Integrated Analysis of Quality Use of Pathology Program (qupp) Final Reports

Automatic Population of Synoptic Reports from Narrative Pathology Reports (Stage 3) (Current)

Description

This project builds on the work of the first two stages and aims to build natural language processors that will automatically extract pertinent information and populate a structured cancer report. This system will enable the analysis of narrative reports to identify and extract key content.

Grant Recipient

University of Sydney

Aims and Objectives

• 
  to build processors for the set of melanoma, skin cancers and lymphoma that can automatically populate the formally defined, structured report
  
• 
  to add to the system the SNOMED CT encoding of the structured report elements.
  

This project is current and the aims and objectives are in the process of being achieved.

Recommendation

1. 
   Due to the results to date which show a less than successful performance for lymphoma, work on lymphoma should be of secondary consideration in progressing this project. The extent of further work on lymphoma will need to be discussed with the Royal College of Pathologists of Australasia (RCPA) and the Quality Use of Pathology Committee (QUPC).
   

Standardisation of Pathology Terminology and Units (Current)

Description

This project is developing a reference set of standardised pathology terminology with guidelines for their use, and standards for units of measure, to minimise the risks of variation in their use between health professionals and patients. The developed terminology, units and measures will be able to be represented electronically.

Grant Recipient

Royal College of Pathologists of Australasia (RCPA)

Aims and Objectives

• 
  to develop and approve a revised set of standard units of measure to be represented electronically (Standard for Units of Measure)
  
• 
  to develop and approve standard terminology sets (SNOMED CT, LOINC etc.), including advice for their use (Australian Pathology Terminology Sets)
  
• 
  to develop a fully specified terminology for the reporting of ‘common’ biochemistry items used in clinical decision support, including advice for its use (standardisation of common biochemistry items)
  
• 
  to review the protocols for cancer reporting and ensure terminology is available, consistent and able to be used in electronic decision support, including advice for their use (terminology for structured cancer reports).
  

Pathology Requesting and Reporting – Requester and Consumer Focus

Requesting and reporting are key components of the pathology process and impact on the quality use of pathology. This chapter includes 17 projects (Table 6) which sought to enable medical students and treating practitioners to augment their knowledge and practice of pathology requesting and improve consumer outcomes. Improved reporting methodologies were also explored, and a flow-on benefit in many cases was cost savings.

One of the issues encountered with the successful implementation of a number of these projects was a resistance to change entrenched practices and a lack of funding to provide sustainability to the projects in the longer term. Identifying ‘champions’ who should ideally hold senior medical positions was one consistent strategy indentified in this integrated analysis to change entrenched practices.
Other issues encountered in this area include:

• 
  projects involving information technology (IT) were prone to technical problems which increased project timeframes
  
• 
  lack of pathology training in medical schools
  
• 
  lack of understanding by pathology requesters regarding the importance of completing pathology request form information.
  

These projects also collectively identified information, issues and strategies that contributed to an overall knowledge base to promote change and improve future practice. Some projects with successful outcomes but were not sustainable at the time of their implementation may benefit from being revisited as their findings and outcomes are still applicable in the current environment, especially as technology becomes more acceptable as a legitimate health care tool. Other areas for future consideration include:

• 
  Review the AUSLAB projects (pages 87 and 89) with a view to implementing them in states outside of Queensland.
  

• 
  Explore the options for Personal Digital Assistant (PDA) system implementation in hospital environments.
  
• 
  Investigate the areas Practice Nurses can assist with information regarding pathology testing and patient education.
  
• 
  Assess the viability of re-establishing the Quality Use of Pathology Services Education Program (on page 102) in rural medical schools.
  

• 
  Review the format and content of pathology request forms.
  

• 
  Investigate implementing an education program which targets the most important errors or omissions on request forms.
  

• 
  Possible development of a training program/modules to be provided to General Practitioner (GP) Registrars and International Medical Graduates (IMGs), and the need for a training module/s.
  

• 
  Produce fact sheets covering the area’s highlighted in recommendation no. 6 of the report Enhancing the Quality Use of Pathology for GP Registrars and International Medical Graduates – Assessing the Need on page 106.
  
• 
  Produce a fact sheet on antibiotic use and bacteriuria for all levels of medical staff, including nurses, to empower them to develop confidence in withholding antibiotics for asymptomatic patients.
  
• 
  Identify further potential users for iNvestigate.
  
• 
  Develop a standard national definition of ‘appropriate’ pathology use.
  

	Project Name	Grant Recipient/s
1	Guidelines for Patient/Consumer Access to Pathology Test Reports (2001)	Quality Use of Pathology Committee (QUPC)
2	AUSLAB Retest Interval Trial Project (2003)	Queensland Health Pathology & Scientific Services
3	AUSLAB Retest Interval Project (2004)	Queensland Health Pathology & Scientific Services
4	Home Monitoring of Warfarin Therapy in Children using the CoaguchekTM Point of Care INR Monitor (2003)	The Royal Women’s Hospital and the Royal Children’s Hospital
5	Facilitating Best Practice Pathology Utilisation by the Use of Hand-Held Decision Support Devices (2004)	Flinders Medical Centre
6	Improving GP Access to and Use of Retrospective and Current Pathology Data to Increase Detection of Early Diabetes (IGT and IFG) in General Practice (2005)	Fremantle Regional GP Network
7	Quality Use of Pathology Services Education Program (2006)	University of Sydney
8	Investigation into the Reasons for Incorrect or Incomplete Pathology Request Forms (2008)	Royal North Shore Hospital
9	Enhancing the Quality Use of Pathology for GP Registrars and International Medical Graduates – Assessing the Need (2009)	University of Adelaide
10	Effect of a Structured Microbiology Laboratory Report on Antimicrobial Prescribing for Asymptomatic Bacteriuria in Elderly Females (2010)	Flinders Medical Centre; South Australia Pathology
11	Identifying how Electronic Decision Support (EDS) in Computerised Pathology Order Entry Systems can Improve Pathology Practice, Rational Ordering and Patient Outcomes (2010)	University of Sydney
12	The Impact of the Implementation of Electronic Ordering of Pathology Requesting and the Quality and Effectiveness of Hospital Pathology Services – Building a Robust Evidence Base and Benefits Framework for Successful e-Health Diffusions (Current)	University of New South Wales
13	Computer Assisted Patient Simulations for Education in the Rational Use of Investigations – Final Report for Phase 1 (iNvestigate Project) (2010)	University of New South Wales
14	iNvestigate: Online Patient Simulations for Education in the Rational Use of Investigations – Final Report for Phase 2 (2011)	University of New South Wales
15	iNvestigate: Online Patient Simulations for Education in the Rational Use of Investigations (Current)	University of New South Wales
16	Encouraging Quality Pathology Ordering in Australia’s Public Hospitals (2011)	National Coalition of Public Pathology (NCOPP)
17	Effective Communication of Pathology Results in Requesting Practitioners and Consumers (Current)	University of Melbourne; Dianella Community Health; Royal College of Pathologists of Australasia (RCPA)

Table 6: Reports summarised for Pathology Requesting and Reporting
– Requester and Consumer Focus