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Bridging the 'Synoptic Gap': Synoptic Reporting Ensures Completeness

At mTuitive, we deal with complicated systems all the time. The intricate designs of computer networks and interfaces to send messages between our products and the Laboratory Information System or EHR. We've worked with elaborate hierarchies of hospital administrations, making sure that specific personnel from the necessary departments are involved in decision making, implementation, providing support. We navigate the sophisticated waters of complying with legal, technical, code and terminology standards, making sure that our solutions are up-to-date with each without compromising ease of use or burdening our customers with the onus of staying on top of all the changes. However, all of these systems pale in complexity when compared to the utterly fascinating mechanics of the human body. The users of our medical synoptic reporting products - primarily pathologists and surgeons - are all too familiar with this fact, spurred on in their education and work by this fascination. But for those of us that don't spend time studying these impressive, microscopic elements that help make us "us," it's easy to forget just how complex the process is for our bodies to complete the simplest of tasks.

One of the most impressive processes to me is how neurons work, sending messages from the nerve endings to the brain. Neurons are nerve cells that transmit information of experiences (touching an angora sweater, feeling rain on your face, stepping on hot coals, etc.) to each other to present the information for interpretation and reaction to your brain.

A neuron begins with dendrites, these long branches designed to pick up information from other cells, then continues down the axon and ending with the axon terminal, where it can send up with the next neuron's dendrites:

One of the more fascinating aspects of the neuron is that it is a cell that comprises two different processes - chemical and electronic - to accomplish its goals. The dendrites accept chemical messages, called 'neurotransmitters,' which then triggers an electric message to go down along the axon until its end where it signals the axon terminal to release neurotransmitters to send to the next neuron, and the process begins again.

Between each neuron is a space called the synaptic cleft or, as I learned it, the synaptic gap. That's the small space where the neurotransmitters go from the axon terminal of Neuron A to the dendrites of Neuron B. This is also where you can get interruptions in the messages - where some of those neurotransmitters don't make it all the way across, or else the receptor sites have been malformed by drug use, disease or age and so the transmitters aren't picked up correctly by the dendrites.

It was thinking about this incredibly complex system of the body and the opportunities for missed communication that I realized that many facilities can face a 'Synoptic Gap' of their own. Except, in this case, the name refers to the solution for the lack of successful information transference. Hospitals are also complicated systems of many departments all performing their duties to work together to provide the best care to each patient. Each area of the hospital is tasked with filling a specific need, which requires different staffs with different (and unique) abilities, specialties, and knowledge. But in order to correctly perform their job of providing excellent care to everyone, these independent systems all have to work with one another. More importantly - they all have to communicate with one another. And that's where confusion can enter, signals get mixed, and problems arise.

Carrying messages through different systems - from a lab to a general practitioner's office, for example - allows for subjectivity, misunderstanding and confusion to set in. An incomplete report or, conversely, one overstuffed with excessive verbiage, can have disastrous effects with the important elements being lost in all of the noise or simply never entered in the first place.

One answer is structured, synoptic reporting. By using standardized reports with clearly delineated fields and responses, doctors are able to easily understand what physicians in other departments are stating. The need to subjectively interpret findings has been eliminated because there is uniform presentation of the information, there is no deviation which allows for vague responses. Physicians can still add comments and other text to make sure that their voices are still 'heard,' but the most important information is plainly captured and effectively communicated.

Large, unstructured texts (produced by dictation or done without synoptic fields) forces the recipients to comb through to find the most pertinent pieces of data to best determine treatment. And combing through for a certain phrase is not a guarantee either, as there are untold number of variations that physicians could use in their reporting. Instituting synoptic reporting has resulted in an increase in satisfaction from physicians receiving the reports and a decrease in follow-up questions as the reports are easy to fully understand. That's how the information can move from one part of the hospital to another, disparate part without any depreciation of its meanings - the integrity of the message is kept intact and fully communicated no matter who is looking at it.

There are complicated systems within us - and we ourselves are working more and more with complicated systems. Lab systems communicating with EHRs that send messages back to practice management software that integrate with patients' PHRs. Yet, with all of these networks communicating with each other, we must find a way to maintain the consistency of the messages; the meanings must remain intact as they go between caregivers and departments or else risk misunderstanding and lower the effectiveness of the care provided. Synoptic reporting bridges this gap by using structure and standards to ensure that consistency is enforced, comprehensiveness is encouraged, and comprehension is guaranteed.

photo credit: ocean.flynn via photopin cc


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