ADR is a valuable quality indicator because it is easily measured and is an established surrogate for rare post-colonoscopy cancer risk. Thus, it is imperative that all endoscopists have the means to know and track their ADR, and tools to facilitate more widespread measurement of ADR have the potential to support the provision of high-value care. Here, we describe a new method, leveraging pre-existing infrastructure within a widely adopted EHR, to achieve this. In a pilot testing environment, our tool demonstrated high sensitivity and accuracy compared to a manual chart review, similar to what studies evaluating NLP methods report.8,9,10,11,12,13,14. To our knowledge, this is the first description of a method using EHR functionality to accurately capture endoscopic IQs.

There are still weaknesses in the tool we are proposing. It still takes effort from clinical staff to open a note and use the Smart list when documenting pathology results. This requires several additional clicks beyond the normal workflow, and in our pilot study, 2/78 positive adenoma results were misclassified. In addition, our tool in its current form does not take into account the indication, completeness or quality of colonoscopy preparation. However, as noted earlier, tADR is an accurate surrogate for ADR, and others have even proposed that it may be a preferred IQ for colonoscopy because it simplifies measurement and may prevent messing with it. the ADR metric by modifying the indication for colonoscopy18.21. Additionally, additional macro selections (e.g. for indication, bowel prep quality, polyp histology, such as jagged lesions) can certainly be added to future iterations of our tool. These features can be customized based on a specific practice’s priorities for quality tracking and reporting (for example, if this information is not tracked elsewhere). The adaptability and customization of our tool is a great strength, especially if professional societies add additional lesion detection rates/benchmarks (such as sawtooth lesion detection rates) to the quality parameters that need to be measured.

We believe that the tool we propose has several advantages. Because our tool relies heavily on pre-existing capabilities built into an EHR, it does not require access to specialized data management systems often needed to adopt NLP-based solutions. Additionally, while NLP methods are often successful in individual settings, adapting these tools to more diverse clinical settings has proven difficult.15. Our tool can be scaled to be used by anyone using Epic EHR. Our tool provides real-time information into the EHR regarding QA performance, allowing endoscopists to benchmark their own performance in the same interface in which they routinely manage patient care. Although our tool requires minimal effort from clinical staff, it is largely part of the normal clinical workflow and still far below what is required for manual extraction. Finally, although our tool was built using Epic EHR, several EHRs have similar discrete data macro functionality that could allow a similar tool to be developed in different systems in the US and Europe. .17.22.

Further work is needed to validate this tool with a larger proportion of endoscopists and ideally across multiple centers using the Epic EHR. Reassuringly, Smart Lists are already widely used in Epic’s day-to-day documentation. Additionally, previous research has demonstrated excellent adoption of Smart Lists in post-colonoscopy EHR documentation23. Adjust the structure of the Reporting Workbench algorithm using other macro data tools such as Smart Lists or processing patterns in the EHR can also allow the capture of additional data such as colonoscopy indication, preparation quality and even allow the use of a similar tool to capture IQs in other areas endoscopic.

This pilot study demonstrates the potential of leveraging existing EHR functionality to achieve accurate measurement and feedback of tADR, a reliable substitute for ADR. This tool may present an easily adoptable alternative to complex NLP-based systems or tedious chart review to facilitate IQ measurement and ensure delivery of high-value care.