Too Much Duplicate Data in Our Pathology Reports?

keyThe latest edition of Archives of Pathology and Laboratory Medicine (Vol. 141, Jan 2017) contains an interesting back-and-forth regarding the value of synoptic reporting for surgical pathology reports of resection specimens with malignancy. Drs. Andrew Renshaw and Edwin Gould from the Baptist Hospital in Miami report an increase in amendments to their department’s surgical pathology reports because of clerical errors during the transcription of synoptic reports. Their workflow, which is likely similar to that of many other pathologists, is to dictate the synoptic report as a checklist derived from those provided by the CAP. Secretaries then type the synoptic report into the LIS from the dictation.

They report that the larger the number of required data elements in a synoptic, the higher the rate of amendments that are issued for clerical error, ranging from 0.5% for synoptic reports with <10 required data elements, to 2.5% for those with >20 required data elements. They suggest streamlining the synoptics to include only those data elements which are  directly relevant to patient care.

In response, Drs. Thomas Baker and Joseph Khoury from the Joint Pathology Center and MD Anderson, respectively, argue that only elements which are “truly needed for clinical management” and “meeting stringent levels of evidence” are included. Later, however, they somewhat weaken that assertion by reminding us that:

…the value of data in pathology reports goes beyond the diagnostic and therapy-guiding facets to impact a myriad of other aspects along the continuum of cancer care [including] tumor registries, rapid learning systems and clinical decision support, survivorship care, population health, health care economics, drug development, and value-based outcomes initiatives…

Some may certainly question whether rapid learning systems, health care economics, and drug development are directly relevant to patient care.

Personally, I don’t think that the data fields required in our synoptics are burdensome and mostly include information that I include in my text reports. I actually like them because they remind me of the pertinent data I should be including in my reports. Also,since my own (academic) department uses a point-and-click module within our LIS for synoptic reporting, transcription errors have not been an issue for me.

However, occasionally I need to amend my reports because I have made changes to either the text report or the synoptic (often when correcting a report prepared by one of my housestaff) but forgot to make changes to the other. Therefore I would prefer a system where data is only entered only once, which is a well-known principle in data management. I don’t question the importance of the data elements within the synoptics I use within my subspecialty (gastrointestinal and pancreatobiliary pathology). However I do think our informatics approach can be improved so that data is only reported once, instead of separately in a text report and a synoptic report.