Evidence-based research indicates that surgical outcomes related to cancer patients such as quality of life and survival can be improved by adhering to specific operative techniques. In addition, replacing narrative operative dictations with synoptic operative reports can improve the capture of vital cancer surgery information. With these facts in mind, the 2020 Commission on Cancer (CoC) standards for accreditation now require synoptic operative reports (SORs) for four new operative standards that span colon, breast, and melanoma surgery.
To facilitate implementation of these operative standards, Across Healthcare co-developed the electronic Documentation of Surgery Standards (eDocSS) app with the American College of Surgeons (ACS). This app, which is embedded into electronic health records (EHRs), provides surgeons with ACS- developed Synoptic Operative Reports (SORs) that include evidence-based data fields, linkages to appropriate coding standards, and detailed explanatory notes to facilitate accurate completion of the report. Across Healthcare is working closely with EHR vendors to embed the app using a standards-based SMART on FHIR framework, that aligns with the 21st Century Cures Act final rule, to speed implementation and adoption.
The eDocSS application includes the following:
1. Auto-population — Pre-existing fields are pulled from the patient record, and the surgeon needs only to verify the information or edit as needed.
2. CoC Standards — Fulfills the synoptic operative reporting requirements for the Commission on Cancer 2020 operative standards 5.3 through 5.6.
3. American Joint Committee on Cancer (AJCC) TNM Staging System —TNM categories are incorporated into any data fields related to staging.
4. National Cancer Database (NCDB) Codes — Select NCDB codes and definitions from the STandards for Oncology Registry Entry (STORE) manual that are relevant to the data fields in the app.
5. EHR Integration — eDocSS uses SMART on FHIR and will be integrated with top EHR vendors. This application is not a standalone app, but rather uses Single Sign On (SSO) and embeds inside the workflow of the EHR.
Currently, there are three SORs available in the eDocSS app. The ACS CSSP (Cancer Surgery Standards Program) team is planning to develop over 45 SORs that will all be available within eDocSS as they are released. Additional management and maintenance of the SORs within eDocSS will be handled by Across Healthcare. The eDocSS app is available to both CoC and non-CoC surgeons and institutions.