In one of his usual insightful pieces on lab software, Bruce Friedman writes about the oops button present in some major anatomic pathology (AP) systems. The feature provides a grace period after a pathology report is signed out before it is released for consumption by the referring physician. Friedman notes how this is not appropriate for clinical lab systems, which deal mainly in numbers, as opposed to AP systems, which deal mainly with narrative text:
Most clinical pathology results are numerical and various rules can be deployed such as autoverification or interval checking to catch errors… By way of contrast, the surgical pathologist frequently works alone, creating narrative reports not amenable to rule-checking or real-time quality control.
I would like to add that the shift toward structured, synoptic AP reports changes this. Unfortunately, most synoptic reporting modules inside traditional AP systems do little more than produce bullet-like text. A very few systems, including mTuitive’s xPert for Pathology, provide true structured, synoptic reporting. What’s the difference? A synoptic report presents discrete data points to the human eye, while a structured report is stored as discrete data and enables all the benefits of granular data — querying, analysis, quality control using database technologies, expert systems, and so forth.
Pathologists are some of the most patient, meticulous, and knowledgable people in the world. The density of information in a typical pathology report on a malignant tumor far outweighs most written communication in medicine or elsewhere. It is time for AP data to become first-class citizens in the modern world of data management. The way to do this is not to turn pathologists into data entry clerks, but to give them tools that enhance their already instant recall of voluminous knowledge, that give them a consistent method of communicating life-and-death factors to surgeons and oncologists, that help keep the generalists up to date with the specialists, that do allow rule-checking and sophisticated algorithms to prevent errors and find rare diagnoses, that via aggregation of structured data enable real-time epidemiology. The people and the job remain the same, but oh what you can do with the results! Synoptic reporting changes everything.