Common Language: The Rise of Standard Formatting for Surgical Reports

June 23, 2010 at 10:22 am Leave a comment

Gottfried Wilhelm von Leibniz

Gottfried Leibniz. That name doesn’t mean much to most people, outside of math nerds with a penchant for historical trivia. Leibniz is credited with simultaneously creating calculus at the same time of Sir Isaac Newton. Years of debate ensnared the scientific community as patriotic mathematicians of Germany and Britain argued for their respective countrymen. Each camp tried to prove the independent, solitary insight needed to develop calculus solely rested with one man or the other – but were unable to find definitive proof that Newton or Leibniz had been the one to originally conceive of this new field of mathematics. There are suggestions that Leibniz was inspired by some of Newton’s works but, as there’s still too many gaps in the works of Newton that would have been available for Leibniz to consult in order to develop calculus, there’s no substantial proof that Leibniz plagiarized Newton’s work.

Rob's attempt to innovate calculus was met with much less enthusiasm

So what happened then? Perhaps this is an example of Rupert Sheldrake’s pseudo-scientific theory of “morphic resonance” in which behavior is somehow transported across great geographical distances between similar types of animals or people. And while it is always interesting and neat to consider such a possibility – an example of some innate telepathic or cultural osmosis that seems to exist on a cellular level between people – it’s rather unlikely. How, then, did this rise of a new way of thinking occur at the same time in two different places? How were two men able to discover the same mathematical principles without being in collaboration? And what does any of this have to do with surgical reporting?

To put it simply – great minds think alike. The fact of the matter is that both Newton and Leibniz recognized a need for something in the world – in this case, the lack of a particular mathematics field that could be applied to many facets of our lives and used to explain so much of what we don’t understand. It is this same ability for multiple people, unrelated and independent of one another, to see the writing on the wall in the medical community and recognize the absolute need and demand for standardized and structured surgical reporting.

Neurosurgeon Dr. Jared Ament said that, in terms of medical reporting,

When it comes to reporting though, most would agree that some standardized lexicon, methodology and criteria are no longer some nice ideas floating somewhere in the stratosphere but are, instead, an absolute requirement in modern evidence-based surgery and medicine.

(in this interview)

There is a growing need to use surgical reports for research purposes – to couple them with outcomes data to figure out the best treatment for specific issues, the best techniques to employ in surgery and other trends that are occurring in the health of patients across the world. Furthermore, in order for this research to be conducted efficiently and effectively, surgeons are going to have to come together to agree on what information has to be captured in their reports and determine what language to use to capture that data. Hence the proliferation in companies offering electronic postoperative reports. In addition, a growing number of these products are trending towards using the structured properties inherent in the design of computer programs to generate synoptic reports. A confluence of technological advances and the expansion of epidemiological interests and research has led to the current, increased options in health IT and to mTuitive’s OpNote product.

oPNote’s conception was a result of the fact that mTuitive recognized that there is a need to apply structure to what have been free-flowing documents; there is a need to coalesce required fields into a standard form in order to strengthen research and patient care; there is a need to establish a universal format with only the essential sections in order to maximize the potential impact that postoperative reports can have on the future of medicine. But it’s not just mTuitive that has recognized this growing demand – as evidenced by our recent discovery that HL7 was working on its own version of standards for electronic postoperative reporting. Previous to learning about their efforts yesterday, we were unaware that HL7 was working on developing a standard format for defining required fields and capturing important data in the operative report. Two different organizations, working independently of each other, recognizing the same need for a new way of doing things.

HL7 – the common way to refer to Health Level Seven – is a “volunteer, nonprofit organization dedicated to developing internationally monitored standards for data supporting clinical patient care and the management, delivery and evaluation of healthcare services.” The aim of HL7 is to “create flexible, cost effective approaches, standards, guidelines, methodologies and related services for interoperability between healthcare information systems.” HL7 has many common languages and formats being used in most hospital systems today – currently, it’s the closest thing to a universal language between various electronic components of healthcare. By seeing the standard they were developing, we at mTuitive felt a great sense of validation: not only were they attempting to construct their own electronic operative report, but they were doing so utilizing many of the exact same fields that we had included in OpNote.

HL7’s standard appears to rely mainly on XML coding and SNOMED codes – but the information captured is roughly the same: pre- and postoperative diagnoses, procedure performed, specimen removed, operative findings, etc. Looking over their proposed architecture for a universal standard for operative reports, we realized that it would be easy for us to fit within that framework should it ever be implemented. By anticipating the same solution and requirements after identifying the same problems poised to the healthcare community, HL7 and mTuitive have confirmed the validity of each others’ suspicions and goals.

At mTuitive, we’ve always viewed competition as a good thing; if nothing else, similar products help disseminate the virtues of synoptic reporting that we’ve been trying to spread. By multiple sources reiterating the same basic strengths of structured data – improved research, increased risk management, portability of data between facilities – it becomes easier for us to show how our products deliver those aspects better than other options in the market. And, while HL7’s reporting standards aren’t posed in competition with OpNote, it underlines the fact that formalized structure is needed in reporting and that the time for its standardized adoption is imminent. There’s a sense of satisfaction that comes from learning that others perceive the problem exactly like you do, and that their answer is the same as yours. Leibniz and Newton may have eventually been bogged down by petty sniping, but there must have been a moment where the two of them could feel content knowing that someone else was out there seeing the same vision of what the future would bring.

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Entry filed under: Standardization, Synoptic Reporting. Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , .

Interview with Dr. Jared Ament: A New Way to Tell an Old Story Press Release: mTuitive Debuts Latest Product, mTuitive OpNote, at Becker’s ASC Conference

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