ACC/AHA/SCAI 2014 Health Policy Statement on Structured Reporting for the Cardiac Catheterization Laboratory: A Report of the American College of Cardiology Foundation Clinical Quality Committee
The Health Policy Statement on Structured Reporting for the Cardiac Catheterization Laboratory, written by the American College of Cardiology Foundation (ACCF) Clinical Quality Committee, is a major step forward in a critically important area. Many federal (e.g., Health Information Technology for Economic and Clinical Health [HITECH] Act) and national programs (e.g., the National Cardiovascular Data Registry [NCDR]) are pushing clinicians toward structured reporting to help with managing clinical data and improving patient care. The document produced by this multidisciplinary work group represents a large amount of work, and its recommendations will have implications for cardiovascular quality of care that spans everything from clinical guidelines, to appropriate use criteria (AUC), to performance measures, to health informatics. The text, tables, and figures are complicated and detailed; this is unfortunately necessary and represents the nature of this technology-deep area. The information in this document will not be easily digestible for most readers. Instead, this document will be most valuable as a comprehensive resource for health care providers focused on quality efforts in the cath lab, as well as those who are interested in the integration of electronic health records into procedure areas of cardiovascular care. It does provide sample reports for readers to better ‘visualize’ some of the suggestions.
The following are 10 points to remember, which I believe are concepts that represent the future of structured reporting in the cath lab:
1. Structured reporting in the cath lab serves many purposes: better communication of findings to diverse audiences; standardizing language around clinical characteristics, processes, and care (i.e., reducing the ‘Tower of Babel’); and improving interoperability across systems to allow for seamless information exchange within and across institutions.
2. Data interoperability is key. The work group writes about the need “to achieve a ‘collect once, verify often, use many times’ approach to data, rather than the manual, inefficient, repetitive, and potentially inaccurate acquisition of data that characterizes health care operations today.”
3. Key principles of structured reporting that were outlined: 1) it must be inclusive; 2) it should be clear, concise, organized, and reproducible while also flexible; 3) it should contain all the required elements for documenting procedure indications and assessing appropriateness; 4) it should include a consistent minimum data set; and 5) it should be brief yet thorough.
4. A critical challenge will be to respect the dynamic workflow of the cath lab. Thus, timeliness matters. The work group writes: ‘A key metric of success—perhaps singularly the most powerful criterion of all—is the capability to generate the final procedure report within a few minutes of the completion of the catheterization procedure. Anything less will mean that the potential of structured reporting has not been realized.’
5. The work group emphasizes the need to capture information as ‘data,’ not ‘prose.’ However, they also point out that physicians need to think more along the line of a ‘poet’ rather than an ‘author.’ The work group writes: ‘Poetry imposes certain rules, with the focus of the poet being on content rather than structure.’ Style matters.
6. Two reports will be required and complementary for clinical care: 1) the structured reporting by the physician; and 2) the procedure log report.
7. A summary in the front page of the structures reporting will be essential for presenting the ‘highest value information,’ followed by the ‘gory’ details of administrative, clinical, and procedural aspects that will be of variable interest to health care providers.
8. Structured reporting will need to comply with data interoperability standards set by leading organizations in health informatics.
9. Engaging vendors will be critical to the success of implementing structured reporting.
10. It will not be an easy transition, but the future is here. If we do it correctly, the benefits will be tremendous. This document aligns well with other statements generated by the ACCF that are moving toward recommendations for structured reporting in the cath lab.
Keywords: Physicians, Electronic Health Records, Health Policy, Patient Care, Health Resources, Cardiac Catheterization, Catheterization, Medical Informatics, United States
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