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. 2021;23(2):129-138.
doi: 10.1016/j.tige.2021.01.005. Epub 2021 Jan 18.

Development of an automated ERCP Quality Report Card using structured data fields

Gregory A Coté  1 , B Joseph Elmunzer  1 , Erin Forster  1 , Robert A Moran  1 , John G Quiles  2   3 , Daniel S Strand  2 , Dushant S Uppal  2 , Andrew Y Wang  2 , Peter B Cotton  1 , Michael G McMurtry  4 , James M Scheiman  2
Affiliations

Development of an automated ERCP Quality Report Card using structured data fields

Gregory A Coté et al. Tech Innov Gastrointest Endosc. 2021.

Abstract

Background and aims: Measuring adherence to ERCP quality indicators (QIs) is confounded by variability in indications, maneuvers, and documentation styles. We hypothesized that incorporation of mandatory, structured data fields within reporting software would permit accurate measurement of QI adherence rates and facilitate generation of a provider ERCP report card.

Methods: At two referral centers, endoscopy documentation software was modified to generate provider alerts prior to finalizing the note. The alerts reminded the provider to document the following components in a standardized manner: indication, altered anatomy, prior interventions, and QIs deemed high priority by society consensus, study authors, or both. Adherence rates for each QI were calculated in aggregate and by provider via data extraction directly from the procedure documentation software. Medical records were reviewed manually to measure the accuracy of automated data extraction. Accuracy of automated measurement for each QI was calculated against results derived by manual review.

Results: During the 9-month study period, 1,376 ERCP procedures were completed by 8 providers. Manual medical record review confirmed high (98-100%) accuracy of automatic extraction of ERCP QIs from the endoscopy report, including cannulation rate of the native papilla and complete extraction of common bile duct stones. An ERCP report card was generated, allowing for individual comparison of adherence to ERCP QIs with colleagues at their institution and others.

Conclusion: In this pilot study, use of mandatory, structured data fields within clinical ERCP reports permit the accurate measurement of high priority ERCP QIs and the subsequent generation of interval report cards.

Keywords: Benchmarking; Cholangiopancreatography; Electronic Health Records; Endoscopic Retrograde; Health Care; Quality Indicators.

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Conflict of interest statement

Potential competing interests: Michael McMurtry is an employee of Provation Medical. All other authors (Gregory Cote, B. Joseph Elmunzer, Erin Forster, Robert Moran, John Quiles, Daniel Strand, Dushant Uppal, Andrew Wang, Peter Cotton, and James Scheiman) report no financial relationships with a commercial entity producing health-care related products and/or services relevant to this article.

Figures

Figure 1.
Figure 1.. Example of a mandatory structured data field
Documentation of an ASGE/ACG QI Indication for the ERCP was a mandatory reporting field. At the time of finalizing the note, the provider would be alerted and mandated to populate the QI Indication structured data field.
Figure 2.
Figure 2.. Distribution of indications for ERCP at the provider level
This highlights differences in the indications for ERCP at the provider level. Biliary ERCP was the most common group of indications for each provider, with a wide range of ERCPs performed for pancreatic (9-39%) and sphincter of Oddi (0-12%) indications.
Figure 3A-B.
Figure 3A-B.. Example of ERCP Quality Report Card
An individual provider’s performance is benchmarked against others performing ERCP at their institution and all participating institutions (n=2 in this pilot study). Data were extracted from the endoscopy procedure software during the first nine months after implementation of structured data fields and physician alerts. ERCP indications are grouped by shades of blue (biliary), yellow (pancreatic), and green (sphincter of Oddi/ampullary indications).
See this image and copyright information in PMC

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