Dramatically better reporting from surgical procedures has set off a grassroots movement among Alberta cancer surgeons, with about 75 per cent of eligible surgeons signing on to use the web-based Synoptic Medical Report (Alberta WebSMR) to record surgery results.
“Surgeons want reliable information—they want to know the impact of their surgery on a given cancer patient,” says Evangeline Tamano, program leader of Cancer Surgery Alberta at Alberta Health Services (Cancer Care). “The only way to meet their vision of having standardized reports on outcomes, generated in real time, is to enter the information themselves through an automated electronic system.”
Instead of forcing surgeons to rely on their memory of a procedure when they dictate a narrative account, then waiting weeks or months for the report to come back, WebSMR enables them to input the information themselves immediately after an operation, and know they have entered it correctly.
Within 24 hours of entering a synopsis, surgeons can analyze the outcomes, then compare their performance against the practice guidelines and the work of other surgeons.
David Stringer, the program’s implementation coordinator, says during the program’s pilot, the synoptic system missed only one per cent of the data generated during surgical procedures, compared to about 50 per cent omitted from traditional narrative reports. The prospect of such a huge improvement was behind a grassroots movement among the surgeons themselves that led to the creation of and high participation rates in WebSMR. In particular, Stringer and Tamano cited the visionary leadership of Dr. Walley J. Temple.
The project’s success has led to a partnership between Alberta and the Canadian Partnership Against Cancer to develop WebSMR on a national scale. Alberta Health Services developed the project as a pilot, then partnered with Infoway to extend WebSMR across Alberta and the rest of the country. By 2010, the system will support various types of cancer surgeries in Manitoba, and at least 20-30 surgeons in Quebec City and Montreal will begin using it for colorectal and breast cancer surgeries. The project will spread to selected centres in Nova Scotia and Ontario in the near future.
Beyond the patient benefits, Stringer and Tamano say WebSMR provides continuing education to surgeons and a platform for measuring a province’s overall delivery of surgical care. Stringer says the act of entering operative reports serves as a “peer review”, feeding into a checklist of eligible procedures developed by a group of surgeons.
The line of questioning in the WebSMR also gives surgeons a refresher on proper procedures for future surgeries by walking them through standard practice guidelines. This is why clinicians receive continuing competency credits for entering their reports into the system.
Within 24 hours of entering a synopsis, surgeons can analyze the outcomes, then compare their performance against the practice guidelines and the work of other surgeons. Using the same data, institutions and governments can chart their performance against provincial and national standards.
“If we’re not satisfied with the province’s performance in a given area, we can institute measures to improve performance, then follow up to see if the intervention worked,” explains Tamano.
Meanwhile, the electronic post-operative record goes directly to the patient’s chart, which means administrative staff does not have to “chase after the surgeon to get a report,” says Tamano. “Other clinicians who need that information don’t have to sift through mounds of paper.” The reports are also distributed instantly to the referring physician, family physician, cancer registry, and pathology department.
No other project has previously addressed the clinical document requirements in an electronic health record system. “That’s why our project was so innovative,” says Tamano. “It’s the first time a surgical community has come together to establish a system that produces standardized reports on surgeries and delivers instant outcomes.”