Structured Reporting: The Road Map for Better Data, Workflow and Reports

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 - James E. Tcheng, MD
James E. Tcheng, MD, FACC, FSCAI

Creating the structured cardiac cath lab procedure report is the first step to improving patient care and data accuracy, coordinating intraprocedure workflow across the clinical team, making registry reporting seamless, and reducing overall cost of care.

With just 10 percent of U.S. cath labs utilizing structured reporting today, it is time to spread the word, says James E. Tcheng, MD, FACC, FSCAI, who is vice-chair and co-author of the ACC/AHA/SCAI 2014 Health Policy Statement on Structured Reporting for the Cardiac Catheterization Laboratory that came out last year and has been gaining attention ever since. “Right now is the time to jump on board; it’s time to start exploring,” he says.

In developing the guidance, the coalition of 14 professional societies, led by members of the American College of Cardiology, American Heart Association, and Society for Cardiovascular Angiography and Interventions, set out to establish normative behavior for professionals and for the expectations of services and practices. The statement defines the clinical standards for structured reporting in the cath lab with the goals of improving patient care by making clinical data more timely, accessible, consistent, effective and useable. Information should be captured as data rather than prose; these data should flow bidirectionally to and from the EHR for subsequent presentation and analysis (Circulation 2014;129:2578-2609).

“You can get the computer to do whatever you want,” says Tcheng, a professor of Community and Family Medicine in Informatics at Duke University Medical Center in Durham, N.C., director of Performance Improvement for the Duke Heart Center and director of the Duke Cardiovascular Data Bank.  “Really it’s the people and the processes that have to change for structured reporting to be successful. That’s what we put together and crafted as a health policy statement.”

Structured reporting is part data, part teamwork, part workflow, part patient record, part analytics, part inventory management, part process improvement, part cost-cutter, part patient educator, and someday, part comparative effectiveness research enabler.

As its name implies, step one of structured reporting is structure. “Structured reporting has at its core structure, meaning that the information that is captured is actually data rather than analog information that cannot be further processed without a lot of work by computers or by computational algorithms,” says Tcheng. “You are documenting what is happening in the cardiac cath lab as much as possible at a discrete data level that can then be easily processed or interpreted by computer systems as those numbers are needed somewhere down the road. We use numbers—like blood pressure of 120 over 80 or a 3.5mm by 28mm diameter and length stent—for analysis and comparisons, especially with future data.”   

Step two is what Tcheng calls the secret sauce: the collection and capture of data integrated into the workflow. Think clinicians handling the information and documenting the data as care is being delivered. No more remembering and recalling numbers, nor the associated inaccuracies. Quality increases. The documentation system then guides the physician through the course of the procedure, presenting the data captured during it in a logical way. For example, in treating a lesion, the system prompts the physician to include the location of the lesion, percentage of stenosis and other important characteristics while automatically collecting information about the devices used to treat it.

“Maximizing the usability, based on human factors engineering, is built into the concepts of structured engineering,” he notes. “As you move through a procedure, the system is actually anticipating what’s going to happen in ways that allow you to stop thinking about the job of documentation per se and instead focus on the data itself. Every person on the team does his or her share. The structured reporting concept really is the integration of the workflow into the management of data, and as a byproduct of that, the quality of that data improves quite dramatically.”

Integrating workflow means team-based healthcare delivery. Team-members rely upon each other for the execution of each portion of care, including data and documentation. The final report is a play by play of what happened during a procedure. “In fact, this increases the accuracy of both the procedure log and the physician’s procedure report,” Tcheng says. “[Post-procedure],