An Integrated Program toImprove Colonoscopy Quality GETTING RESULTS TO PROVIDERS AND PATIENTS MORE EFFICIENTLY Holly M. Harmes Spring 2012
Background Over 6500 colonoscopies are performed at UNC Hospitals annually. Specimens are obtained for pathologic analysis in 30- 50% of colonoscopies . Many systems are involved in the process of capturing procedure and results information. Currently there is extreme variability in the results delivery time, review time and follow-up procedures.
What to do? (Goals of Project) Goal 1: Develop and implement an efficient, semi- automated, and standardized process for reviewing colonoscopy-generated results and clearly communicating appropriate follow-up recommendations. Goal 2: Assess the effects of this new standardized process on provider efficiency and endoscopic quality.
Goal 1: Steps Determine project team Review current process and areas for improvement Evaluate data available and data needs Request access to data if not available Design and develop processes needed to bring GI procedure and pathology results together and track late/missing reports Design and develop presentation of results Test, Solicit Feedback and Implement System
Project Team Project Team included: Dr. Spencer Dorn - Customer Brent Lamm – NC TraCS IT Director Dr. Larry Klein – NC TraCS/Cardiology MD Emily Pfaff – NC TraCS Research Analyst Ashraf Farrag – NC TraCS Research Analyst Robert Sandler - Sponsor Weekly status and planning meetings held
Review Current Process Colonoscopy Updates Pathology Pathology Logged into Provider is Module in Specimen Provation RN “Reminded” Provation MD Specimen Dictation Copied into Free Text DumpProcessed and Report Dictated Transcribed CoPATH into WebCIS Interpreted Documents activities in medical record?? Provider Does Nothing Provider Reviews Provider Does Send letter to Pathology Results Nothing referring MD +/- in WebCIS Patient ??? Provider uses his/ her own “system” for managing the results Update ProVation Recall Module???
Issues with Current Process No standardization of GI procedure follow-up and documentation No alerts when results have not been returned Pathology results not in format for pulling data needed for quality measures Difficult to view GI report data and pathology report together
Evaluation of Data Needs Most of the data needed for complete solution is already in the CDW-H. Initial need was for ProVation data that is not in the data warehouse The final ETL process is in development but not live in the production data warehouse.
Bring GI and Path Data Together-NLP Review pathology reports Developed set of terms to search for in pathology reports – Need to determine which are from colonoscopies (all reports go into same table) Set up LanguageWare project to run tests against test dataset Review results Extract one month of pathology reports to test model with Run model with ICA on larger set of data
Bring GI and Path Data Together-Queue Pull GI Report Data into one table Pull Pathology Report into another table Develop process to search Pathology data for results that should be added to GI Report Data Develop process to search for GI Report Data where No Pathology Report is found within certain time (initially set at 21 days)
Challenges Along the Way Performance Issues with ICA – worked with IBM Consultant to Resolve Unable to write data extracted from Path Reports to CDW-H – IBM Support resolved problem Delays in getting ProVation data into CDW-H – Other work prioritized due to Meaningful Use needs Questions about whether new tables behind application should reside in CDW-H
Next Steps There is still work to do… Refine and finalize data requirements from physicians involved in project after initial test run of the whole system Interface to allow physicians to view GI and pathology data together still in development
Conclusion Once implemented this complete solution will help to streamline the GI follow-up process and help to get results to physicians and patients sooner. The scope of this project was only colonoscopies but other areas could benefit such as: Any department that performs procedures where specimens are sent to pathology Other tests that have dictated/clinical notes and require better alerting of results and standardized follow-up