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Use of a Web-Based Checklist to Improve Compliance With Medicare Access and CHIP Reauthorization Act of 2015 Reporting.

To the Editor.--Checklists can improve compliance with defined standards in a variety of situations, (1,2) including surgical pathology. (3-6) Along these lines, we have previously shown that a Web-based checklist can improve the completeness of synoptic reporting in surgical pathology. (7)

The Medicare Access and CHIP [Children's Health Insurance Program] Reauthorization Act of 2015 (MACRA) for pathology is a standard that requires that pathologists report both the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD10) and billing codes for specific types of pathology specimens. In the past and without the use of a checklist, the accurate reporting of the MACRA features in our laboratory was relatively low (1297 of 1707; 76%). We wondered if the inclusion of a question on our Web-based synoptic report checklist related to MACRA compliance would improve our laboratory's performance.

Since August 2016, our synoptic reports for breast, lung, prostate, and melanoma resections have included a question that asks the pathologist to report both the ICD10 and the billing code for that specimen. In contrast, there was no checklist for reporting these features on esophageal biopsies for Barrett mucosa. For the 19 months ending February 28, 2018, compliance for reports using the Web-based checklist has been significantly better (100%; 1667 of 1667) compared with that for Barrett mucosa (82.9%; 169 of 204; P < .001, 2-tailed [chi-square] test). These results demonstrate that checklists can be of value in improving compliance in the reporting of surgical pathology for topics other than synoptic reporting. The exact benefit of any particular checklist varies with the specifics of how it is implemented. (7) We have found that reminder functions are critical to achieving a very high rate of compliance. Force functions such as those seen in the College of American Pathologists (CAP) electronic cancer checklist would likely also achieve a very high rate of compliance. We would encourage pathologists and the CAP to consider incorporating additional features into their own synoptic report checklists for surgical pathology.

doi: 10.5858/arpa.2018-0233-LE

Andrew A. Renshaw, MD; Edwin W. Gould, MD

Department of Pathology, Baptist Hospital and Miami Cancer Institute, Miami, Florida

(1.) Kalapurakal JA, Zafirovski A, Smith J, et al. A comprehensive quality assurance program for personnel and procedures in radiation oncology: value of voluntary error reporting and checklists. Int J Radiat Oncol Biol Phys. 2013;86(2):241-248.

(2.) Hayes C. Surgical safety checklist: improved patient safety through effective teamwork. Healthc Q. 2012;15(suppl):57-62.

(3.) Baskovich BW, Allan RW. Web-based synoptic reporting for cancer checklists. J Pathol Inform. 2011;2:16.

(4.) Kang HP, Devine LJ, Piccoli AL, Seethala RR, Amin W, Parwani AV. Usefulness of a synoptic data tool for reporting head and neck neoplasms based on the College of American Pathologists cancer checklists. Am J Clin Pathol. 2009;132(4):521-530.

(5.) Hassell LA, Parwani AV, Weiss L, Jones MA, Ye J. Challenges and opportunities in the adoption of College of American Pathologists checklists in electronic format: perspectives and experience of Reporting Pathology Protocols Project (RPP2) participant laboratories. Arch Pathol Lab Med. 2010; 134(8):1152-1159.

(6.) Renshaw SA, Mena-Allauca M, Touriz M, Renshaw A, Gould EW. The impact of template format on the completeness of surgical pathology reports. Arch Pathol Lab Med. 2014;138(1):121124.

(7.) Renshaw MA, Renshaw SA, Mena-Allauca M, et al. Performance of a Web-based method for generating synoptic reports. J Pathol Inform. 2017;8:13.

Accepted for publication June 14, 2018.
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Title Annotation:Letters to the Editor
Author:Renshaw, Andrew A.; Gould, Edwin W.
Publication:Archives of Pathology & Laboratory Medicine
Article Type:Letter to the editor
Geographic Code:1USA
Date:Nov 1, 2018
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