Synoptic Reporting: A Refresher for Cancer Registrars

Cancer registrars are driven by health data and play a vital role in collecting information that is crucial to oncology research, improved treatment and patient outcomes, and cancer prevention. The data we use comes from a variety of sources and it’s important to understand the significance of each data source. Synoptic reports have recently been added to CoC, NAPRC, and NAPBC standards, which is why a refresher on what synoptic reporting is can help cancer registrars understand why it is so important in the fight against cancer.

What is synoptic reporting?

Synoptic reporting is a process for reporting specific data elements in a specific format in surgical pathology reports. The benefit of synoptic reporting, as opposed to previous free text, narrative reporting, is that it captures all the critical data elements in a standardized way that supports scalable data capture, interoperability, and exchange.1

The College of American Pathologists (CAP) has been promoting synoptic reporting for more than 20 years and in order to be an accredited lab through CAP, the pathology lab must report using CAP synoptic report formats. More recently, other accreditation programs have started to require synoptic reports, and as cancer medicine and technology move forward, it is anticipated that more reports and documentation will be developed into synoptic reports.

  • American College of Surgeons (ACS) Commission on Cancer (CoC) – 2020 Standards require a CAP-compliant pathology report for resected cancer specimens.
  • National Accreditation Program for Rectal Cancer (NAPRC) – A standardized format for reporting of MRI findings in the work-up of rectal cancer is required. Surgical resections must be documented in a synoptic operative report and pathological evaluation of resected specimens must be reported in a CAP-compliant synoptic report format.
  • National Accreditation Program for Breast Centers (NAPBC) – A CAP-compliant synoptic pathology report for resected breast cancer specimens is required. A standardized synoptic surgical report for breast cancer resections is not currently required but is under consideration for future implementation.

What are the benefits of synoptic reporting?

Ultimately, having standardized reporting makes critical data available to clinicians and researchers working to prevent, treat, and cure cancer. However, there are some specific reasons for – and benefits to – using synoptic reporting.

Standardized reporting formats set a national minimum reporting mechanism, which includes expectations of documentation, completeness, accuracy, and diminished documentation “misses.”  The required elements for reporting are determined and curated by the human mind and having all elements in place assists physicians in determining the correct patient treatment guidelines as well as patient prognosis.

Synoptic reporting also makes data gathering easier. Multiple attempts have been made to introduce natural language processing (NLP) to electronic health records (EHR) and documents available within the EHR. Unfortunately, these attempts have had varying levels of success, most of which were less than favorable. Since all elements in a synoptic report are documented in a standardized manner, this bypasses the need for data gathering using NLP. Additionally, the data will be more accurate as there will be fewer interpretive errors. Synoptic reports, being structured data, allow for increased automated data gathering.

Once implemented, synoptic reporting is a cost-saving measure. More cancer registry data abstraction will be automated, allowing the cancer registry to spend less time doing data entry and more time with data reporting and analysis. Medical record coding and abstraction will also be impacted as quality will go up, leading to less audit reparation and potential penalties. Structured data may also allow for quicker clinical trial accruals that are so often predicated on timeliness requirements.

As technology becomes more and more sophisticated, synoptic reports will be able to relate to each other, making quality assessment of both data and patient care easier. Relatability of synoptic reports allows for apples to apples comparisons. For example, areas of relatability would be rectal MRI reports to rectal surgical reports or breast surgical reports to breast pathological reports.

Synoptic reports are also a time-saving mechanism. In pilot testing, the breast surgical report took five minutes to complete and the rectal MRI report took six minutes.

The synoptic reports do allow for a narrative report, which may contain information that is vital but may not be included in the synoptic report (e.g., adhesions, unexpected surgical incidents, etc.). It will also serve as a bridge from total narrative to total synoptic to help ease the pain of change. As artificial intelligence (AI) and NLP become more reliable, there will be opportunities to mine data from the narrative reports as well.

Reliable, valid, complete, secure, and accessible clinical data is the lifeblood of healthcare. Understanding why and how data in the synoptic reports is collected and used allows us as cancer registrars to continue to have an impact on advancing quality of care, treatments, and patient outcomes.

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