2005 Scientific Session Abstracts
Beyond Clinical Tumor Staging
William F. O’Toole, MD ( bill.otoole@mtuitive.com V.P. and Chief Medical Officer at mTuitive, Inc., Centerville, MA
Context : The AJCC requirement to require certain data elements in the surgical pathology report presents an opportunity to transform the arcane process of data abstraction into a clinical tool for patient treatment - streamlining and improving the quality of data collected. The basic premise is that the most accurate, efficient and valuable place to collect data is at the point where the decision is made. Not only is it more accurate, it can be made available to treat the patient on a nearly real time basis as opposed to just providing statistical benefit.
Design : Completion of the pathology synoptic checklist results in a coding classification or “pathologic stage.” The pathologic stage accounts for approximately half of the data elements required to “fully stage” or code a tumor for a cancer registry database. mTuitive mapped the flow of data from the pathology stage to the final, managing physician stage. Working backward from the full or “collaborative” set of data elements, mTuitive created “smart” checklists for the most likely sources of input from the cancer treatment team. Treatment team members could include the surgeon, radiation therapist, oncologist, radiologist and other clinicians. The checklists, similar in nature to those from the CAP, were authored for each clinical specialty. Resulting reports are reviewed and approved by the managing physician to fully stage the tumor and sent tumor registrar.
Technology : The product design is a distributed services-oriented architecture and is composed of the following distributed components:
- xPert “rich client” that incorporates a full-fledged expert system. Defined entirely by XML-based templates and rules that are downloaded from the content server, new functionality is delivered to clients without having to re-install software.
- knowledge server provides authentication, authorization, and report template synchronization to the client.
- integration services are used to route data to the databases or host applications through HL/7, XML Web Services, and SQL.
Results : mTuitive goes beyond increasing efficiency and accuracy by automating the data collection process. The product set provides the means to improve communication between treatment team members in a near real time manner to ensure the optimum patient treatment. Accuracy of data is preserved downstream all the way to the tumor registry simply because it is captured once at the point of diagnosis. The elimination of inefficiencies associated with transcription, data mining, abstracting and re-entry into cancer registry software provide an immediate ROI. Cancer registrars are empowered to be analysts rather than abstractors.
Conclusion : The time has arrived for an entirely new approach to clinical data capture.