Synoptic reporting speeds diagnosis

Patients at Thunder Bay Regional Health Sciences Centre used to have to wait an average of 22 days after having a biopsy to find out if they had cancer. The long wait caused unnecessary anxiety and delayed treatment, but a new method of pathology reporting has reduced the average wait time for a diagnosis to seven days.

The pathology department at Thunder Bay Regional was an early adopter of synoptic reporting, a standardized, computer-based reporting tool being championed by Cancer Care Ontario as an improvement over narrative reports that were sometimes difficult to read, incomplete and lacking in precision.

"In the past, the information a physician needed would have been buried in the narrative," explained Dr. Joseph Wasielewski, chief of pathology and medical director of Thunder Bay Regional's lab. "Synoptic reports," he said, "are more readable and complete. I used to get a lot of calls from physicians who wanted to discuss parts of the narrative report that weren't clear to them. Now, I hardly get any calls."


Award

Wasielewski received an award in December from the Cancer Quality Council of Ontario for streamlining laboratory testing for cancer patients at Thunder Bay Regional.

Synoptic reports use drop-down menus and pick lists, which makes reporting easier for pathologists and less confusing for oncologists and other physicians. Narrative reports, on the other hand, varied depending on the pathologist's writing style.

"It was like reading a different author," said Wasielewski. "Now, the reports look the same whether they come from me or one of the other pathologists.

The software used for synoptic reporting of lab tests forms part of the patient's electronic medical record at the hospital, allowing physicians caring for the patient to view it at any time. The results are also uploaded to a centralized Cancer Care Ontario database for accurate province-wide statistical reporting.

Cancer Care Ontario has mandated the adoption of synoptic reporting by all pathology departments in the province by March 2011.

The improved turnaround for biopsy reports has reduced patient anxiety and allows oncologists to accelerate treatment.

"As pathologists, we think about (the patients) all the time because, if we were in their shoes, or if we were a family member or friend, we'd feel the same way," said Wasielewski. "But you also want to put out an accurate report, so there's always a balance."


Checks, balances

There are a number of checks and balances in the process to ensure reporting accuracy, including external quality assessment and accreditation by the Ontario Medical Association's Quality Management Program - Laboratory Services program, as well as quarterly reviews of a cross-section of reports and slides by Sunnybrook Hospital.

There are also internal controls, said Wasielewski. "Our positive biopsies - the malignant ones - are always seen by a second pathologist before a report is released, and for negative biopsies, we have a random review to make sure there is good consistency."

A graduate of Wayne State University's School of Medicine in Detroit, Wasielewski practiced in Hawaii for 10 years before accepting a position in Thunder Bay in 1986. An outdoors enthusiast, he fell in love with the natural beauty of the region and the opportunities for cross-country skiing, sailing and cycling.

The Canadian health-care system was also appealing.

"I was totally disillusioned with the health-care system in the U.S.," he said.

"I had my own pathology practice in Hawaii and we had to file our fees for service to numerous insurance vendors. It was unbelievable. They don't pay you what your fee is. They pay what they consider an allowable payment for the service. Then, there are patients who are covered by the government and those who aren't covered at all. When I looked into the Canadian health-care system, it seemed to me the right way to go."

Wasielewski had several other job offers at the same time for more money, but the health-care environment in Canada and the lifestyle in Thunder Bay won him over.