Getting results to providers and patients more efficiently

1. An Integrated Program to
Improve Colonoscopy Quality
GETTING RESULTS TO PROVIDERS AND
PATIENTS MORE EFFICIENTLY
Holly M. Harmes
Spring 2012

2. 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.

3. 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.

4. 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

5. 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

6. 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 Dump
Processed 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???

7. 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

8. 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.

9. 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

10. 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)

11. Bring GI and Path Data Together-Data Flow

12. 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

13. 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

14. 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