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Cancer Care Ontario

Pathology Information Management System

More than 50,000 people in Ontario are diagnosed with cancer each year. By the end of 2007, the number of Ontarians living with cancer will approach half a million. The organization charged with overseeing the battle against cancer in the province is called Cancer Care Ontario. It is an agency of the Ministry of Health and Long-Term Care, responsible for planning the full range of cancer services provincially and at the local level, setting quality standards, implementing quality improvements and measuring and reporting to the public on the performance of cancer care.

It is the responsibility of Cancer Care Ontario to gather statistics about cancer cases for research and healthcare planning purposes. But until recently, weaknesses in the paper-based reporting system meant that only 75 to 80 per cent of cases were fully documented, and reporting was often slow. The transcription of pathology reports involved significant labour and was susceptible to error.

Challenges

For half a century, Cancer Care Ontario and its predecessor organizations have been collecting information from physicians about cancer cases. Everything had been done on paper for all that time.

A report was typically generated by a pathologist in a lab, reading test results and dictating the findings. An administrative staffer transcribed the dictation, and a copy of the report was sent to Cancer Care Ontario, often in a monthly batch of faxes. There were no standards governing content or format. When reports were received, staff at Cancer Care Ontario had to wade through each one to pick out key statistical information.

It often took six months from the time a patient was diagnosed until the data was available for analysis at Cancer Care Ontario - and sometimes it never came in at all.

How could this collection of widespread data, involving so many individuals accustomed to their own particular working routines, be brought up to the standards of the 21st century? Who could overturn five decades of paper-based practices?

"The biggest human challenge we faced," says Victoria Welch, director of the Pathology Information Management System (PIMS) project, "was establishing this initiative as a priority in hospitals among the multitude of priorities that they have raining down on them."

Objectives

Cancer Care Ontario set out to implement PIMS as a reliable, automated, secure and timely pathology reporting solution to collect cancer-related pathology information across the province - in real time, not months. PIMS was also planned to be the foundation data source for the initial identification of a patient into the cancer system.

Solution

When the project began in April 2003, Cancer Care Ontario's project management, information technology and registry teams knew that change management would be their most difficult challenge. Any new system would have to disrupt pathologists' routines as little as possible. So they chose a system that transformed, not the way that pathologists reported their data, but the way that the data was presented and organized when it reached its destination.

Today, many pathologists still dictate their reports. But when the reports are entered into a computer, they change. The information is organized into a standard format, with key information always presented in the same place on the document and in the same way.

The PIMS system is an implementation of a software product called E-Path, from a Toronto company called Artificial Intelligence in Medicine Inc. The software performs a lexical analysis of the pathology report text against a domain-specific, standard nomenclature. The lexical analysis produces a set of codes for the disease morphology and topography concepts expressed in the pathology report. These disease codes are then used to classify the type and seriousness of the condition reported.

As a result of PIMS, pathology reports are submitted 3.9 times faster then with the manual process, and the average processing cost of a report has plunged to 81 cents from between $3.35 and $4.00. The system has enabled Ontario to move forward with adopting quality-control standards for pathology reporting that would never before have been possible.

Achieving these results took almost two years, through March 2005, and $3.5 million. The system was implemented across 46 hospital laboratories by a core team of six people, with lots of help from clinicians and hospital staff.

"The key to success in delivering this project was the models we built for implementing it, which were based on change management, stakeholder management, customer engagement, and in-your-face support and help through personal visits," Welch says.

Innovative Use of Technology

Ontario was the first large jurisdiction in North America to successfully put into practice an electronic pathology reporting system. PIMS remains the largest installation of its kind.

The project is serving as a blueprint for the implementation of healthcare technology projects in the province. And in addition to the research and planning improvements it is generating at Cancer Care Ontario, the PIMS system is feeding cancer-care statistics back to hospitals, providing management information never available before.

A 2005 CIPA Winner!

For its exceptional and innovative application of information technology to solve real-world business problems and bring greater benefit to all its stakeholders, Cancer Care Ontario has been declared a Gold Best of Category Winner by the 2005 Canadian Information Productivity Awards in the Organizational Transformation Not For Profit category.

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