Bettina Casati

Template reporting matters—a nationwide study on histopathology reporting on colorectal carcinoma resections

Complete and accurate histopathology reports are fundamental in providing quality cancer care. The Cancer Registry of Norway and the Norwegian Society of Pathology have previously developed a national electronic template for histopathology reporting on colorectal carcinoma resection specimens. The present study was undertaken to investigate (1) whether quality routines in Norwegian pathology laboratories might affect completeness of such histopathology reports and (2) whether the national electronic template improves completeness of histopathology reports compared with other modes of reporting. A questionnaire on quality routines was sent to the 21 pathology laboratories in Norway. All histopathology reports on colorectal cancer submitted to the Cancer Registry for a 3-month period in the autumn of 2007 were then evaluated on the mode of reporting and the presence of 11 key parameters. Of the 20 laboratories that handled resection specimens, 16 had written guidelines on histopathology reporting. Of these, 4 used the national electronic template, 5 used checklists, 3 used locally developed electronic templates, whereas the remaining 4 had neither obligatory checklists nor templates. Of the 650 histopathology reports submitted to the Cancer Registry in the 3-month period, the national template had been used in 170 cases (26.2%), checklists/locally developed templates in 112 cases (17.2%), and free text in 368 cases (56.6%). Quality routines in the pathology laboratories clearly governed reporting practice and the completeness of the histopathology reports. Use of the national electronic template significantly improved (P < .05) the presence of the 11 key parameters compared with reporting by checklists, locally developed electronic templates, or free text.

Structured electronic template for histopathology reports on colorectal carcinomas: a joint project by the Cancer Registry of Norway and the Norwegian Society for Pathology

Both individual patient treatment and cancer registries depend on adequate histopathology reports. To ensure the quality of these reports, professional organizations have published guidelines on minimum data sets for various cancer types. Norway has a population of 4.6 million, and all individuals have a unique identification number. As required by law, relevant information on cancer is submitted to the Cancer Registry of Norway. A closed, national health data network has been established facilitating electronic transferal between various institutions. The Cancer Registry and the Norwegian Society for Pathology have jointly established a nationwide project to (i) develop standardized templates in database format for histopathology reports on cancer resection specimens and (ii) develop an Extensible Markup Language (XML) standard to facilitate future electronic transfer of cancer reports from hospitals to the Cancer Registry. A minimum data set template for reporting colorectal carcinoma resection specimens and the Extensible Markup Language standard have been established. The template is based on international guidelines and classification systems. For most key parameters, pull-down menus with predefined alternatives have been constructed. The template is fully integrated into software being used by all pathology laboratories in Norway. Since the introduction of the template in April 2005, the template had been used for reporting 430 (93%) of 462 colorectal resections at 2 pilot laboratories (Akershus University Hospital [Lørenskog, Norway] and Stavanger, University Hospital [Stavanger, Norway]), demonstrating that high and consistent quality can be ascertained. Pathologists have found the template both time saving and user friendly. The template is now gradually implemented nationwide.

Structured electronic template for histopathology reporting on colorectal carcinoma resections: five-year follow-up shows sustainable long-term quality improvement.

CONTEXT To improve quality, pathology organizations have published guidelines with key parameters for histopathology reporting on cancer resections. Checklists or structured templates improve upon the presence of key parameters in histopathology reports, but data are lacking on long-term sustainability of such reporting. From 2003 to 2006, the Cancer Registry of Norway and the Norwegian Society of Pathology collaborated on the development of a structured electronic template for histopathology reporting on colorectal carcinoma resections. OBJECTIVE To investigate use and long-term effect of this structured template in one of the first laboratories implementing the template for routine diagnostic work. DESIGN All histopathology reports (n =123) in the 1-year period prior to implementation were evaluated with respect to presence of key parameters. Likewise, all histopathology reports (n =1186) in the 5-year period after implementation were evaluated with respect to template use and presence of key parameters. RESULTS The electronic template had been used in 1089 (91.8%) of the 1186 cases. Template use was stable in the entire 5-year period, and had significantly improved upon the presence of data on 7 of 11 key parameters valid for both the pre-implementation and the post-implementation period. Eight hundred and twenty-two (75.5%) of the 1089 template reports contained information on all key parameters, compared to just 20 (16.3%) of the 123 free text reports in the 1-year pre-implementation period. CONCLUSION Electronic template reporting has a significant and sustainable long-term, positive effect upon the quality of histopathology reports.

Stakeholder analysis: a useful tool for biobank planning.

