Structured Reporting

Background

In June 2007, a National Round Table was held to discuss the use of structured pathology reporting of cancer throughout Australia.  All who were present at The Round Table agreed that structured reporting of cancer cases in anatomical pathology and haematology is likely to contribute to better cancer control through improvements in:

• Clinical management and treatment planning
• Cancer notification, registration and aggregated analyses
• Research.

The Cancer Institute NSW secured funding in February 2008 from the Dept of Health & Ageing (Quality Use of Pathology Programs) to work with the RCPA and Cancer Australia to develop an initial 6 reporting protocols (lung, melanoma, breast, colorectal, lymphoma and prostate) and a framework to guide development of the protocols, in partnership with national clinician and pathologist organisations.

2nd Stage Project

A second round of funding from the Dept of Health & Ageing (Quality Use of Pathology Programs) has been awarded to promote and expand the use of structured reporting of cancer. This program of work includes developing further protocols in conjunction with international bodies; undertaking a national program of education on the developed cancer protocols (breast, melanoma, lung, lymphoma, colorectal and prostate); and developing a recommended report format in which to report the structured information from the protocols. This program of work is being overseen by the Royal College of Pathologists Australasia with clinical consultation from the Cancer Institute, and in conjunction with Cancer Australia.

The project has been set up under a governance structure which provides a blend of communication and support – incorporating the interconnectivity to external partners to support long term development and expansion.

To review the Governance structure - click here.

Framework documents for the development of cancer protocols

Work on the Framework was undertaken by a Framework Committee and was based on the National Pathology Accreditation Advisory Committees (NPAAC) structure with a view to their future incorporation into NPACC standards. The Framework committee was comprised of a team of pathologists, Michael Legg (President of the Health Informatics Society of Australia - HISA), and the project manager for structured reporting. Input from a team of medical writers, Biotext, fine tuned this initial version into documents that could be used to edit the six identified cancer specific protocols.  The Framework documents consist of a word template and a general guideline document. Continued refinement of the Framework documents was undertaken as editing of the initial six cancer specific protocols occurred and common issues and themes emerged. When the first of the six protocols, Melanoma, was ready for public consultation, the protocol and Framework documents used to create the protocol, were sent to the newly created Cancer Services Advisory Committee (CanSAC) at the Royal College of Pathologists of Australasia (RCPA) (see governance below).  CanSAC has been established to take responsibility for coordinating the review of the Framework documents and the protocols. This committee will also co-ordinate the revision of protocols in the future. CanSAC members reviewed the Framework documents and agreed that the documents, and the Melanoma protocol as the example protocol, worked for their intended purpose and the general structure and approach were comprehensive.
 
Final editing of the Framework documents occurred in Oct 2009 after feedback from the Public Consultation process on five of the six protocols. Feedback from review of the protocols through Public Consultation highlighted a number of points on the general structure and approach of the protocols which enabled the Framework committee to revise the documents, which will assist developers of future protocols. The Framework documents were posted on the RCPA website in Oct 09. Updates to the Framework documents are also expected in the future as additional protocols are developed and general themes and issues arise.

Click here to review the framework for the development of cancer protocols.

Cancer Reporting Protocols

The melanoma, prostate (radical prostatectomy), lung, colorectal and lymphoma protocols were developed based on the Framework documents. Each protocol went though an exhaustive process of checking/re-editing by the relevant expert group and chair; Assoc. Prof. David Ellis (as the chief clinician for the project, who sat on all expert groups and the Framework committee); the Structured Pathology Project Manager and the medical editors. As each protocol was completed it was sent for review and approval by CanSAC. Following the review by CanSAC each protocol was posted to the Cancer Institute website for a period of 28days public consultation.  Notification of the posting of each of the protocols was via email, distributed to a comprehensive list of stakeholders; as well as publications in Pathology Today. Feedback was via email either directly to the Structured Pathology generic email address, the Structured Pathology Project Manager or via the online form posted on the web site with each protocol. Feedback from the consultation process was compiled and reviewed by the expert groups and Assoc. Prof. David Ellis, and amendments and updates planned.
The breast protocol did not undergo public consultation, as unlike the other protocols, the breast cancer protocol was based largely on the set of structured reporting guidelines published by the National Breast and Ovarian Cancer Centre (NBOCC) which had been developed by a national team of experts with considerable stakeholder involvement and endorsement (including the RCPA). The breast guidelines were reformatted according to the framework documents. 


Click here to review the completed protocols.

HL7 Messaging and Archetypes

Work is also underway to develop HL7 messaging standards and archetypes in conjunction with the National E-Health Transition Authority (NEHTA). NeHTA commissioned Ocean Informatics to develop archetypes based on all six of the initial cancer specific protocols. Ocean worked in parallel to the protocol development and in October 09 the archetypes were at the stage to have key clinicians review them to ensure that the intent and logic of the protocols had been preserved. Work continues on these archetypes.

If you require further information about the project please contact the Project Manager for Structured Pathology Reporting:

Meagan Judge
Project Manager
Structured Pathology Reporting for Cancer
Tel: 02 83565854
Email: meaganj@rcpa.edu.au