disease. By improving the manner of input, by focusing on the efficiencies of the format in which data is captured, physicians and facilities are reaping the benefits on the output as well.