Stakeholders are individuals, groups, or organizations that are affected by or can affect a particular action undertaken by others. Biobanks relate to a number of donors, researchers, research institutions, regulatory bodies, funders, and others. These stakeholders can potentially have a strong influence upon the organization and operation of a biobank. A sound strategy for stakeholder engagement is considered essential in project management and organization theory. In this article, we review relevant stakeholder theory and demonstrate how a stakeholder analysis was undertaken in the early stage of a planned research biobank at a public hospital in Norway.

Factors affecting the implementation and use of electronic templates for histopathology cancer reporting

The surgical pathology report on cancer resection specimens is fundamental for providing clinicians with the information needed for adequate patient oncology treatment. Since the multi-institutional quality study on pathology reporting of colorectal cancer published by Zarbo in 1992,1 many other studies have shown that the use of checklists or synoptic reporting is superior to traditional narrative (free text) reporting.2–4 Using electronic health records, synoptic histopathology reporting tools can be designed to be very sophisticated with discrete data fields, drop down menus, and automated SNOMED encoding.5 The use of discrete data fields (’atomic data’) means that it is possible to automatically search, extract, and transmit data electronically.4 Despite the apparent benefits of electronic synoptic histopathology reporting, and the successful regional implementation of such a reporting system in Ontario, Canada,5 others have reported that the implementation and use of electronic histopathology reporting is no easy organisational task.6,7 Similar challenges have also been reported regarding the implementation and use of a web-based synoptic reporting tool for cancer surgery.8,9 From a management and organisational perspective, the list of possible causes for project failure with respect to information technology development, implementation and use is long.10 In our opinion, a pro-active understanding and management of key organisational issues is a requirement for successful long-term synoptic histopathology cancer reporting.

Implementation and use of electronic synoptic cancer reporting: an explorative case study of six Norwegian pathology laboratories

BackgroundThe information contained in histopathology reports on surgical resections of cancer is fundamental for both patient treatment and cancer registries. Electronic synoptic histopathology reporting is considered superior to traditional narrative reporting with respect to both completeness and feasibility of data use. An electronic template for colorectal cancer reporting was introduced in Norway in 2005, but implementation has varied greatly between different pathology departments. In 2012, four pathology departments and the Norwegian Cancer Registry started a new initiative on electronic cancer reporting. As part of this initiative, this study was undertaken to learn more about factors influencing implementation and use.MethodsQualitative and quantitative data were obtained from six of the 17 public pathology departments in Norway using explorative case study methodology. Methods included document studies, semi-structured interviews with key informants, and audits on actual template use. A systematic analysis of data was conducted based on theoretical models for project management, stakeholder engagement, and individual acceptance of new information technology.ResultsMost key informants had a positive view on synoptic reporting, and five departments had tested the electronic template. Of these, four had implemented the template while one department had decided not to implement it due to layout concerns. Of the four departments using the template in daily routine, one had compulsory use, two consensus based use, while the fourth had voluntary use. Annual average usage of the electronic template in the three departments with compulsory or consensus based use was 92% compared to 53% in the department with voluntary use.ConclusionsThere was a general positive attitude towards electronic synoptic reporting. Reasons for not implementing the colorectal template were specific technical and quality issues not adequately addressed by the project organization having developed the template. A formal assessment of project outcomes with a task force handling such technical issues should accordingly have been established as part of the project. After an organizational decision on implementation, perceived job relevance and practical benefits are factors important for individual template use. Consistent high long-term usage was related to a departmental environment with a consensus based decision on use.

Retrospective review of diagnostic histopathology samples in research projects: transparency should be the practice with respect to diagnostic discordance

Retrospective review of diagnostic histopathology samples in secondary research projects may generate cases with discordance in diagnosis between the pathologist originally signing out the sample and the reviewer. In this article the authors discuss ethical and legal issues involved in secondary review and propose how diagnostic discrepancies in research projects can be handled. Research participants have the right to know about and control the handling of personal data. Researchers have a duty to inform research participants about research findings of relevance to the current or future health or quality of life. Such feedback is to be provided within a healthcare framework. The authors recommend that pathology laboratories should require researchers to provide feedback on diagnostic discrepancies of potentially clinical significance in secondary research projects using retrospective review of diagnostic histopathology material. The pathology laboratory in charge of the archival material should be responsible for the follow-up on such cases.

Provision of diagnostic material for research purposes

Roger Bjugn rogbju@ous-hf.no Bettina Casati The Health Research Act requires that an internal quality assurance system be established for medical and health research. We will describe our experience of the establishment and application of such a system for provision of human diagnostic material for research purposes. In our experience, a systematic review of project documentation will in many cases reveal errors or deficiencies.