mTuitive, Inc.'s Blog

Synoptic reporting has been in use for a while now and is especially prominent in the pathology field. Instead of dictating and transcribing findings in an unstructured narrative, pathologists are completing synoptic reports and populating structured data fields with vital health information. There are myriad reasons for why this data capture method is preferable for medical reporting. Each response in a given section is an actionable point of data. That means the information entered is now searchable, able to be discretely sent back into disease registries, and used for research.

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.

The Lessons Learned from Pathology Synoptic Reporting and the Goals Needed for Surgical Synoptic Reporting

Deja Vu all over again.  In the second time in under a decade, Canada is rolling out provincial initiatives to implement synoptic reporting solutions to capture important health information. Previously this was done for the field of pathology, where the method of recording vital data about cancer specimens was standardized. The current project is focused on identifying and capturing similar important elements in surgical cancer cases. Having worked with facilities to implement the pathology synoptic reporting initiative and now involved with launching another site for the surgery synoptic reporting, mTuitive thought it might be good to reflect on our prior experience and to see if there are any important lessons to be learned and applied to this new venture.

Becker's ASC review recently ran a post on "11 Ways to Make More Money Per Procedure." The post goes into detail on the various ways that Ambulatory Surgery Center administrators can maximize the profits on each procedure their surgeons perform. Within that list, there are two particular areas that tie into operative reporting and will benefit greatly from synoptic operative reports.

There are many changes facing healthcare today - changes in coding, billing, how information is collected, entered and processed. While many things are in a state of flux, the ultimate goal of healthcare remains the same - provide better care. Better care relies on informed physicians who, in turn, rely on quality (and qualified) data.

There are many reasons to adopt electronic Cancer Checklists (eCC) in your pathology reporting - standardization of results reported, ease of reading for the referring physician, structured data easily sent in to cancer registries. One of the best reasons to adopt the eCC in creating reports for your lab is compliance - not just complying with data standards but also to comply with occupational standards that can result in accreditation and better compensation for your lab and your pathologists.

ComputerWorld's Juergen Fritsch writes cogently on the failure of EHRs to transform physician clinical documentation from unstructured narrative text to structured data:

A new customer recently sent us the following feedback on his experiences with implementing mTuitive's pathology solution. With his permission, it's reprinted below: