Cancer Care Ontario (CCO), in partnership with more than 400 pathologists and 100 cancer treating hospitals across Ontario, has implemented a new system and process that standardizes cancer pathology reports.
This breakthrough will significantly improve the quality of cancer diagnosis and the effectiveness of subsequent treatment. Moreover, the new system enables pathologists to use standardized checklists when creating a pathology report after examining a tumour or tissue specimen removed by a surgeon.
The electronic checklists, coupled with innovative technologies, help pathologists ensure information is consistent and complete based on an internationally recognized gold standard for reporting set out by the College of American Pathologists (CAP). The CAP protocols have also been endorsed as the pan-Canadian standard by the national professional body – the Canadian Association of Pathologists and Canada Health Infoway.
The provincial Pathology Reporting Project, funded in part by the Canadian Partnership Against Cancer (CPAC), has been successful in improving the quality of over 50,000 surgical pathology reports that are created annually in the province. Standardized pathology reporting checklists contain pre-formatted, multiple choice drop-down lists, ready for the pathologist to select the right data. This allows pathologists to automatically generate a clear, standardized report for surgeons and oncologists. The new format provides a consistent look and language to ensure report completeness. Patients can be reassured that Ontario pathologists are providing quality reporting based on clinical best practices.
“Pathologists are like society’s diagnostic oncologists,” describes Dr. John Srigley, Provincial Head of Pathology and Laboratory Medicine at CCO. “Nearly every cancer patient is touched by a pathologist- the great majority of all cancers are diagnosed by pathologists. At the end of the day, we want to ensure the information we give to surgeons and oncologists is accurate and complete to inform and support decisions to treat patients. We want patients and doctors to have absolute confidence in the pathology analyses we provide.”
Before this project began, pathologists typically dictated their findings into a recorder which were often transcribed into long, narrative reports. Studies find that narrative reports commonly do not provide the information required to make optimal treatment decisions, either because information is missing, or because information is not presented clearly.
Traditional narrative reports also make it more difficult to easily extract the pertinent information to determine the course of treatment. “Standardizing reports helps ensure all necessary patient information is included within pathology reports – it’s about providing quality findings in the analysis, no matter what hospital you visit in Ontario and improving communications between physicians involved in a patient’s care,” reveals Dr. Srigley.
Dr. Demo Divaris, Chief of Pathology at Grand River Hospital and Clinical Advisor at CCO agrees. “The new (pathology) reports remove doubt about report findings. There is clarity of information which is presented in a crisp, consistent format. It gives confidence to health care providers who are involved in multi-care conferences – it’s easier and quicker (for physicians) to see the data needed for treatment discussions and decisions.”
After almost 10 years of Ontario hospitals and pathologists working alongside CCO, Ontario has a new system that ensures patients get the same high-quality pathology reporting no matter where they live in the province. As an added benefit, it informs policy makers on how well Ontario is performing in treating cancers. CCO can also provide key surgical and pathology performance indicators back to hospitals within weeks of surgery, thereby providing feedback on how they are doing.
So far, 97 per cent of cancer treating hospitals in Ontario have successfully implemented standardized pathology reporting and the data is being collected centrally at CCO for the Ontario Cancer Registry- the province’s cancer data warehouse. Today, CCO uses this data to monitor the occurrence of cancer, mortality and survival patterns and cancer trends – all factors used to monitor the patterns of disease and continually improve cancer care in the province.
The legacy of this project is the transformational shift in how pathologists report data across Ontario and Canada. In fact, the rest of the provinces are following Ontario’s lead through a Pan-Canadian collaboration led by CPAC. Implementation of standardized reporting by Ontario’s pathologists is also a first for any jurisdiction of this size in the world. As a result, international interest has increased from health care organizations in Brazil, the United Kingdom, Australasia, United States, Scandinavia, Poland and Japan.
Dr. Tom McGowan, Chief of Radiation Oncology at Credit Valley Hospital and Clinical Advisor at CCO for this project, describes the transformative quality initiative. “We can get every single data element for every single pathology report. This means that wherever you get surgery you know all the information is going to get reported to the physicians that are going to be treating you. It gives people information they can act on at a local level with a patient, at the same time giving clinicians unprecedented insight into how they compare to their peers doing the same work. That’s how you improve care, by simultaneously looking at individual patients and overall performance.”